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Sample records for anterior knee pain

  1. Anterior knee pain

    Science.gov (United States)

    ... thighbone where the kneecap normally rests is too shallow. You have flat feet. Anterior knee pain is ... the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should ...

  2. Evaluating anterior knee pain.

    Science.gov (United States)

    Hong, Engene; Kraft, Michael C

    2014-07-01

    Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    LLopis, Eva [Hospital de la Ribera, Alzira, Valencia (Spain) and Carretera de Corbera km 1, 46600 Alzira Valencia (Spain)]. E-mail: ellopis@hospital-ribera.com; Padron, Mario [Clinica Cemtro, Ventisquero de la Condesa no. 42, 28035 Madrid (Spain)]. E-mail: mario.padron@clinicacemtro.com

    2007-04-15

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  4. Anterior Knee Pain (Chondromalacia Patellae).

    Science.gov (United States)

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  5. MRI of anterior knee pain.

    Science.gov (United States)

    Samim, Mohammad; Smitaman, Edward; Lawrence, David; Moukaddam, Hicham

    2014-07-01

    Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

  6. Chronic anterior knee pain in athletes: Common causes ...

    African Journals Online (AJOL)

    Anterior knee pain is a very common clinical presentation. In this article, the classification of anterior knee pain syndromes according to the anatomy of the knee extensor mechanism is described. The clinical diagnosis, special investigations, and principles of management of the more common causes of anterior knee pain ...

  7. Anterior knee pain after total knee arthroplasty: a narrative review.

    Science.gov (United States)

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

  8. Quadriceps strength and anterior knee pain following tibia ...

    African Journals Online (AJOL)

    The tension generated on extension of the knee against a resistance using tensiometer was measured in Newton. ... There was no statistically significant relationship between the force of tension (N) generated in the extensor in patients with anterior knee pain compared with those without knee pain (158.43 ± 49.35, 189.54 ...

  9. Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Niki, Yasuo; Hakozaki, Akihiro; Iwamoto, Wataru; Kanagawa, Hiroya; Matsumoto, Hideo; Toyama, Yoshiaki; Suda, Yasunori

    2012-08-01

    The purpose of this study was to evaluate the prevalence of anterior knee pain in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and to identify critical factors affecting postoperative anterior knee pain development. Subjects comprised 171 patients (171 knees) who underwent anatomic double-bundle ACL reconstruction with a follow-up period of ≥2 years. The procedure used bone-patellar tendon-bone plus gracilis tendon (BTB-G) in 56 knees, semitendinosus tendon (ST) in 71 knees, and ST-G in 44 knees. Clinical results and prevalence and severity of anterior knee pain were assessed at 3 months and 2 years postoperatively. Clinical variables influencing anterior knee pain development at each postoperative period were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. Overall prevalences of anterior knee pain at 3 months and 2 years postoperatively were 42.0 and 11.1%, respectively. Use of BTB-G graft represented the highest prevalence of anterior knee pain between the 3 different grafts (P = 0.001); however, this statistical significance disappeared at 2 years postoperatively. Prevalence of postoperative extension deficit was significantly higher in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 3 months postoperatively. Level of quadriceps strength was significantly lower, and Lysholm score was significantly worse in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 2 years postoperatively. According to logistic regression analysis, knee extension deficit was a predisposing factor for the development of anterior knee pain at 3 months postoperatively (odds ratio, 2.76; P = 0.004); however, there was no significant predisposing factor for anterior knee pain at 2 years postoperatively. Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early

  10. A censervative programme for treatment of anterior knee pain in ...

    African Journals Online (AJOL)

    week conservative rehabilitation programme in addressing anterior knee pain in adolescents. Design. Subjects were randomly allocated to a control group (N=12) and an experimental group (N=18). The experimental group was subjected to a ...

  11. Anterior knee pain in patients with cerebral palsy.

    Science.gov (United States)

    Choi, Young; Lee, Sang Hyeong; Chung, Chin Youb; Park, Moon Seok; Lee, Kyoung Min; Sung, Ki Hyuk; Won, Sung Hun; Lee, In Hyeok; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon; Lee, Seung Yeol

    2014-12-01

    The aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy. This prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation. Seventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) ≤ 3, 9 patients showed 3 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98). Approximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting.

  12. [Progress on prevention for anterior knee pain after primary total knee arthroplasty].

