Kinematic characteristics of ankle joint during walking in young adults with general joint hypermobility

doi:10.3877/cma.j.issn.1674-134X.2023.01.003

Abstract

Abstract:

Objective

To analyse kinematic characteristics and regularity of six-degrees of freedom (6-DOF) of both healthy participates and study subjects with general joint hypermobility (GJH) by collecting ankle gait data during uphill and downhill walking.

Methods

Healthy college students, excluded from ankle history and medical history associated with neuropsychiatric diseases, were divided into control group (Beighton score<four, 45 subjects) and general joint hypermobility group (GJH group, Beighton score≥four, 33 subjects). A three-dimensional motion analysis system was employed to collect kinematic parameters of ankle joints from the healthy participates and study subjects during walking uphill and downhill. Independent sample t test was used to analyse the two groups of gait data which were in accordance with normal distribution and homogeneity of variance. If a normal distribution or variance homogeneity test was not applicable, Mann-Whitney U test was used instead.

Results

There was no significant difference in the angles of dorsal extension and plantar flexion between the two groups in uphill walking (P>0.05). While in downhill walking, GJH group showed a smaller angle of plantar flexion in the initial contact and at the end of swing phase, with flexion and extension angles at (-28.19±9.23)° vs (-32.92±9.90)° (t=2.119, P=0.037) in the initial landing state of 2% gait. In comparison with the control group, GJH group showed greater medial rotation angle and lateral translation when walking uphill and downhill, with medial and lateral rotations while in uphill walking with loading response period of 9% gait: (-2.84±6.18)° vs (-0.04±5.93)° (t=2.028, P=0.046). In downhill walking, in the GJH group, the medial rotation and lateral translation occurred with more significantly increased angles of medial and lateral rotations in loading response period of 9% gait: (-7.7±4.8)° vs (-5.0±6.3)° (t=2. 057, P=0. 043).

Conclusions

Compared with a normal young adult, the young adult with GJH showed more significant changes in kinematic parameters in downslope walking than an upslope walking. In order to adapt to higher functional requirements in downhill movement, muscles such as gastrocnemius muscle should be excessively activated to maintain an ankle stability.

Key words: Joint instability, Ankle joint, Gait analysis

Haobin Chen, Xiaolong Zeng, Zhenyan Xie, Guoqing Zhong, Xuecheng He, Xinyu Zhou, Wenhan Huang, Yu Zhang. Kinematic characteristics of ankle joint during walking in young adults with general joint hypermobility[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 19-28.

