• PNF and Movement
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• v.19 no.1
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• pp.1-8
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• 2021

Purpose: The purpose of this study was to determine how the position of tibial rotation affects peak force and hamstring muscle activation during isometric knee flexion in healthy women. Methods: Seventeen healthy women performed maximum isometric knee flexion at 30˚ with three tibial rotation positions (tibial internal rotation, neutral position, and tibial external rotation). Surface electromyographic (EMG) activity was recorded from the medial hamstring (MH) and lateral hamstring (LH) muscles. The strength of the knee flexor was measured with a load-cell-type strength-measurement sensor. Data were analyzed using one-way repeated analysis of variance. Results: The results showed that MH and LH activities and peak force were significantly different among the three tibial rotation conditions (p < 0.01). The post-hoc comparison revealed that the MH EMG activity in tibial neutral and internal rotation positions were significantly greater than tibial external rotation (p < 0.01). The LH activity in tibial external rotation was significantly greater than the tibial neutral position and internal rotation (p < 0.01). The peak force of the knee flexor was also greater in the external tibial rotation position compared with the tibial neutral and internal rotation positions (p < 0.01). Conclusion: Our findings suggest that hamstring muscle activation could be changed by tibial rotation.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.1
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• pp.43-49
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• 2017

PURPOSE: This study investigated the relationship among hip adduction angle, tibial rotation, and ITB length during an Ober test to determine the most appropriate position for performing the test. METHODS: The study included thirty-nine asymptomatic participants (23 males, 16 females). Their hip adduction angles were measured using the Ober test during three tibial rotation conditions (internal tibial rotation, external rotation, and neutral position). ITB length was calculated by measuring the position of the patella to lateral femoral condyle using ultrasonography (patella-condyle distance; PCD). RESULTS: The relationship among hip adduction angle, tibial rotation, and ITB length was analyzed under the three conditions using the Pearson correlation. The hip adduction angle of the internal tibial rotation, the external rotation, and the neutral position were significantly related to ITB length. Moreover, the hip adduction angle measured during the internal tibial rotation had the highest correlation with ITB length among the three conditions (r=.58, p<.001). CONCLUSION: Internal tibial rotation caused by the Ober test led to increased iliotibial band (ITB) tension and a decreased adduction angle. These findings support that tibial rotation influences the flexibility of ITB. Therefore, therapists should consider the position of the internal tibial rotation when taking measurements using an Ober test.

• Korean Journal of Applied Biomechanics
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• v.21 no.4
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• pp.467-477
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• 2011

This study was performed to investigate the effects of tibial rotation while going up stair on muscle activity of vastus medialis oblique and vastus lateralis, and on patellar displacement. The subjects included 30 people (male: 15; female: 15) who were randomly assigned to the tibial internal-rotation, neutral-rotation, and external-rotation groups. The subjects went up the stair while performing the assigned rotations, and the rotation of the hip and the displacement of the patella were measured using a 3D motion analyzer. In addition, the maximum voluntary isometric contraction (MVIC) of the vastus medialis oblique and vastus lateralis were measured using surface electromyogram. On the tibial internal rotation, the hip rotation significantly appeared in the same direction and so did on the tibial neutral and external rotations(p<.001). Although the MVIC of the vastus medialis oblique and vastus lateralis did not significantly differ by tibial rotation during the stair ascent, the MVIC of the vastus medialis oblique was higher than that of the vastus lateralis during the internal and neutral rotations (p<.05). In addition, during the stair ascent, the displacement of the patella was more significant during the tibial external rotation than during the tibial internal and neutral rotations(p<.001). Thus, patients with patellofemoral pain are required to be considered the effects of tibial rotation for their rehabilitation.