    Science.gov (United States)

    Gao, Yao-Zu; Chen, Chong-Wei; Wei, Xiao-Chun

    2014-04-01

    Total knee arthroplasty (TKA) identified as an effective treatment for ultimate knee joint disease can effectively relieve pain, correct deformity, improve knee function and enhance the quality of life of patients. Patient satisfaction has been increasingly considered as an important factor in evaluating the success of primary TKA. Anterior knee pain that usually appears in the region of the anterior knee is a recognized complaint for primary TKA and has a strong impact on the improvement of knee function and patient satisfaction of primary TKA. Accordingly, the relief of anterior knee pain has become one of the primary goals of primary TKA. At present, soft tissue lesions around the patellar caused by patellar maltracking and the elevation of internal pressure in subchondral bone because of the high contact stress of patellofemoral joint are both considered as the mechanism of anterior knee pain. For the past few years,on increasing number of studies have focused on the prevention of anterior knee pain following primary TKA. However, none of the past treatment such as patellar resurfacing, patellar denervation without patellar resurfacing or a mobile-bearing prosthesis has a good and affirmative effect on it. The prevention and treatment of anterior knee pain following primary TKA still is a difficult solved problem. To address this problem, we need further researches about the cause of anterior knee pain, knee joint prosthesis and biomechanics of patellofemoral joint, as well as lots of randomized controlled trials.

  13. Holistic approach to understanding anterior knee pain. Clinical implications.

    Science.gov (United States)

    Sanchis-Alfonso, Vicente

    2014-10-01

    Anterior knee pain is one of the most frequent reasons for consultation within knee conditions. The aetiology is not well known, which explains the sometimes unpredictable results of its treatment. Normally, when we see a patient in the office with anterior knee pain, we only study and focus on the knee. If we do this, we are making a big mistake. We must not forget to evaluate the pelvis and proximal femur, as well as the psychological factors that modulate the course of the illness. Both the pelvifemoral dysfunction as well as the psychological factors (anxiety, depression, catastrophization and kinesiophobia) must be included in our therapeutic targets of the multidisciplinary treatment of anterior knee pain. We must not only focus on the knee, we must remember to "look up" to fully understand what is happening and be able to solve this difficult problem. The aetiology of anterior knee pain is multifactorial. Therefore, diagnosis and treatment of patellofemoral disorders must be individualized. Our findings stress the importance of tailoring physiotherapy, surgery and psycho-educational interventions to each patient.

  14. Anterior knee pain: an update of physical therapy.

    Science.gov (United States)

    Werner, Suzanne

    2014-10-01

    Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.

  15. Imaging assessment of anterior knee pain and patellar maltracking

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    McNally, E.G. [Nuffield Orthopaedic Centre, Oxford (United Kingdom)

    2001-09-01

    Anterior knee pain is a common complaint in the orthopaedic clinic. The differential diagnosis is wide and the principal goal of initial assessment is to detect remediable causes. The majority of patients do not have a specific disease and increasingly interest has focused on the role of patello-femoro-tibial morphology and of patellar maltracking in the aetiology of anterior knee pain. Classification in this group of patients is poor and there is no uniform agreement on which patient groups benefit from treatment and which treatment is best. Much of the literature involves relatively small numbers of patients, is poorly controlled and there is little agreement on outcome measures [1, 2]. The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking. (orig.)

  16. MR imaging of anterior knee pain: a pictorial essay.

    Science.gov (United States)

    Skiadas, Vasilios; Perdikakis, Evangelos; Plotas, Athanasios; Lahanis, Stefanos

    2013-02-01

    Anterior knee pathology is a frequent cause of joint pain and limitation of function and mobility among patients presenting to an orthopaedic department. Proper recognition and treatment of pathologic conditions depend on the knowledge of normal anatomy and of the various abnormalities, which affect this area of the knee and may present with anterior knee pain. A broad array of benign and malignant processes may be manifested as anterior knee discomfort, and this common clinical entity is among the most frequent indications for MR imaging of the lower extremities. Clinical history and physical examination are also of paramount importance. The disorders can be categorized and differentiated primarily according to their location. Traumatic or non-traumatic disorders of the patella, patellar retinacula, quadriceps and patellar tendons and supra or infrapatellar fat pad can be the source of symptoms. This article includes a comprehensive pictorial essay of the characteristic MR features of common and uncommon disorders causing anterior knee pain. For accurate assessment of the aforementioned clinical problem, a radiologist should be able to identify typical MR imaging patterns that contribute in establishing the correct diagnosis and thus tailoring the appropriate therapy. Level of evidence IV.

  17. Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty

    NARCIS (Netherlands)

    Kievit, Arthur J.; Breugem, Stefan J. M.; Sierevelt, Inger N.; Heesterbeek, Petra J. C.; van de Groes, Sebastiaan A. W.; Kremers, Keetie C. A. L. C.; Koëter, Sander; Haverkamp, Daniel

    2013-01-01

    To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect. After standard forward and backward

  18. A conservative programme for treatment of anterior knee pain in ...

    African Journals Online (AJOL)

    gramme in addressing anterior knee pain in adolescents. Design. Subjects were randomly allocated to a control group. (N=12) and an experimental group (N=18). The experimental group was subjected to a 2½-week strength, flexibility and neuromuscular rehabilitation programme. Both groups were tested before and after ...

  19. Differences in gait pattern parameters between medial and anterior knee pain in patients with osteoarthritis of the knee.

