3D knee kinematics variability pre-operation versus post-operation in adolescence with Anterior Cruciate Ligament injury using functional principle component analysis
Background: Anterior cruciate ligament (ACL) injuries in adolescents have increased in the past decade. The goal of ACL reconstructive surgery is to restore knee stability, however apart from subjective manual testing, there is no objective method to assess the impact of the treatment on knee stability. In clinical biomechanics, decreased variability in three dimensional (3D) kinematic angles can be associated with increased stability of the joint in performing a movement. Typically, the study of variability of 3D knee kinematics proceeds by reducing what are intrinsically functional responses to a single discrete measurement (e.g. peak flexion angle). As a result, many potentially informative data is ignored.
Aim: Prospective gait variability analysis pre- and 6 months post- ACL reconstructive surgery in adolescence patients using Principle Component Analysis (FPCA).
Method: FPCA is a multivariate statistical data analysis technique that focuses on treating an entire dataset as functions. Twenty eight ACL adolescent patients pre- and post-operation walked on a treadmill and the 3D knee kinematics were collected (flexion/extension, abduction/adduction and internal/external rotation angles). Functional Principle Component (FPCs) scores of the angle data were extracted to compare variability in gait. Repeated measures of ANOVA and box plots on FPC scores provided evidence of significant difference with decreased variability post-operation for both within-group and within-patients studies.
Variability in the 3D knee kinematics have been significantly reduced six months post- versus pre-operation. The proposed functional objective assessment method suggests that ACL reconstructive surgery increases joint stability during walking in adolescents.
Full Text:Subscribers Only
Andriacchi, T. et al., 2006. Rotational changes at the knee after ACL injury cause cartilage thinning. Clinical Orthopaedics and Related Research, 442, pp.39-44.
Andriacchi, T., Koo, S. & Scanlan, F.., 2009. Influence Healthy Cartilage Morphology and Osteoarthritis of the Knee. The Journal of Bone and Joint Surgery., 1(91 (Supplement_1)), pp.95-101.
Andriacchi, T.P. & Dyrby, C.O., 2005. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. Journal of biomechanics, 38(2), pp.293-8.
Bulgheroni, P. et al., 1997. Walking in anterior cruciate ligament injuries. The Knee, 4(3), pp.159-165.
Chau, T., Young, S. & Redekop, S., 2005. Managing variability in the summary and comparison of gait data. , 20.
Chaudhari, A.M.W. et al., 2008. Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Medicine and Science in Sports and Exercise, 40(2), pp.215-222.
Crane, E. et al., 2010. Functional Data Analysis for Biomechanics.
DeVita, P., Hortobagyi, T. & Barrier, J., 1998. Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation. Medicine and science in sports and exercise, 30(10), pp.1481-8.
Decker, L.M. et al., 2011. New insights into anterior cruciate ligament deficiency and reconstruction through the assessment of knee kinematic variability in terms of nonlinear dynamics. Knee surgery, sports traumatology, arthroscopy, 19(10), pp.1620-33.
Dingwell, J.B. et al., 2001. Local Dynamic Stability Versus Kinematic Variability of Continuous Overground and Treadmill Walking. Journal of Biomechanical Engineering, 123(1), p.27.
Donoghue, O. a et al., 2008. Functional data analysis of running kinematics in chronic Achilles tendon injury. Medicine and science in sports and exercise, 40(7), pp.1323-35.
Donà, G. et al., 2009. Application of functional principal component analysis in race walking: an emerging methodology. Sports biomechanics / International Society of Biomechanics in Sports, 8(4), pp.284-301.
Finsterbush, a et al., 1990. Secondary damage to the knee after isolated injury of the anterior cruciate ligament. The American journal of sports medicine, 18(5), pp.475-9.
Fuentes, A. et al., 2011. Gait adaptation in chronic anterior cruciate ligament-deficient patients: Pivot-shift avoidance gait. Clinical biomechanics (Bristol, Avon), 26(2), pp.181-7.
Gao, B. & Zheng, N.N., 2010. Alterations in three-dimensional joint kinematics of anterior cruciate ligament-deficient and -reconstructed knees during walking. Clinical biomechanics (Bristol, Avon), 25(3), pp.222-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20005613 [Accessed July 9, 2012].
