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Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation

Ross H Miller1, Aryeh Y Esterson2, Jae Kun Shim3

  • 1Department of Kinesiology, University of Maryland, College Park, MD, USA; Neuroscience & Cognitive Science Program, University of Maryland, College Park, MD, USA.

The Knee
|July 29, 2015
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Summary

Optimizing gait modification strategies can significantly reduce knee adduction moment (KAM) and knee joint contact force (JCF). Considering whole-body motion and muscle forces is crucial for effective KAM reduction and JCF management.

Keywords:
Gait modificationJoint contact forceKnee adduction momentMinimizationSimulation

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Area of Science:

  • Biomechanics
  • Human locomotion
  • Musculoskeletal modeling

Background:

  • Gait modification is frequently employed to decrease the external knee adduction moment (KAM) during walking.
  • The precise relationship between KAM reduction and alterations in medial knee joint contact force (JCF) remains incompletely understood.

Purpose of the Study:

  • To investigate the effects of maximally reducing KAM on medial JCF.
  • To examine the limiting case of KAM-based gait modification.

Main Methods:

  • Utilized musculoskeletal modeling and optimal control simulations.
  • Performed simulations for normal walking, a gait minimizing KAM (Min(KAM)), and a gait minimizing KAM plus metabolic cost of transport (Min(KAM+CoT)).

Main Results:

  • Both modified gaits substantially reduced peak KAM (-82% for Min(KAM), -74% for Min(KAM+CoT)) through strategies like increased trunk lean and step width.
  • The Min(KAM+CoT) simulation achieved a greater reduction in peak medial JCF (-27%) compared to the Min(KAM) simulation (-15%), despite a larger KAM, due to reduced knee muscle activity.
  • Sensitivity analysis indicated qualitative robustness but variable quantitative outcomes based on knee joint models.

Conclusions:

  • Effective gait modification necessitates a holistic approach considering whole-body movements over isolated adjustments.
  • Accounting for muscle forces is essential for accurately interpreting the impact of KAM on medial JCF.
  • Subject-specific knee models are vital for precise quantification of KAM reduction effects on JCF.