    Science.gov (United States)

    Debi, Ronen; Mor, Amit; Segal, Ganit; Debbi, Eytan M; Cohen, Marc S; Igolnikov, Ilya; Bar Ziv, Yaron; Benkovich, Vadim; Bernfeld, Benjamin; Rozen, Nimrod; Elbaz, Avi

    2012-07-01

    Patients with osteoarthritis of the knee have unique spatiotemporal gait alterations. These gait changes have not yet been differentiated according to the location of knee pain. The purpose of this study was to compare the gait patterns of patients with symptomatic knee osteoarthritis that exhibit either anterior or medial joint pain. 240 Patients with knee osteoarthritis were evaluated at one therapy center. Patients were divided into two groups according to the location of greatest pain in their worse knee. Patients underwent a computerized spatiotemporal gait analysis. Differences in gait patterns between the two knee pain locations were also examined within each gender. Compared with patients with pain in the anterior knee compartment, those with pain in the medial knee compartment exhibited a significantly slower walking speed (Panterior knee pain. Furthermore, gender differences in gait may exist between patients with medial knee pain compared to patients with anterior knee pain. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    OpenAIRE

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 p...

  1. Anterior knee pain after unreamed intramedullary nailing of the tibia

    Directory of Open Access Journals (Sweden)

    Hossein Fanian

    2008-10-01

    Full Text Available

    • BACKGROUND: Tibial shaft fracture is the most common type of long bone fractures, and intramedullary nailing is the treatment of choice. Anterior knee pain (AKP is the most common complication of tibial nailing. The exact etiology of AKP is unknown, and the reported incidence is between 10-86%. Since many activities of daily living of Iranians need kneeling, squatting, and tailor position, knee pain can effectively limit these activities. We decided to evaluate knee pain in patients with tibial shaft fractures treated with unreamed intramedullary nailing in our hospital.
    • METHODS: We evaluated 232 patients between 16-77 year-old with tibial shaft fractures treated with intramedullary nailing from 2005 to 2007 with six months follow up period.
    • RESULTS: According to visual analogue scale (0-10, 165 (71.1% patients had no pain. Anterior knee pain was mild in 54 (28.9% cases; 12 (5.2% cases had moderate pain, and one patient (0.4% experienced severe pain. The most severe pain was felt in kneeling position and the mildest pain was felt in resting position.
    • CONCLUSIONS: The incidence of moderate to severe AKP in patients who had intramedullary nailing for tibial shaft fractures was relatively low. In view of medicolegal litigation, patients should be aware of this complication.
    • KEYWORDS: Tibia, fracture, knee pain, trauma, internal fixation.

  2. Anterior knee pain in the young athlete: diagnosis and treatment.

    Science.gov (United States)

    Kodali, Pradeep; Islam, Andrew; Andrish, Jack

    2011-03-01

    The underlying etiology of anterior knee pain has been extensively studied. Despite many possible causes, often times the diagnosis is elusive. The most common causes in the young athlete are osteosynchondroses, patellar peritendinitis and tendinosis, synovial impingement, malalignment, and patellar instability. Less common causes are osteochondritis dissecans and tumors. It is always important to rule out underlying hip pathology and infections. When a diagnosis cannot be established, the patient is usually labeled as having idiopathic anterior knee pain. A careful history and physical examination can point to the correct diagnosis in the majority of cases. For most of these conditions, treatment is typically nonoperative with surgery reserved for refractory pain for an established diagnosis.

  3. [Anterior knee pain after total knee arthroplasty : Causes, diagnosis and treatment].

    Science.gov (United States)

    Michalik, R; Rath, B; Springorum, H-R; Lüring, C; Tingart, M

    2016-05-01

    Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies. The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain. Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants. Instability, increased contact pressure in the patellofemoral joint and patella maltracking due to malrotation of components, offset errors, ligament insufficiencies or patella baja are mechanical reasons for anterior knee pain. Functional causes include pathologic gait patterns, quadriceps imbalance and dynamic valgus. They have to be differentiated from infectious and inflammatory causes as well as soft tissue impingement, arthrofibrosis and neurologic diseases. A differentiated treatment algorithm is recommended. Often conservative treatment options exist, however, particularly with most mechanical causes revision surgery is necessary.

  4. Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

    Science.gov (United States)

    Kohl, Sandro; Evangelopoulos, Dimitrios S; Hartel, Maximilian; Kohlhof, Hendrik; Roeder, Christoph; Eggli, Stefan

    2011-09-01

    Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n = 34) with no pain or discomfort (NRS range 0-4) and group B (n = 16) with anterior knee pain (NRS range 5-10). Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P anterior knee pain (mean NRS 7.1 ± 1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1 ± 2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7 ± 0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5 ± 1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5 ± 1.4 preoperatively to NRS 0.4 ± 1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on

  5. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain.

    Science.gov (United States)

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment.

