Plane Dependent Subject-Specific Neuromuscular Training for Knee Rehabilitation

Song Joo Lee, Yupeng Ren, Alison H. Chang, Joel M Press, Marc C. Hochberg, Li-Qun Zhang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Knee injuries at risk of post-traumatic knee osteoarthritis (PTOA) and knee osteoarthritis (OA) are closely associated with knee transverse plane and/or frontal plane instability and excessive loading. However, most existing training and rehabilitation devices involve mainly movements in the sagittal plane. An offaxis elliptical training system was developed to train and evaluate neuromuscular control about the off-axes (knee varus/valgus and tibial rotation) as well as the main flexion/extension axis (sagittal movements). Effects of the offaxis elliptical training system in improving either transverse or frontal neuromuscular control depending on subjects' need (Pivoting group, Sliding group) were demonstrated through 6-week subject-specific neuromuscular training in subjects with knee injuries at risk of PTOA or medial knee osteoarthritis. The combined pivoting and sliding group, named as offxis group demonstrated significant reduction in pivoting instability, minimum pivoting angle, and sliding instability. The pivoting group showed more reduction in pivoting instability, maximum and minimum pivoting angle than the sliding group. On the other hand, the sliding group showed more reduction in sliding instability, maximum and minimum sliding distance than the pivoting group. Based on these findings, the offaxis elliptical trainer system can potentially be used as a therapeutic and research tool to train human subjects for plane-dependent improvements in their neuromuscular control during functional weight-bearing stepping movements.

Original languageEnglish (US)
Article number9126858
Pages (from-to)1876-1883
Number of pages8
JournalIEEE Transactions on Neural Systems and Rehabilitation Engineering
Issue number8
StatePublished - Aug 2020


  • ACL injuries
  • degenerative knee disease
  • multiaxis neuromuscular control
  • therapeutic intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Neuroscience(all)
  • Biomedical Engineering

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