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Visualising knee loading patterns during kneeling and the development of a laboratory-based adaptation of the Aberdeen Weight-Bearing Test (Knee)

Published:September 10, 2022DOI:https://doi.org/10.1016/j.knee.2022.08.019

      Highlights

      • Developed technique to visualise knee loading patterns during kneeling.
      • Inferior patella tendon was most frequently loaded during kneeling.
      • The lab-AWT-K indicates location and magnitude of applied loads.

      Abstract

      Background

      Information regarding the loading of key anatomical structures of the knee during kneeling would enhance existing functional tests, yet current visualisation methods are limited and require further development.

      Aims

      (1) Develop a knee loading visualisation technique to investigate loading patterns of the knee during kneeling; and (2) determine the utility of the technique in combination with vertical ground reaction forces and centre of pressure data in the lab-based Aberdeen Weight-Bearing Test (Knee) by assessing their reliability.

      Methods

      Fourteen healthy participants conducted kneeling tasks with and without knee pads across two testing sessions. Eight force-sensitive resistors were affixed to the right knee throughout different kneeling tasks: upright kneeling, and reaching forward, back, left, and right. A photo of the force-sensitive resistor configuration was used to generate participant-specific heat maps of knee loading. Two in-ground force platforms were used to measure vertical ground reaction forces and centre of pressure.

      Results

      The inferior patella tendon showed the highest proportion of activation during both bare and knee pad kneeling for all kneeling tasks. Knee pads reduced the repeatability of knee loading patterns. Force-sensitive resistor activation and vertical ground reaction force components of the lab-based Aberdeen Weight-Bearing Test (Knee) were shown to be reliable, whereas the centre of pressure data was unreliable.

      Conclusion

      We have developed a lab-based technique for visualising knee loading using force-sensitive resistors. The combination of force-sensitive resistor activation and vertical ground reaction force data provides valuable insights into both the magnitude and locations of applied loads throughout kneeling.

      Keywords

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      References

        • Amin R.M.
        • Vasan V.
        • Oni J.K.
        Kneeling after total knee arthroplasty.
        J Knee Surg. 2020; 33 (ISSN 1538-8506. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1676801): 138-143https://doi.org/10.1055/s-0038-1676801
        • Artz N.J.
        • Hassaballa M.A.
        • Robinson J.R.
        • Newman J.H.
        • Porteous A.J.
        • Murray J.R.
        Patient reported kneeling ability in fixed and mobile bearing knee arthroplasty.
        J Arthroplasty. 2015; 30 (ISSN 0883-5403): 2159-2163https://doi.org/10.1016/j.arth.2015.06.063
        • Baker P.
        • Reading I.
        • Cooper C.
        • Coggon D.
        Knee disorders in the general population and their relation to occupation.
        Occup Environ Med. 2003; 60 (http://oem.bmj.com/content/60/10/794.abstract): 794https://doi.org/10.1136/oem.60.10.794
        • Bhattacharyya T.
        • Seng K.
        • Nassif N.A.
        • Freedman I.
        Knee pain after tibial nailing: the role of nail prominence.
        Clin Orthop Relat Res. 2006; 449 (ISSN 0009-921X (Print) 0009-921X (Linking). https://www.ncbi.nlm.nih.gov/pubmed/16702914): 303-307https://doi.org/10.1097/01.blo.0000223976.91089.08
        • Calvert Nicholas D.
        • Smith Anne
        • Kuster Lukas
        • Calvert Maya
        • Ebert Jay
        • Ackland Tim
        • Kuster Markus S.
        The kneeling test is a valid method of assessing kneeling tolerance.
        Knee SUrgery, Sports Traumatol, Arthroscopy: Off J ESSKA. 2019; 27 (ISSN 0942-2056): 3705-3712https://doi.org/10.1007/s00167-019-05505-3
      1. Cicchetti Domenic V. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assessm 1994;6(4):284–290. ISSN 1040-3590.

      2. Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 1997;11(2):103–5. ISSN 0890-5339 (Print) 0890-5339.

      3. Deepankar Datta. blandr: a Bland-Altman Method Comparison package for R, 2017. URL https://github.com/deepankardatta/blandr.

        • Dawson J.
        • Fitzpatrick R.
        • Murray D.
        • Carr A.
        Questionnaire on the perceptions of patients about total knee replacement.
        J Bone Joint Surg Br. 1998; 80 (ISSN 0301-620X (Print) 0301-620x): 63-69https://doi.org/10.1302/0301-620x.80b1.7859
        • Fontalis Andreas
        • Weil Simon
        • Williamson Michael
        • Houston James
        • Ads Tamer
        • Trompeter Alex
        A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing.
        Eur J Orthopaedic Surg Traumatol. 2021; 31: 1143-1150https://doi.org/10.1007/s00590-020-02851-8
      4. Hartmann B, Fleischer AG. Physical load exposure at construction sites. Scand J Work Environ Health, 2005;31 Suppl 2:88–95. ISSN 0355-3140 (Print) 0355-3140.