  6. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    Directory of Open Access Journals (Sweden)

    Vicente Sanchis-Alfonso

    2015-01-01

    Full Text Available Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS, knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS. Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS. Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment.

  7. The Effect of Patellar Taping on Squat Depth and the Perception of Pain in People with Anterior Knee Pain

    OpenAIRE

    Clifford, Amanda M.; Harrington, Elaine

    2013-01-01

    peer-reviewed Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squa...

  8. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain

    OpenAIRE

    Lee, Paul Yuh Feng; Nixion, Amy; Chandratreya, Amit; Murray, Judith M.

    2017-01-01

    Synovial plica syndrome (SPS) occurs in the knee, when an otherwise normal structure becomes a source of pain due to injury or overuse. Patients may present to general practitioners, physiotherapists, or surgeons with anterior knee pain with or without mechanical symptoms, and the diagnosis can sometimes be difficult. Several studies have examined the epidemiology, diagnosis, and treatment of SPS. We review these resources to provide an evidence-based guide to the diagnosis and treatment of S...

  9. Knee kinetic pattern during gait and anterior knee pain before and after rehabilitation in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Claudon, B; Poussel, M; Billon-Grumillier, C; Beyaert, C; Paysant, J

    2012-05-01

    Patellofemoral pain is likely due to compressive force acting on the patella related in turn to knee extension moment. The latter variable was assumed to be (i) reduced during short-distance free walking in case of patellofemoral pain syndrome and (ii) increased after therapeutic pain reduction. Peak knee extension moment at beginning of stance phase was recorded by three-dimensional gait analysis in 22 controls and in 23 patients with patellofemoral pain syndrome before and after rehabilitation of knee extensors and flexors to reduce the pain. Pain would occur mainly in stressful activities such as stair negotiation or squatting and was quantified by the anterior knee pain scale. Peak knee extension moment was significantly reduced in all the patients before treatment (n=23) compared to controls, although no one had pain during free walking. In the 17 patients who experienced significant post-rehabilitation pain reduction in their stressful activities, the peak knee extension moment was significantly reduced before treatment compared to controls and significantly increased after treatment, reaching values similar to control values. The peak knee extension moment during free walking appears to be a good kinetic variable related to a compensatory mechanism limiting or avoiding anterior knee pain and may be of interest in assessing knee dynamics alteration in patients with PFPS. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Incidence of non-traumatic anterior knee pain among 11 - 17-year-olds

    African Journals Online (AJOL)

    active individuals, especially adolescent girls.7,15,27 During the adolescent phase the knee structure becomes compromised which predisposes it to injury. This, combined with the added stress during sport participation, could account for the higher incidence of anterior knee pain. Conclusion. Anterior knee pain is common ...

  11. Flexion and anterior knee pain after high flexion posterior stabilized or cruciate retaining knee replacement.

    Science.gov (United States)

    van de Groes, Sebastiaan; van der Ven, Paul; Kremers-van de Hei, Keetie; Koëter, Sander; Verdonschot, Nico

    2015-12-01

    Special high-flexion prosthetic designs show a small increase in postoperative flexion compared to standard designs and some papers show increased anterior knee pain with these prosthesis. A prospective double blind randomized controlled trial investigates the difference in flexion and anterior knee pain between standard and high-flexion total knee arthroplasty. In total 47 patients were randomly allocated to a standard cruciate retaining fixed bearing design (CR) in 23 patients and to a high-flexion posterior stabilized mobile bearing design (HF-PS) in 24 patients. The HF-PS did show a significantly higher passive postoperative flexion; 120.8° (SD 10.3°) vs. 112.0° (SD 9.5°) for the CR group (p = 0.004). The active postoperative flexion, VAS-pain score and Feller score did not show significant differences between both groups. Sub analysis with the HF-PS group showed a higher VAS-pain for the patients achieving ≥130° of flexion; 30.5 (SD 32.2) vs. 12.2 (SD 12.5) (p = 0.16). The present study showed a significant higher passive flexion in the high-flexion prosthesis compared to the standard prosthesis. However this difference disappeared when comparing active flexion. No difference in anterior knee pain was found between both groups.

  12. The contemporary management of anterior knee pain and patellofemoral instability.

    Science.gov (United States)

    Smith, Toby O; McNamara, Iain; Donell, Simon T

    2013-09-01

    In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. The key to managing these patients is by improving muscle function, the patient losing weight (if overweight), and judicious use of analgesics if pain is an important feature. Hypermobility syndrome should always be looked for since this is a prognostic indicator for a poor operative outcome. Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. Clinical Rehabilitation of Anterior Knee Pain: Current Concepts.