• Physical Therapy Korea
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• v.20 no.2
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• pp.60-68
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• 2013

The purpose of this study was to assess the intra-rater test-retest reliability of tibial external rotation angle measurement using a smartphone-based photographic goniometer, DrGoniometer (DrG) compared to a three-dimensional motion analysis system (Vicon). The current study showed an interchangeable method using DrG to measure the tibial external rotation angle in standing knee flexion at $90^{\circ}$. Twelve healthy subjects participated in this study. A rest session was conducted 30 minutes later for within-day reliability and five days later for between-day intra-rater test-retest reliability. To assess the validity of the measurement using DrG, we used a three dimensional motion analysis system as a gold standard to measure the angle of tibial external rotation. Intra-class correlation coefficient (ICC) and the standard error of measurement (SEM) values were used to determine the within- and between- day intra-rater test-retest reliability of using DrG and a three dimensional motion analysis system. To assess validity, Pearson correlation coefficients were used for two measurement techniques. The measurement for tibial external rotation had high intra-rater test-retest reliability of within-day (ICC=.88) and between-day (ICC=.83) reliability using DrG and of within-day (ICC=.93) and between-day (ICC=.77) reliability using a three-dimentional motion analysis system. Tibial external rotation angle measurement using DrG was highly correlated with those of the three-dimensional motion analysis system (r=.86). These results represented that the tibial external rotation angle measurement using DrG showed acceptable reliability and validity compared with the use of three-dimensional motion analysis system.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.420-426
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• 2018

Background: The tibial tuberosity-trochlear groove (TT-TG) distance is used to determine the necessity of tibial tubercle osteotomy. We conducted this study to determine the extent to which each of the tibial tuberosity lateralization, trochlear groove medialization, and knee rotation angle affects the TT-TG distance in both normal and patella dislocated patients and thereby scrutinize the rationale for tuberosity transfer based on the TT-TG distance. Methods: Retrospective analysis of rotational profile computed tomography was done for patella dislocated and control group patients. Femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization were assessed in all patients. Relationship of these parameters with the TT-TG distance was investigated to evaluate their effects on the TT-TG distance. Results: We observed that the patellar dislocation group, compared to the control group, had increased TT-TG distance (mean, 19.05 mm vs. 9.02 mm) and greater tuberosity lateralization (mean, 64.1% vs. 60.7%) and tibial external rotation in relation to the femur (mean, $7.9^{\circ}$ vs. $-0.81^{\circ}$). Conclusions: Tuberosity lateralization and knee rotation were factors affecting patellar dislocation. These factors should be considered in addition to the TT-TG distance to determine the need for tibial tubercle osteotomy in patients with patellar dislocation.

• Journal of Veterinary Clinics
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• v.37 no.4
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• pp.175-179
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• 2020

The objective of this study was to determine the effect of osteotomy angle and tibial proximal segment rotation angle on angular and torsional tibial deformities and to assess the trends of these deformities during the rotation of the tibial proximal segment in a center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) by performing computer modeling of the tibia. Four tibias of toy breed dogs with no history of lameness were used in this study. Osteotomies were performed in the proximal tibias at angles of 0°, 10°, 20°, -10°, and -20°, perpendicular to either the proximodistal or craniocaudal tibial axes. The mechanical medial proximal tibial angle (mMPTA) and transcondylar (TC) and distal cranial tibial (CnT) axes were used to measure angular and torsional deformities, respectively. All tibias showed an increase in angular and rotational deformities with an increase in the tibial plateau rotation angle. The tibia with osteotomies performed in the proximodistal and craniocaudal directions showed the highest magnitude of torsional and angular deformities, respectively. The results of this study revealed a tendency of occurrence of angular and torsional deformities with osteotomy performed along the proximodistal and craniocaudal directions in the CBLO.

• Journal of Veterinary Clinics
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• v.39 no.3
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• pp.100-106
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• 2022

The center of rotation of angulation-based leveling osteotomy (CBLO) has been introduced for the stabilization of cranial cruciate ligament rupture (CCLR) in small-breed dogs. This technique can be applied to the tibia without damaging its tuberosity. Although different designs of CBLO plates are available, tibial plateau leveling osteotomy (TPLO) plates have been still used for stabilization during CBLO. To the best of our knowledge, no studies have reported the effects of TPLO plates on the postoperative limb alignment after CBLO. Therefore, the present study (January 2020 to February 2021) aimed to compare the postoperative outcomes (postoperative tibial plateau angle [TPA] and tibial alignment) in patients receiving CBLO and TPLO plates during CBLO. Paired stifle joints (n = 16) were obtained from eight toy-breed cadaver dogs (mean weight, 4.4 kg) that underwent CBLO. The joints were randomly assigned to receive the CBLO (CBLO group) or TPLO plates (TPLO group). Pre-and postoperative radiographs were obtained, and the dissected tibiae were evaluated. The following postoperative parameters were compared to evaluate the surgical outcome: TPA, osteotomy location, mechanical medial proximal tibia angle, inter-segment gap, and tibial plateau translation. No significant differences were found in the postoperative alignment between the two groups. Therefore, TPLO plates may be considered as a viable alternative in toy-breed dogs undergoing CBLO.