        • Hassaballa M.A.
        • Porteous A.J.
        • Newman J.H.
        • Rogers C.A.
        Can knees kneel? kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty.
        Knee. 2003; 10 (ISSN 0968-0160 (Print) 0968-0160): 155-160https://doi.org/10.1016/s0968-0160(02)00148-5
        • Hassaballa M.A.
        • Porteous A.J.
        • Newman J.H.
        Observed kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty: perception versus reality.
        Knee Surg Sports Traumatol Arthrosc. 2004; 12 (ISSN 0942-2056 (Print) 0942-2056): 136-139https://doi.org/10.1007/s00167-003-0376-5
      5. Hassaballa MA, Porteous AJ, Learmonth ID. Functional outcomes after different types of knee arthroplasty: kneeling ability versus descending stairs. Med Sci Monit 2007;13(2):Cr77–81. ISSN 1234-1010 (Print) 1234-1010.

        • Hernandez Manuel E.
        • Snider Joseph
        • Stevenson Cory
        • Cauwenberghs Gert
        • Poizner Howard
        A correlation-based framework for evaluating postural control stochastic dynamics.
        IEEE Trans Neural Syst Rehabil Eng. 2016; 24: 551-561https://doi.org/10.1109/TNSRE.2015.2436344
        • Hofer J.K.
        • Gejo R.
        • McGarry M.H.
        • Lee T.Q.
        Effects of kneeling on tibiofemoral contact pressure and area in posterior cruciate-retaining and posterior cruciate-sacrificing total knee arthroplasty.
        J Arthroplasty. 2012; 27 (ISSN 0883-5403): 620-624https://doi.org/10.1016/j.arth.2011.07.011
        • Irrgang J.J.
        • Snyder-Mackler L.
        • Wainner R.S.
        • Fu F.H.
        • Harner C.D.
        Development of a patient-reported measure of function of the knee.
        J Bone Joint Surg Am. 1998; 80 (ISSN 0021-9355 (Print) 0021-9355): 1132-1145https://doi.org/10.2106/00004623-199808000-00006
      6. Jensen LK, Rytter S, Bonde JP. Exposure assessment of kneeling work activities among floor layers. Appl Ergon 2010;41(2):319–325. ISSN 0003-6870.

      7. Karachalios T, Babis G, Tsarouchas J, Sapkas G, Pantazopoulos T. The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device. Injury 2000;31(6):451–9. ISSN 0020-1383 (Print) 0020-1383. https://www.sciencedirect.com/science/article/pii/S0020138300000243?via%3Dihub.

      8. Keating JF, Orfaly R, O’Brien PJ. Knee pain after tibial nailing. J Orthopaedic Trauma 1997;11(1). ISSN 0890-5339. https://journals.lww.com/jorthotrauma/Fulltext/1997/01000/Knee_Pain_After_Tibial_Nailing.4.aspx.

        • Lee T.Q.
        Biomechanics of hyperflexion and kneeling before and after total knee arthroplasty.
        Clin Orthop Surg. 2014; 6 (ISSN 2005-291X (Print) 2005-291x): 117-126https://doi.org/10.4055/cios.2014.6.2.117
      9. David Robert Walker MacDonald, Haroon Rehman, Carol Ann Carnegie, Jordi Tomas-Hernandez, Alan John Johnstone. The aberdeen weight-bearing test (knee): a new objective test for anterior knee discomfort. Eur J Trauma Emerg Surgery: Off Publ Eur Trauma Soc 2020;46(1):93–98. https://doi.org/10.1007/s00068-018-0986-8. ISSN 1863-9941 1863-9933. https://pubmed.ncbi.nlm.nih.gov/30030552, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026230/.

      10. Martin Bland J, Altman Douglas G. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet 1986;327(8476):307–310. https://doi.org/10.1016/S0140-6736(86)90837-8. ISSN 0140-6736. https://www.sciencedirect.com/science/article/pii/S0140673686908378.

      11. Moore Susan M, Pollard Jonisha P, Mary Ellen Nelson. Task-specific postures in low-seam underground coal mining. Int J Ind Ergon 2012;42(2):241–248. https://doi.org/10.1016/j.ergon.2012.01.002. ISSN 0169-8141. https://www.sciencedirect.com/science/article/pii/S016981411200011X.

        • Nagura T.
        • Dyrby C.O.
        • Alexander E.J.
        • Andriacchi T.P.
        Mechanical loads at the knee joint during deep flexion.
        J Orthop Res. 2002; 20 (ISSN 0736-0266 (Print) 0736-0266): 881-886https://doi.org/10.1016/s0736-0266(01)00178-4
        • Osti L.
        • Papalia R.
        • Rinaldi P.
        • Denaro V.
        • Bartlett J.
        • Maffulli N.
        The kneeling view: evaluation of the forces involved and side-to-side difference.
        Knee. 2009; 16 (ISSN 0968-0160): 463-465https://doi.org/10.1016/j.knee.2009.04.010
      12. Palmer SH, Servant CT, Maguire J, Parish EN, Cross MJ. Ability to kneel after total knee replacement. J Bone Joint Surgery. British volume 2002;84(2):220–222. ISSN 0301-620X.