    Science.gov (United States)

    Hiemstra, Laurie A; Kerslake, Sarah; Arendt, Elizabeth A

    Rehabilitation is the hallmark of the nonoperative treatment of anterior knee pain (AKP). Whether a patient has had appropriate rehabilitation can be assessed in the office with a selection of basic and advanced screening tests. Most important, providing specific instructions in your referral to a therapist skilled in treating patients with AKP can ensure that any identified deficits are appropriately addressed. The etiology of AKP is multifactorial. Whatever its "cause," AKP alters neuromuscular function, and correcting these altered body movement patterns will benefit the patient. Understanding how to assess and guide treatment of neuromuscular deficits in this population is essential for managing care and optimizing outcomes. In this article, factors associated with the diminished neuromuscular control seen in AKP are reviewed, appropriate rehabilitation concepts are discussed, and practical strategies are provided that can aid in identifying neuromuscular deficits and the need for further rehabilitation.

  14. ANTERIOR KNEE PAIN AND LOWER EXTREMITY FUNCTIONS IN INDIAN ADOLESCENT POPULATION

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    Riddhi Shroff

    2016-01-01

    Full Text Available Background & Purpose - Anterior knee pain is one of the most common musculoskeletal complain seen in Indian adolescent population with high incidence among those who are active in sports and recreation. The purpose of this study was to investigate the age of onset of anterior knee pain, to find its effect on sports participation and also to find the activities which are maximally affected due to anterior knee pain in Indian population. Method- A questionnaire based survey was conducted among 50 subjects using three outcome measures namely self made demographic questionnaire, anterior knee pain scale and lower extremity functional scale. Result- Maximally affected activities are running, jumping & squatting and maximally affected functions are squatting, running on uneven ground, making sharp turns while running and hopping with increase incidence of anterior knee pain among those who participate daily in sports. Conclusion- The study concluded, that in adolescent age group of 11-17 years, anterior knee pain is more prevalent in adolescent girls with the age of onset being around 13 years for girls & 14.5 years in boys and it also showed moderate positive correlation between anterior knee pain and lower extremity functions.

  15. Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty.

    Science.gov (United States)

    Kievit, Arthur J; Breugem, Stefan J M; Sierevelt, Inger N; Heesterbeek, Petra J C; van de Groes, Sebastiaan A W; Kremers, Keetie C A L C; Koëter, Sander; Haverkamp, Daniel

    2013-11-01

    To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect. After standard forward and backward translation was performed, 302 patients who have received a TKA or UKA filled out the AKPS together with Hospital for Special Surgery (HSS) patella score, visual analogue score (VAS) for pain, the Oxford 12-item questionnaire and the SF-36 at follow-up. The internal consistency was tested using Cronbach's α coefficient. The construct validity was assessed using Spearman's rank correlation (R) to test for correlations between the AKPS and VAS HSS, HSS patella score, VAS month, Oxford 12-item questionnaire and SF-36 subscales. Ceiling or floor effects are given in percentage of patients giving a maximum or minimum score. The internal reliability of the AKPS is acceptable with a Cronbach's α of 0.81 in patients after TKA or UKA. A high correlation was found between the AKPS and the Oxford 12-item questionnaire (R = 0.81). Moderate correlations were found with the VAS month (R = 0.63), HSS patella score (R = 0.51) and SF-36 subscales physical functioning (R = 0.59), role-physical (R = 0.59), bodily pain (R = 0.57). Other correlations were poor, therefore indicating a good convergent and divergent validity. Ceiling effects were observed for the HSS patella score (31 %), VAS HSS (51 %), VAS pain (19 %), SF36-RP (46 %), SF36-RE (80 %) and SF36-BP (24 %). No ceiling or floor effect was found for the AKPS, Oxford 12-item and the other SF36 domains. The AKPS appears to be reliable and valid in patients after knee arthroplasty, with no ceiling and floor effects, and can be used to assess anterior knee pain in patient who underwent joint replacement surgery.

  16. Anterior knee pain caused by patellofemoral pain syndrome can be relieved by Botulinum toxin type A injection.

    Science.gov (United States)

    Chen, John Tzu-Ning; Tang, Alice Chu-Wen; Lin, Shih-Cherng; Tang, Simon Fuk-Tan

    2015-02-01

    To investigate the therapeutic effects of Botulinum toxin type A (BTA) for anterior knee pain caused by patellofemoral pain syndrome (PFPS). Prospective case control study for intervention. A tertiary hospital rehabilitation center. Twelve bilateral PFPS patients with anterior knee pain were recruited. The worse pain knee was selected for injection, and the counterpart was left untreated. Injection of BTA to vastus lateralis (VL) muscle. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and functional status of the knee, and CYBEX isokinetic dynamometer to assess isokinetic muscle force before and after BTA application to VL. Remarkable improvement after receiving BTA injection was obtained not only in the questionnaire of WOMAC (pknee flexion torque (pknee extension torque was noted (p=0.682). BTA injection is a good alternative treatment to improve anterior knee pain, knee function and isokinetic flexion torque. © 2015 Elsevier B.V. All rights reserved.

  17. Knee pain

    Science.gov (United States)

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  18. Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain.