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References 44

[1]	Tinkle BT, Levy HP. Symptomatic joint hypermobility: the hypermobile type of ehlers-danlos syndrome and the hypermobility spectrum disorders[J]. Med Clin North Am, 2019, 103(6): 1021－1033.
[2]	Castori M, Colombi M. Generalized joint hypermobility, joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type[J]. Am J Med Genet C Semin Med Genet, 2015, 169C(1): 1－5.
[3]	Juul-Kristensen B, Schmedling K, Rombaut L, et al. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-a systematic review[J]. Am J Med Genet C Semin Med Genet, 2017, 175(1): 116－147.
[4]	Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population[J]. Ann Rheum Dis, 1973, 32(5): 413－418.
[5]	Nikolajsen H, Larsen PK, Simonsen EB, et al. Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study[J/OL]. BMC Musculoskelet Disord, 2013, 14: 341. DOI: 10.1186/1471-2474-14-341.
[6]	Fatoye FA, Palmer S, van der Linden ML, et al. Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome[J]. Gait Posture, 2011, 33(3): 447－451.
[7]	Celletti C, Galli M, Cimolin V, et al. Use of the gait profile score for the evaluation of patients with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type[J]. Res Dev Disabil, 2013, 34(11): 4280－4285.
[8]	Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children[J]. J Pediatr, 2011, 158(1): 119－123.e4.
[9]	Al-Rawi ZS, Al-Aszawi AJ, Al-Chalabi T. Joint mobility among university students in Iraq[J]. Br J Rheumatol, 1985, 24(4): 326－331.
[10]	Hakim A, Grahame R. Joint hypermobility[J]. Best Pract Res Clin Rheumatol, 2003, 17(6): 989－1004.
[11]	Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature[J]. J Rheumatol, 2007, 34(4): 804－809.
[12]	Remvig L, Flycht L, Christensen KB, et al. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: hypermobile type and joint hypermobility syndrome[J]. Am J Med Genet A, 2014, 164A(3): 591－596.
[13]	Juul-Kristensen B, Schmedling K, Rombaut L, et al. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-a systematic review[J]. Am J Med Genet C Semin Med Genet, 2017, 175(1): 116－147.
[14]	Ahlqvist K, Bjelland EK, Pingel R, et al. The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study[J/OL]. BMC Musculoskelet Disord, 2020, 21(1): 474. DOI: 10.1186/s12891-020-03486-w.
[15]	Seçkin U, Tur BS, Yilmaz O, et al. The prevalence of joint hypermobility among high school students[J]. Rheumatol Int, 2005, 25(4): 260－263.
[16]	Russek LN, Errico DM. Prevalence, injury rate and, symptom frequency in generalized joint laxity and joint hypermobility syndrome in a "healthy" college population[J]. Clin Rheumatol, 2016, 35(4): 1029－1039.
[17]	Zhong G, Zeng X, Xie Y, et al. Prevalence and dynamic characteristics of generalized joint hypermobility in college students[J]. Gait Posture, 2021, 84: 254－259.
[18]	Eston RG, Mickleborough J, Baltzopoulos V. Eccentric activation and muscle damage: biomechanical and physiological considerations during downhill running[J]. Br J Sports Med, 1995, 29(2): 89－94.
[19]	Abdelraouf OR, Abdel-Aziem AA. Ankle and foot mechanics in individuals with chronic ankle instability during shod walking and barefoot walking: a cross-sectional study[J]. Chin J Traumatol, 2021, 24(3): 174－179.
[20]	Tsai TY, Li JS, Wang S, et al. In-vivo 6 degrees-of-freedom kinematics of metal-on-polyethylene total hip arthroplasty during gait[J]. J Biomech, 2014, 47(7): 1572－1576.
[21]	Yim JH, Seon JK, Kim YK, et al. Anterior translation and rotational stability of anterior cruciate ligament-deficient knees during walking: speed and turning direction[J]. J Orthop Sci, 2015, 20(1): 155－162.
[22]	Park SK, Jeon HM, Lam WK, et al. The effects of downhill slope on kinematics and kinetics of the lower extremity joints during running[J]. Gait Posture, 2019, 68: 181－186.
[23]	Simonsen EB, Tegner H, Alkjær T, et al. Gait analysis of adults with generalised joint hypermobility[J]. Clin Biomech (Bristol, Avon), 2012, 27(6): 573－577.
[24]	Flowers PPE, Cleveland RJ, Schwartz TA, et al. Association between general joint hypermobility and knee, hip, and lumbar spine osteoarthritis by race: a cross-sectional study[J/OL]. Arthritis Res Ther, 2018, 20(1): 76. DOI: 10.1186/s13075-018-1570-7.
[25]	Golightly YM, Hannan MT, Nelson AE, et al. Relationship of joint hypermobility with ankle and foot radiographic osteoarthritis and symptoms in a community-based cohort[J]. Arthritis Care Res (Hoboken), 2019, 71(4): 538－544.
[26]	Grant AD. Gait Analysis: normal and pathological function[M]. Amsterdam: Elsevier, 2010: 180.
[27]	钟国庆，曾小龙，谢宇，等. 全身关节过度活动患者步行时膝关节步态图特征[J/CD]. 中华关节外科杂志(电子版), 2020, 14(1): 33－39.
[28]	Grahame R. Joint hypermobility and genetic collagen disorders: are they related？[J]. Arch Dis Child, 1999, 80(2): 188－191.
[29]	Clinch J, Deere K, Sayers A, et al. Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation[J]. Arthritis Rheum, 2011, 63(9): 2819－2827.
[30]	Ewertowska P, Trzaskoma Z, Sitarski D, et al. Muscle strength, muscle power and body composition in college-aged young women and men with generalized joint hypermobility[J/OL]. PLoS One, 2020, 15(7): e0236266. DOI: 10.1371/journal.pone.0236266.
[31]	Jansson A, Saartok T, Werner S, et al. General joint laxity in 1845 Swedish school children of different ages: age- and gender-specific distributions[J]. Acta Paediatr, 2004, 93(9): 1202－1206.
[32]	Brown SP, Miller WC, Eason JM. Exercise physiology: Basis of human movement in health and disease[M]. Philadelphia: Lippincott Williams & Wilkins, 2006.
[33]	Ferrell WR, Tennant N, Sturrock RD, et al. Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility syndrome[J]. Arthritis Rheum, 2004, 50(10): 3323－3328.
[34]	Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility[J]. Rheumatol Int, 2021, 41(10): 1707－1716.
[35]	Rigoldi C, Galli M, Cimolin V, et al. Gait strategy in patients with Ehlers-Danlos syndrome hypermobility type and Down syndrome[J]. Res Dev Disabil, 2012, 33(5): 1437－1442.
[36]	Galli M, Cimolin V, Rigoldi C, et al. Gait strategy in patients with Ehlers-Danlos syndrome hypermobility type: a kinematic and kinetic evaluation using 3D gait analysis[J]. Res Dev Disabil, 2011, 32(5): 1663－1668.
[37]	Schmid S, Luder G, Mueller Mebes C, et al. Neuromechanical gait adaptations in women with joint hypermobility—an exploratory study[J]. Clin Biomech (Bristol, Avon), 2013, 28(9－10): 1020－1025.
[38]	de Noronha M, Refshauge KM, Herbert RD, et al. Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain？[J]. Br J Sports Med, 2006, 40(10): 824－828；discussion 828.
[39]	Foss KD, Ford KR, Myer GD, et al. Generalized joint laxity associated with increased medial foot loading in female athletes[J]. J Athl Train, 2009, 44(4): 356－362.
[40]	Stettler M, Luder G, Schmid S, et al. Passive anterior tibial translation in women with and without joint hypermobility: an exploratory study[J]. Int J Rheum Dis, 2018, 21(10): 1756－1762.
[41]	Armstrong R. Relative joint contribution to joint hypermobility in rugby players, netballers and dancers: the need for careful consideration of lumbar flexion[J]. Int J Sports Phys Ther, 2018, 13(4): 676－686.
[42]	Graf C, Schierz O, Steinke H, et al. Sex hormones in association with general joint laxity and hypermobility in the temporomandibular joint in adolescents-results of the epidemiologic LIFE child study[J]. J Oral Rehabil, 2019, 46(11): 1023－1030.
[43]	Daman M, Shiravani F, Hemmati L, et al. The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: a randomized clinical trial[J]. J Bodyw Mov Ther, 2019, 23(1): 202－205.
[44]	Pacey V, Adams RD, Tofts L, et al. Proprioceptive acuity into knee hypermobile range in children with joint hypermobility syndrome[J/OL]. Pediatr Rheumatol Online J, 2014, 12: 40. DOI: 10.1186/1546-0096-12-40.