• Journal of muscle and joint health
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• v.17 no.2
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• pp.142-150
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• 2010

Purpose: The purpose of this study was to examine EMG activities and VMO/VL ratio of the vastus medialis oblique, vastus lateralis, and rectus femoris during squat exercise (knee angle: 15, 45, and 60 degrees; tibial rotation: internal rotation, neutral, and external rotation). Methods: Twelve subjects performed squat exercise at each knee angle and tibial rotation while electromyographic (EMG) activity was collected. Statistical analysis consisted of two-way repeated measures analysis of variance with post hoc analysis. Results: There were significant main effects of knee angles and foot positions and interaction effect on EMG activities of vastus medialis oblique and vastus lateralis. VMO/VL ratios were significantly different by tibial rotations and there was an interaction effect. A neutral position produced significantly more VMO/VL activity ratio than that from internally rotated position and externally rotated position at 60 degrees. Conclusion: Considering the interaction effects for EMG activity across quadriceps muscles tested, the 60 degrees knee angle with a neutral foot position may provide the most effective condition for patients with acute patellofemoral syndrome.

• Physical Therapy Korea
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• v.25 no.4
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• pp.46-52
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• 2018

Background: The hamstring muscles in the lower extremity are highly important for knee joint stability and can be classified into medial and lateral hamstrings according to the anatomical position, which have some different functions. To measure the strength of the individual hamstring muscles, manual muscle testing is clinically performed by dividing rotation postures into internal and external postures. However, this has no sufficient scientific background. Objects: This study aimed to test the difference that the tibial rotation would cause in the muscle activity of the medial and lateral hamstrings. Methods: The muscle activities of the biceps femoris, semitendinosus, and semimembranosus were measured in a total of three different postures (neutral position and internal and external rotations) with 3 replications. During the maximal isometric contraction, resistance was constantly provided by the string attached to the strap, not by manual resistance of the examiner. Before and after electromyography measurements, the participants underwent hamstring flexibility measurement using the active knee extension test in the supine position on the treatment table. Results: The semitendinosus had a 12.56% reduction in muscle activity in external rotation as compared with that in neutral position. The biceps femoris and semimembranosus showed reduced muscle activities in both external and internal rotations as compared with those in neutral position. Only the women showed significant decreases in the comparison between pre and post-active knee extension. Conclusion: Only the semitendinosus muscle was consistent with the anatomical speculation. However, the reduction in the muscle activity of the semitendinosus as compared with that in neutral position was only 12.56%, the clinical value of which may be difficult to justify.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.2
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• pp.33-41
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• 2018

PURPOSE: Femur and tibia alignment in the knee joint is important to the biomechanics of lower limb movement. The purpose of this study was to compare vastus medialis oblique (VMO) and vastus lateralis electromyographic muscle activities according to tibial rotation taping methods. METHODS: Twenty-nine healthy subjects (13 males and 16 females) in the 20s, without knee joint-related diseases or disorders, participated in our study. After identifying each subject's dominant foot, the maximal voluntary isometric contraction (MVIC) was determined using a manual muscle tester. The activity of each target muscle was measured at 50% MVIC in isometric muscle contraction and at a $30^{\circ}$ knee flexion position before and after applying internal and external rotation taping by the Mulligan concept and in the neutral position. Non-elastic tape was used to stabilize the tibia rotation position. RESULTS: In the males, VMO muscle activity was significantly increased in the tibia internal rotation position ($47.2{\pm}14.6$, $mean{\pm}SD$) than in the neutral position ($39.3{\pm}14.9$) (p<.05). CONCLUSION: The results of this study indicate that when applying tibia internal rotation taping in healthy males, VMO muscle activity significantly increases during isometric extension of the knee. Therefore, this study provides a basis for selecting the appropriate taping method, in consideration of the available treatments in clinical practice for patients with knee problems.