    Science.gov (United States)

    Erkocak, Omer Faruk; Altan, Egemen; Altintas, Murat; Turkmen, Faik; Aydin, Bahattin Kerem; Bayar, Ahmet

    2016-09-01

    Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.

  19. Influence of nail prominence and insertion point on anterior knee pain after tibial intramedullary nailing.

    Science.gov (United States)

    Chen, Chun-Yu; Lin, Kai-Cheng; Yang, Shan-Wei; Tarng, Yih-Wen; Hsu, Chien-Jen; Renn, Jenn-Huei

    2014-03-01

    Chronic anterior knee pain is the most common complication after tibial nail insertion. Its etiology remains unknown, and multifactorial sources have been suggested. The authors believe that nail prominence and the insertion point of the nail are important in the development of anterior knee pain. The purpose of this retrospective study was to evaluate the roles of the insertion point and nail prominence in anterior knee pain after tibial intramedullary nailing using a transtendinous approach and a common nail type. A total of 108 patients with tibial shaft fractures underwent reamed intramedullary nailing using a transtendinous approach between 2006 and 2009. Mean follow-up was 26.8±5.0 months. A visual analog scale (0-100) was used to estimate anterior knee pain severity while patients performed 7 activities retrospectively. Radiographic assessments, including nail prominence and insertion point, were performed. Sixty (55.6%) patients experienced knee pain (group P) and 48 (44.4%) did not (group N). Significant differences were not found between the groups with respect to demographics, nail diameters, or fracture classifications. Less superior and more anterior nail prominences in radiographic assessments were significantly associated with anterior knee pain. When the insertion point was over the bottom half of the anterior cortex, the influence of anterior nail prominence was more obvious. Nail removal resulted in diminished pain during the 7 assessed activities. Nail insertion should be over the bottom half of the anterior cortex, with minimal anterior nail prominence. If anterior knee pain occurs, removal of the nail should be considered. Copyright 2014, SLACK Incorporated.

  20. The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing.

    Science.gov (United States)

    Lee, Gun Woo; Lee, Sun-Mi; Jang, Soo-Jin; Son, Jung-Hwan

    2013-04-01

    Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing. A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change. There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees. As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.

  1. Diagnostic Differences for Anterior Knee Pain between Sexes in Adolescent Basketball Players

    Science.gov (United States)

    Foss, Kim D Barber; Myer, Gregory D; Magnussen, Robert A; Hewett, Timothy E

    2014-01-01

    Background The purpose of this study was to determine if there is a sex difference in the prevalence of specific patellofemoral disorders that cause anterior knee pain in adolescent basketball players undergoing pre-participation screening. Methods Setting Biomechanical Laboratory. Participants A total of 810 (688 female and 122 male) basketball players from a single county public school district. Main outcome measures Prior to the start of three consecutive basketball seasons, participants were evaluated for anterior knee pain. Testing consisted of completion of the Anterior Knee Pain Scale. Those with positive findings completed an IKDC form, a standardized history and a physician-administered physical examination. Results Anterior knee pain was noted in 410 of 1620 knees (25.3%). 26.6% of female knees and 18.0% of male knees were affected (pOsgood-Schlatter Disease (OSD) 2.5% (2.3% females; 4.1% males); and plica syndrome 2.3% (2.1% females; 3.3% males). The remaining diagnoses (trauma, fat pad syndrome, IT band and pes anserine bursitis) had a combined prevalence of 1.7% (1.9% females; 1.6% males). Conclusions PFD was significantly more common in females (p<0.05). Anterior knee pain was more common in adolescent female basketball players than in adolescent male basketball players. Level of Evidence Descriptive Laboratory Study. Level 1 PMID:25362859

  2. Anterior Knee Pain after Tibial Intra-medullary Nailing: Is it Predictable?

    OpenAIRE

    Soraganvi, PC; Anand-Kumar, BS; Rajagopalakrishnan, R; Praveen-Kumar, BA

    2016-01-01

    Introduction: Intramedullary nailing has been used frequently for the treatment of tibial diaphyseal fractures. Chronic anterior knee pain has been considered the most frequent post-operative complication of this technique. We investigated the relationship between anterior knee pain and position of nail tip in proximal tibia. Methods: 103 patients were selected among patients who underwent interlocking nailing in our institution. Patients with other factors that might ...