组别Group	例数Case number	性别Gender[男/女，例(%)][male/female，number (%)]	年龄Age[岁，(±s)]	身高Hight[cm，(±s)]	体重Weight[kg，(±s)]	BMI[kg /m², (±s)]
对照组Nonrmal group	33	25(83.3)/ 20(41.7)	20.3±1.7	167.5±7.4	59.5±10.6	21.1±2.9
GJH组GJH group	45	5(16.7)/ 28(58.3)	20.2±1.7	163.4±6.5	55.1±11.4	20.5±2.9
统计值		χ²＝13.131	t＝0.254	t＝－2.593	t＝1.755	t＝0.926
P值		<0.001	>0.05	0.011	>0.05	>0.05

组别Group	例数Case number	性别Gender[男/女，例(%)][male/female，number (%)]	年龄Age[岁，(±s)]	身高Hight[cm，(±s)]	体重Weight[kg，(±s)]	BMI[kg /m², (±s)]
对照组Nonrmal group	33	25(83.3)/ 20(41.7)	20.3±1.7	167.5±7.4	59.5±10.6	21.1±2.9
GJH组GJH group	45	5(16.7)/ 28(58.3)	20.2±1.7	163.4±6.5	55.1±11.4	20.5±2.9
统计值		χ²＝13.131	t＝0.254	t＝－2.593	t＝1.755	t＝0.926
P值		<0.001	>0.05	0.011	>0.05	>0.05

