Mechanical Engineering - Theses
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ItemLower-limb muscle forces and patellofemoral joint loading in people with and without patellofemoral osteoarthritis during walking and stair ambulation( 2012)Osteoarthritis (OA) is a chronic degenerative joint disease that is the leading cause of musculoskeletal pain and disability in Australia. OA often affects the knee joint and commonly occurs between the patella (knee cap) and femur (thigh bone), known as patellofemoral joint osteoarthritis (PFJ OA). PFJ OA is highly prevalent in elderly populations and is more common than tibiofemoral joint osteoarthritis (TFJ OA). Despite the differences in prevalence, PFJ OA is less studied than TFJ OA. The mechanical loading transferred through a joint is generally thought to play a major role in OA initiation and progression via the lifelong “wear and tear” of a joint’s articular cartilage. Alterations to gait patterns and muscle dysfunction are commonly observed in people with knee disorders. However, little is known on how these changes actually combine to alter patellofemoral joint (PFJ) loading. The use of computational models is becoming a popular approach to quantify in vivo muscle forces and joint contact forces in healthy individuals during common activities. However, these models have rarely been applied to pathological populations, such as PFJ OA. Given the dearth of knowledge in the gait characteristics, in vivo muscle function and PFJ joint loading in the PFJ OA population, the purpose of this study was to investigate the joint kinematics, joint moments, muscle forces and PFJ loading in individuals with and without PFJ OA during three common activities of daily life: (1) overground walking, (2) stair ascent and (3) stair descent. Four specific research questions are addressed in this thesis. 1. Do people with PFJ OA demonstrate altered trunk and lower-limb joint biomechanics in comparison to people without PFJ OA during walking and stair ambulation? 2. Do people with PFJ OA demonstrate differences in hip and knee muscle forces when compared to controls during walking and stair ambulation? 3. Is the patellofemoral joint reaction force different in people with and without PFJ OA during walking and stair ambulation? 4. Are there biomechanical characteristics that distinguish people with isolated PFJ OA from people with concurrent TFJ OA and PFJ OA? Quantitative gait experiments and computational modelling were utilised to address the above research questions. The main findings of this study were that subjects with PFJ OA (with and without concurrent TFJ OA) adopted activity-specific gait modifications to off-load the PFJ. Specifically, participants with PFJ OA chose to alter their sagittal-plane kinematics, such as increased anterior pelvic tilt and/or decreased knee flexion, during stair ambulation to reduce the knee extension moment, quadriceps force and the patellofemoral joint reaction force. PFJ OA participants also walked and descended stairs with lower hip abductor muscle forces and lower knee adduction moments, which may represent a frontal-plane adaptation to off-load the PFJ. The alterations in quadriceps and hip abductor muscle forces observed in the individuals with PFJ OA suggest that hip and knee muscle dysfunction may be characteristic features of the PFJ OA population. These findings indicate the importance of including the PFJ and the dynamics of joints proximal to the knee when investigating the knee OA disease process.