  3. Anterior Knee Pain after Tibial Intra-medullary Nailing: Is it Predictable?

    Directory of Open Access Journals (Sweden)

    Soraganvi PC

    2016-07-01

    Full Text Available Introduction: Intramedullary nailing has been used frequently for the treatment of tibial diaphyseal fractures. Chronic anterior knee pain has been considered the most frequent post-operative complication of this technique. We investigated the relationship between anterior knee pain and position of nail tip in proximal tibia. Methods: 103 patients were selected among patients who underwent interlocking nailing in our institution. Patients with other factors that might cause anterior knee pain were excluded. In all patients intramedullary nailing was done using transpatellar approach. The patients were evaluated in two groups, 42 patients had anterior knee pain (Group A, whereas 61 patients did not have pain (Group B. The distance from nail tip from tibial plateau was measured on lateral radiographs. Nail prominence from anterior tibial cortex was also measured. Results: The two groups were similar with respect to gender and follow up period. Out of 42 patients who had knee pain 21 (50% had nail tip within proximal third distance from plateau to tibial tuberosity. Twenty-four patients (42% among knee pain group had nail prominence of more than 5mm from anterior tibial cortex followed by 12 patients (29% within 5mm and 12 patients (29% nail tip buried within the anterior cortex. Conclusion: A greater incidence of knee pain was found when nail was prominent more than 5mm and when it is in the proximal third distance from tibial plateau to tuberosity. Patients should be aware of high incidence of knee pain when the nail tip is placed in proximal third and prominence of more than 5mm.

  4. Suprapatellar fat-pad mass effect: MRI findings and correlation with anterior knee pain.

    Science.gov (United States)

    Tsavalas, Nikolaos; Karantanas, Apostolos H

    2013-03-01

    The purpose of this study was to evaluate the MRI characteristics of the suprapatellar fat-pad, determine the prevalence and pattern of suprapatellar fat-pad edema, and correlate the findings with the presence of anterior knee pain, patellofemoral malalignment, and patellofemoral joint osteoarthritis. We retrospectively reviewed 879 consecutive knee MRI examinations of 843 patients for the presence of a suprapatellar fat-pad mass effect on the suprapatellar joint recess. The relative signal intensity and the maximum anteroposterior, craniocaudal, and oblique diameters of the suprapatellar fat-pad on sagittal fat-suppressed intermediate-weighted turbo spin-echo images were measured. Findings of anterior knee pain, patellofemoral malalignment, and patellofemoral joint osteoarthritis were also recorded. The Fisher exact, Mann-Whitney, and independent samples Student t tests and Spearman rank correlation coefficient were used for statistical analysis. The prevalence of suprapatellar fat-pad mass effect on the suprapatellar joint recess in our study population was 13.8%. The relative signal intensity (p anterior knee pain, patellofemoral malalignment, or patellofemoral joint osteoarthritis. Six patients with suprapatellar fat-pad edema had anterior knee pain. Suprapatellar fat-pad edema with a mass effect on the suprapatellar joint recess is a common finding at MRI examinations of the knee that is rarely associated with anterior knee pain.

  5. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

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    Jones, R.B. [Dept. of Physiology, School of Medicine, East Carolina Univ., Greenville, NC (United States); Bartlett, E.C. [Dept. of Surgery, School of Medicine, East Carolina Univ., Greenville, NC (United States); Vainright, J.R. [Dept. of Radiology, School of Medicine, East Carolina Univ., Greenville, NC (United States); Carrol, R.G. [Dept. of Physiology, School of Medicine, East Carolina Univ., Greenville, NC (United States)

    1995-10-01

    Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 {+-} 0.5 mm) than did the asymptomatic knee (9.0 {+-} 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 {+-} 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 {+-} 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment. (orig./MG)

  6. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

    International Nuclear Information System (INIS)

    Jones, R.B.; Bartlett, E.C.; Vainright, J.R.; Carrol, R.G.

    1995-01-01

    Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 ± 0.5 mm) than did the asymptomatic knee (9.0 ± 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 ± 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 ± 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment. (orig./MG)

  7. Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

    Science.gov (United States)

    Rio, E; Kidgell, D; Moseley, G L; Cook, J

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P knee pain may direct better treatment approaches. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. The effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain.

    Science.gov (United States)

    Telles, Gustavo; Cristovão, Delmany R; Belache, Fabiana Azevedo Terra Cunha; Santos, Mariana Rezende Araujo; Almeida, Renato Santos de; Nogueira, Leandro Alberto Calazans

    2016-10-01

    Anterior knee pain is a common complaint and can cause difficulty with its inability to bear weight. The aim of the study was to analyse the effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. A clinical trial with 18 patients with a clinical diagnosis of anterior knee pain was conducted. One group (E) with nine individuals was treated with hip muscle strengthening exercises; another group (EM), with nine individuals, had myofascial techniques added. To quantify the results, the Numeric Pain Rating Scale (NPRS) and the Lower Extremity Functional Scale (LEFS) were used. The E group showed an improvement in pain (p = 0.02), but not in the mean degree of disability. The EM group showed an improvement in pain (p = 0.01), as well as the degree of disability (p = 0.008). The effect size analysis showed that participants of the EM group had a greater impact on clinical pain and disability (Cohen's d = .35 and .30, respectively). The addition of myofascial techniques should be considered to improve the functionality of the lower limbs and reduce pain in patients with anterior knee pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. French translation and validation of the "Anterior Knee Pain Scale" (AKPS).