组别Group	例数Case number	最大跖屈角度(68%)Maximum plantar flexion angle at 68% of the gait cycle[°，(±s)]	承重反应期(9%)内外旋角度Internal/external rotation angle at loading response period (9%)[°，(±s)]	摆动相早期(67%)内翻外翻角度Eversion/inversion angle at initial swing phase (67%)[°，(±s)]	屈伸活动范围Range of dorsiextension/plantar flexion angle [°，M(P₂₅，P₇₅)]	前后位移活动范围Range of anterior/posterior displacement[mm，M(P₂₅，P₇₅)]	远近位移活动范围Range of proximal/distal displacement [mm，M(P₂₅，P₇₅)]	内外位移活动范围Range of medical/lateral displacement [mm，M(P₂₅，P₇₅)]
GJH组GJH group	33	－33.33±11.10	－2.84±6.18	－5.59±8.40	－11.18(－14.80，－5.38)	－4.26(－5.23，－3.74)	4.92(2.81，6.00)	0.93(0.52，1.30)
正常组Nonrmal group	45	－31.73±18.21	－0.04±5.93	－7.09±7.94	－9.85(－13.61，－4.03)	－6.74(－8.14，－5.70)	4.47(1.93，6.11)	0.61(0.11，0.81)
统计值		t＝0.448	t＝2.028	t＝0.802	Z＝2.292	Z＝7.748	Z＝0.828	Z＝5.104
P值		>0.05	0.046	>0.05	0.022	<0.001	>0.05	<0. 001

组别Group	例数Case number	最大跖屈角度(68%)Maximum plantar flexion angle at 68% of the gait cycle[°，(±s)]	承重反应期(9%)内外旋角度Internal/external rotation angle at loading response period (9%)[°，(±s)]	摆动相早期(67%)内翻外翻角度Eversion/inversion angle at initial swing phase (67%)[°，(±s)]	屈伸活动范围Range of dorsiextension/plantar flexion angle [°，M(P₂₅，P₇₅)]	前后位移活动范围Range of anterior/posterior displacement[mm，M(P₂₅，P₇₅)]	远近位移活动范围Range of proximal/distal displacement [mm，M(P₂₅，P₇₅)]	内外位移活动范围Range of medical/lateral displacement [mm，M(P₂₅，P₇₅)]
GJH组GJH group	33	－33.33±11.10	－2.84±6.18	－5.59±8.40	－11.18(－14.80，－5.38)	－4.26(－5.23，－3.74)	4.92(2.81，6.00)	0.93(0.52，1.30)
正常组Nonrmal group	45	－31.73±18.21	－0.04±5.93	－7.09±7.94	－9.85(－13.61，－4.03)	－6.74(－8.14，－5.70)	4.47(1.93，6.11)	0.61(0.11，0.81)
统计值		t＝0.448	t＝2.028	t＝0.802	Z＝2.292	Z＝7.748	Z＝0.828	Z＝5.104
P值		>0.05	0.046	>0.05	0.022	<0.001	>0.05	<0. 001

组别Group	例数Case number	初始着地期(2%)的屈伸角度Dorsiflexion/plantarflexion angle at the initial contact stage (2%)[°，(±s)]	承重反应期(9%)内外旋角度Internal/external rotation angle at loading response period (9%) [°，(±s)]	摆动相早期(67%)内翻外翻角度Eversion/inversion angle at initial swing phase (67%) [°，(±s)]	屈伸活动范围Range of dorsiextension/plantarflexion angle[°，M(P₂₅，P₇₅)]	前后位移活动范围Range of anterior/posterior displacement[mm，M(P₂₅，P₇₅)]	远近位移活动范围Range of proximal/distal displacement[mm，M(P₂₅，P₇₅)]	内外位移活动范围Range of medial/lateral displacement[mm，M(P₂₅，P₇₅)]
GJH组GJH group	33	－28.19±9.23	－7.72±4.82	－6.67±9.23	－19.97(－24.98，－16.33)	－7.18(－8.06, －6.32)	2.47(0.24，4.00)	2.22(1.31，2.51)
正常组Nonrmal group	45	－32.92±9.90	－5.03±6.26	－8.28±8.91	－21.68(－26.49，－16.91)	－8.41(－10.01，－6.97)	2.98(0.08，4.49)	1.12(0.75，1.40)
统计值		t＝2.119	t＝2.057	t＝0.777	Z＝1.752	Z＝4.183	Z＝0.596	Z＝7.650
P值		0.037	0.043	>0.05	>0.05	<0.001	>0.05	<0.001

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