Research Papers

Frontal Plane Tibiofemoral Alignment is Strongly Related to Compartmental Knee Joint Contact Forces and Muscle Control Strategies During Stair Ascent

[+] Author and Article Information
Hunter J. Bennett

Department of Human Movement Sciences,
Old Dominion University,
2016 Student Recreation Center,
Norfolk, VA 23529
e-mail: hjbennet@odu.edu

Joshua T. Weinhandl

Department of Kinesiology, Recreation,
and Sport Studies,
The University of Tennessee,
322 HPER Building 1914 Andy Holt Avenue,
Knoxville, TN 37996-2700
e-mail: jweinhan@utk.edu

Kristina Fleenor

Department of Human Movement Sciences,
Old Dominion University,
2016 Student Recreation Center,
Norfolk, VA 23529
e-mail: Kflee006@odu.edu

Songning Zhang

Department of Kinesiology, Recreation,
and Sport Studies,
The University of Tennessee,
322 HPER Building 1914 Andy Holt Avenue,
Knoxville, TN 37996-2700
e-mail: szhang@utk.edu

1Corresponding author.

Manuscript received October 18, 2017; final manuscript received February 19, 2018; published online April 4, 2018. Assoc. Editor: Tammy L. Haut Donahue.

J Biomech Eng 140(6), 061011 (Apr 04, 2018) (8 pages) Paper No: BIO-17-1472; doi: 10.1115/1.4039578 History: Received October 18, 2017; Revised February 19, 2018

Static frontal plane tibiofemoral alignment is an important factor in dynamic knee alignment and knee adduction moments (KAMs). However, little is known about the relationship between alignment and compartment contact forces or muscle control strategies. The purpose of this study was to estimate medial (MCF) and lateral (LCF) compartment knee joint contact forces and muscle forces during stair ascent using a musculoskeletal model implementing subject-specific knee alignments. Kinematic and kinetic data from 20 healthy individuals with radiographically confirmed varus or valgus knee alignments were simulated using alignment specific models to predict MCFs and LCFs. Muscle forces were determined using static optimization. Independent samples t-tests compared contact and muscle forces between groups during weight acceptance and during pushoff. The varus group exhibited increased weight acceptance peak MCFs, while the valgus group exhibited increased pushoff peak LCFs. The varus group utilized increased vasti muscle forces during weight acceptance and adductor forces during pushoff. The valgus group utilized increased abductor forces during pushoff. The alignment-dependent contact forces provide evidence of the significance of frontal plane knee alignment in healthy individuals, which may be important in considering future knee joint health. The differing muscle control strategies between alignments detail-specific neuromuscular responses to control frontal plane knee loads.

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Grahic Jump Location
Fig. 1

Root-mean-square errors after residual reductions: (a) residual force and moment root-mean-square errors (RMS). Note: F: force errors in newtons (N); M: moment errors in newton meters (N·m); x, y, and z: anteroposterior, vertical, and mediolateral directions/axes. (b) Kinematic RMS errors. Note: pel_tx, pel_ty, and pel_tz are the pelvic translation errors in the anteroposterior, vertical, and mediolateral directions measured in centimeters (cm); pel: pelvis segment; rot: rotation about vertical axis; flex: flexion; add: adduction; dflx: dorsiflexion; tilt, list, rot, flex, add, and drsflx: rotation errors in degrees.

Grahic Jump Location
Fig. 2

Ensemble knee contact force curves (mean: lines and one standard deviation: shading) for varus and valgus alignment groups: (a) medial compartment contact force, (b) lateral compartment contact force, and (c) resultant contact force. Note: Varus group—solid black lines and dark shading; Valgus group—dashed black lines and light shading.

Grahic Jump Location
Fig. 3

Peak muscle forces during weight acceptance and pushoff of stance phase: (a) the varus group had larger vastus medialis, intermedius, and lateralis (VM, VI, VL, respectively) muscle forces than the valgus group during weight acceptance and (b) the varus group had larger gluteus maximus (GMAX_RES) and adductor (ADD_RES) resultant forces during pushoff. The valgus group had larger gluteus medius, gluteus minimus, and abductor resultant forces (GMED_RES, GMIN_RES, and ABD_RES, respectively) during pushoff. Notation for both graphs: RF: rectus femoris; VM, VI, and VL: vastus medialis, intermedius, and lateralis, respectively; SM: semimembranosus; ST: semitendinosus; BFLH and BFSH: biceps femoris long and short head, respectively; SART: Sartorius; TFL: tensor fascia lata; GRAC: gracilis; MED_GAS and LAT_GAS: medial and lateral gastrocnemius heads, respectively; GMAX_RES, GMED_RES, and GMIN_RES: gluteus maximus, medius, and minimus resultant forces, respectively; ABD_RES and ADD_RES: abductor and adductor resultant forces, respectively.

Grahic Jump Location
Fig. 4

Knee extensor muscle forces during stair ascent: (a) varus group knee extensor forces and (b) valgus group knee extensor forces. Note: RF: rectus femoris, VM: vastus medialis, VI: vastus intermedius, and VL: vastus lateralis.

Grahic Jump Location
Fig. 5

Knee flexor muscle forces during stair ascent: (a) varus group knee flexor forces and (b) valgus group knee flexor forces. Note: SM: semimembranosus, ST: semitendinosus, BFLH: biceps femoris long head, BFSH: biceps femoris short head, SAR: sartorius, MG: medial gastrocnemius, and LG: lateral gastrocnemius.

Grahic Jump Location
Fig. 6

Glute and tensor fascia lata muscle forces during stair ascent: (a) varus group glutes and tensor fascia lata forces and (b) valgus group glutes and tensor fascia lata forces. Note: GMED: gluteus medius, GMIN: gluteus minimus, GMAX: gluteus maximus, and TFL: tensor fascia lata; glute muscle forces are the vector norms of each muscles respective components.

Grahic Jump Location
Fig. 7

Summed abductor and adductor muscle forces during stair ascent: (a) varus group abductor and adductor forces and (b) valgus group abductor and adductor forces. Note: abductors and adductors are the sums of all muscles in respective groups.



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