        • Porter William
        • Mayton A.
        • Moore S.
        Pressure distribution on the anatomic landmarks of the knee and the effect of kneepads.
        Appl Ergon. 2010; 42: 106-113
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee injury and osteoarthritis outcome score (koos)–development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28 (ISSN 0190-6011 (Print) 0190-6011): 88-96https://doi.org/10.2519/jospt.1998.28.2.88
      13. Schai PA, Gibbon AJ, Scott RD. Kneeling ability after total knee arthroplasty. perception and reality. Clin Orthop Relat Res 1999;(367):195–200. ISSN 0009-921X (Print) 0009-921x.

        • Schenker Nathaniel
        • Gentleman Jane F.
        On judging the significance of differences by examining the overlap between confidence intervals.
        Am Stat. 2001; 55: 182-186https://doi.org/10.1198/000313001317097960
        • Schofield Jonathon S.
        • Evans Katherine R.
        • Hebert Jacqueline S.
        • Marasco Paul D.
        • Carey Jason P.
        The effect of biomechanical variables on force sensitive resistor error: Implications for calibration and improved accuracy.
        J Biomech. 2016; 49 (URL https://www.sciencedirect.com/science/article/pii/S0021929016300343. ISSN 0021-9290): 786-792https://doi.org/10.1016/j.jbiomech.2016.01.022
        • Sharkey P.F.
        • Miller A.J.
        Noise, numbness, and kneeling difficulties after total knee arthroplasty: is the outcome affected?.
        J Arthroplasty. 2011; 26 (ISSN 0883-5403): 1427-1431https://doi.org/10.1016/j.arth.2010.10.009
        • Smith J.R.A.
        • Mathews J.A.
        • Osborne L.
        • Bakewell Z.
        • Williams J.L.
        Why do patients not kneel after total knee replacement? is neuropathic pain a contributing factor?.
        Knee. 2019; 26 (ISSN 0968-0160): 427-434https://doi.org/10.1016/j.knee.2018.12.009
      14. Si Young Song, Ho Geun Chang, Jae Chul Byun, Tae Young Kim. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthopaedic Trauma 2012;26(3). ISSN 0890-5339. https://journals.lww.com/jorthotrauma/Fulltext/2012/03000/Anterior_Knee_Pain_After_Tibial_Intramedullary.8.aspx.

        • Tennant L.M.
        • Chong H.C.
        • Acker S.M.
        The effects of a simulated occupational kneeling exposure on squat mechanics and knee joint load during gait.
        Ergonomics. 2018; 61 (ISSN 0014-0139. https://www.tandfonline.com/doi/pdf/10.1080/00140139.2017.1411529?needAccess=true): 839-852https://doi.org/10.1080/00140139.2017.1411529
      15. Liana Tennant, David Kingston, Helen Chong, Stacey Acker. The effect of work boots on knee mechanics and the center of pressure at the knee during static kneeling. J Appl Biomech 2015;31(5):363–369. ISSN 1065-8483.

      16. Toivanen Jarmo AK, Olli Väistö, Pekka Kannus, Kyösti Latvala, Honkonen Seppo E, Järvinen Markku J. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: A prospective, randomized study comparing two different nail-insertion techniques. JBJS 2002;84(4). ISSN 0021-9355. https://journals.lww.com/jbjsjournal/Fulltext/2002/04000/Anterior_Knee_Pain_After_Intramedullary_Nailing_of.11.aspx.

      17. Weiss Jennifer M, Noble Philip C, Conditt Michael A, Kohl Harold W, Seth Roberts, Cook Karon F, et al. What functional activities are important to patients with knee replacements? Clin Orthopaedics Related Res 2002;404(404):172–188. ISSN 0009-921X.

        • White L.
        • Stockwell T.
        • Hartnell N.
        • Hennessy M.
        • Mullan J.
        Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty.
        J Orthop Traumatol. 2016; 17 (ISSN 1590-9921 (Print) 1590-9921): 333-338https://doi.org/10.1007/s10195-016-0411-1
        • Wilkens K.J.
        • Duong L.V.
        • McGarry M.H.
        • Kim W.C.
        • Lee T.Q.
        Biomechanical effects of kneeling after total knee arthroplasty.
        J Bone Joint Surg Am. 2007; 89 (ISSN 0021-9355): 2745-2751https://doi.org/10.2106/jbjs.E.01201
        • Wylde V.
        • Artz N.
        • Howells N.
        • Blom A.W.
        Kneeling ability after total knee replacement.
        EFORT Open Rev. 2019; 4 (ISSN 2058-5241 (Print) 2058-5241): 460-467https://doi.org/10.1302/2058-5241.4.180085
        • Hang Xu.
        • Jampala Sree
        • Bloswick Donald
        • Zhao Jie
        • Merryweather Andrew
        Evaluation of knee joint forces during kneeling work with different kneepads.
        Appl Ergon. 2017; 58 (ISSN 0003-6870. https://www.sciencedirect.com/science/article/pii/S000368701630134X): 308-313https://doi.org/10.1016/j.apergo.2016.07.003