Georgoulis, A.D. et al., 2006. A novel approach to measur variability in the anterior cruciate ligament deficient knee during walking: the use of the approximate entropy in orthopaedics. Journal of clinical monitoring and computing, 20(1), pp.11-8.
Georgoulis, A.D. et al., 2003. Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. The American journal of sports medicine, 31(1), pp.75-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12531761.
Grood, E.S. & Suntay, W.J., 1983. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J. Biomech. Eng, 105(2), pp.136-144.
Hagemeister, N. et al., 2005. A reproducible method for studying three-dimensional knee kinematics. Journal of biomechanics, 38(9), pp.1926-31.
Hagemeister, N. et al., 2008. A simple and rapid method for electromagnetic field distortion correction when using two Fastrak sensors for biomechanical studies. Journal of biomechanics, 41(8), pp.1813-7.
Hamill, J., Haddad, J.M. & Emmerik, R.E.A.V., 2006. Overuse injuries in running: Do complex analyses help our understanding? In XXIV ISBS Symposium. Salzburg-Austria, pp. 1-6.
Harrison, A., Ryan, W. & Hayes, K., 2007. Functional data analysis of joint coordination in the development of vertical jump performance. Sports biomechanics / International Society of Biomechanics in Sports, 6(2), pp.199-214.
Hausdorff, J.M., 2007. Gait dynamics, fractals and falls: finding meaning in the stride-to-stride fluctuations of human walking. Human movement science, 26(4), pp.555-89.
Hooper, D. et al., 2002. Gait analysis 6 and 12 months after anterior cruciate ligament reconstruction surgery. Clin Orthop Relat Res, 1(403), pp.168-78.
Hurd, W.J. & Snyder-mackler, L., 2007. Knee Instability after Acute ACL Rupture Affects Movement Patterns during the Mid-Stance Phase of Gait. , (October), pp.1369-1377.
Knoll, Z., Kiss, R.M. & Kocsis, L., 2004. Gait adaptation in ACL deficient patients before and after anterior cruciate ligament reconstruction surgery. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 14(3), pp.287-94. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15094142 [Accessed July 17, 2012].
Labbe, D.R. et al., 2008. Reliability of a method for analyzing three-dimensional knee kinematics during gait. Gait & posture, 28(1), pp.170-4.
Lustig, S. et al., 2012. The KneeKG system: a review of the literature. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 20(4), pp.633-8.
Lysholm, M. & Messner, K., 1995. Sagittal plane translation of the tibia in anterior cruciate ligament-deficient knees during commonly used rehabilitation exercises. Scandinavian journal of medicine & science in sports, 5(1), pp.49-56.
Moraiti, C.O. et al., 2009. The effect of anterior cruciate ligament reconstruction on stride-to-stride variability. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 25(7), pp.742-9.
Newell, J. et al., 2006. Using functional data analysis to summarise and interpret lactate curves. Computers in biology and medicine, 36(3), pp.262-75.
Papadonikolakis, A. et al., 2003. Compensatory mechanisms in anterior cruciate ligament deficiency. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 11(4), pp.235-43.
Papannagari, R. et al., 2006. In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. The American journal of sports medicine, 34(12), pp.2006-12.
Ramsay, J.O. and Silverman, B.W., 2005. Functional data analysis, New York: Springer Series.
Ryan, W., Harrison, A. & Hayes, K., 2006. Sports Biomechanics Functional data analysis of knee joint kinematics in the vertical jump Functional Data Analysis of Knee Joint Kinematics in the Vertical Jump. Sports Biomechanics, 5(1), pp.121-137.
Sati, M. et al., 1996. Improving in vivo knee kinematic measurements: application to prosthetic ligament analysis. The knee, 3, pp.179-190.
Südhoff, I. et al., 2007. Comparing three attachment systems used to determine knee kinematics during gait. Gait and posture, 25(4), pp.533-43.
Tsivgoulis, S.D. et al., 2011. Pre-operative versus post-operative gait variability in patients with acute anterior cruciate ligament deficiency. The Journal of international medical research, 39(2), pp.580-93.
Tzagarakis, G.N. et al., 2010. Influence of acute anterior cruciate ligament deficiency in gait variability. The Journal of international medical research, 38(2), pp.511-25.
Winter, D.A., 1984. Kinematic and kinetic pattens in human gait: Variability and compensating effects. Human Movement Science, 3(1-2), pp.51-76.
- There are currently no refbacks.