Knee joint biomechanics in transtibial amputees in gait, cycling, and elliptical training

PLoS One. 2019 Dec 12;14(12):e0226060. doi: 10.1371/journal.pone.0226060. eCollection 2019.

Abstract

Transtibial amputees may experience decreased quality of life due to increased risk of knee joint osteoarthritis (OA). No prior studies have compared knee joint biomechanics for the same group of transtibial amputees in gait, cycling, and elliptical training. Thus, the goal of this study was to identify preferred exercises for transtibial amputees in the context of reducing risk of knee OA. The hypotheses were: 1) knee biomechanics would differ due to participant status (amputee, control), exercise, and leg type (intact, residual) and 2) gait kinematic parameters would differ due to participant status and leg type. Ten unilateral transtibial amputee and ten control participants performed exercises while kinematic and kinetic data were collected. Two-factor repeated measures analysis of variance with post-hoc Tukey tests and non-parametric equivalents were performed to determine significance. Maximum knee compressive force, extension torque, and abduction torque were lowest in cycling and highest in gait regardless of participant type. Amputee maximum knee extension torque was higher in the intact vs. residual knee in gait. Amputee maximum knee flexion angle was higher in the residual vs. intact knee in gait and elliptical. Gait midstance knee flexion angle timing was asymmetrical for amputees and knee angle was lower in the amputee residual vs. control non-dominant knees. The results suggest that cycling, and likely other non-weight bearing exercises, may be preferred exercises for amputees due to significant reductions in biomechanical asymmetries and joint loads.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Amputees* / rehabilitation
  • Bicycling / physiology*
  • Biomechanical Phenomena
  • Case-Control Studies
  • Exercise Therapy / methods
  • Female
  • Gait / physiology*
  • Humans
  • Knee Joint / physiology*
  • Male
  • Middle Aged
  • Tibia / surgery
  • Torque
  • Walking / physiology
  • Young Adult

Grants and funding

The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Defense Health Program, through the Department of Defense Broad Agency Announcement for Extramural Medical Research Program Number W81XWH-BAA-14-1 under award no. W81XWH-16-1-0051 (SK) and by the Donald E. Bentley Center (https://me.calpoly.edu/bently-center) (SK). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.