    Science.gov (United States)

    Buckinx, F; Bornheim, S; Remy, G; Van Beveren, J; Reginster, Jy; Bruyère, O; Dardenne, N; Kaux, J F

    2017-12-21

    To linguistically and cross-culturally translate the Anterior Knee Pain Scale into French and to evaluate the reliability and validity of this translated version of the questionnaire. The translation part was performed in six stages, according to international guidelines: (i) two initial translations from English to French; (ii) synthesis of the two translations; (iii) backward translations into the original language; (iv) expert committee to compare the backward translations with the original questionnaire; (v) pre-final version testing and (VI) expert committee appraisal. To validate the French version of the Anterior Knee Pain Scale, we assessed its validity, reliability and floor/ceiling effects. To do this, volunteer patients from the French part of Belgium and from France, with patellofemoral pain were asked to answer the French version of the Anterior Knee Pain Scale at baseline and after 7 days, as well as the generic SF-36 questionnaire. The Anterior Knee Pain Scale was translated without any major difficulties. A total of 101 subjects aged 34.5 ± 11.4 years (58.4% of women) were included in this study. Results indicated an excellent test-retest reliability (Intra-class correlation coefficient (ICC) = 0.97, 95%CI: 0.96-0.98), a high internal consistency (Cronbach's alpha = 0.87), a consistent construct validity (high correlations with the SF-36 questionnaire were found with domains related to physical function (r = 0.80), physical role (r = 0.70) and pain (r = 0.64)) and low or moderate correlations with domains related to mental health (r = 0.26), vitality (r = 0.32) and social function (r = 0.41). Moreover, no floor/ceiling effects have been found. A valid French version of the Anterior Knee Pain Scale is now available and can be used with confidence to better assess the disease burden associated with patellofemoral pain. It was successfully cross-culturally adapted into French. Implications for rehabilitation The

  10. The Effect of Patellar Denervation by Circumpatellar Electrocautery on Anterior Knee Pain Following Total Knee Replacement – An Experimental Study

    Directory of Open Access Journals (Sweden)

    Balaji Zacharia

    2017-07-01

    Full Text Available ABSTRACT OBJECTIVES Anterior knee pain is a common problem in patients who have undergone TKR which causes dissatisfaction among them. There are Various methods for prevention of anterior knee pain following TKR .The  objective of this study is to determine the  effect of circumpatellar electrocautery on anterior knee pain following TKR and to compare the results with that of those patients who have undergone TKR without circumpatellar denervation. METHODS This is a cohort study conducted in Dept. of Orthopedics, Govt. Medical College, Kozhikode,kerala, 2014. Total sample size was 90.out of which 2 patients died during the study period. We lost follow up of 7 patients.  Among the remaining 81 patients 42 had undergone TKR with circumpatellar denervation using electocautery and 39 without circumpatellar denervation. They were kept under follow up. Patients were followed up postoperatively at 1 month, 3 months, 6 months and at one year. At all postoperative visits, a clinical score was determined using the Knee Society score and the clinical anterior knee pain rating system described by Waters and Bentley RESULTS There is no statistically significant difference in AKP score between both groups.There is a statistically significant difference in the knee society score at 1st month(p value <.001.  But there is no difference on further follow up visits . CONCLUSION There is no statistically significant difference between final outcome of patients who underwent patella denervation using circumpatellar electrocauterisation and those without denervation  with respect to anterior knee pain among patients who have undergone TKR.

  11. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    OpenAIRE

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patie...

  12. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis.

    Science.gov (United States)

    Song, Eun-Kyoo; Park, Ju-Kwon; Park, Chan-Hee; Kim, Min-Cheol; Agrawal, Pranav R; Seon, Jong Keun

    2016-01-01

    The purpose of the present study was to compare functional outcomes of medial unicompartmental knee arthroplasty (UKA) in patients with patellofemoral osteoarthritis (PF OA) and those without PF OA and to evaluate the effect of PF OA on functional outcomes after UKA. The outcomes of 48 knees in patients without PF OA who underwent medial UKA (non-PF OA group) were compared to the outcomes of 57 knees in patients with PF OA [Kellgren-Lawrence (K-L) grade ≤ 2] who underwent medial UKA (PF OA group) with a median follow-up of 5.4 years (range 3.1-10.2 years). Clinical outcomes including anterior knee pain, HSS scores, radiological parameters, and the progression of patellofemoral osteoarthritis were compared, and their effects on functional outcomes were evaluated at the final follow-up visits. At final follow-up visits, no significant inter-group difference was found in terms of anterior knee pain (1.9 vs. 1.9 in non-PF OA and PF OA groups, respectively), HSS score, or range of motion. Preoperative anterior knee pain and patellofemoral joint degeneration were found to be unrelated to poor outcome in patients that underwent medial UKA. Furthermore, no correlation was found between any functional outcome variable and chondral lesion pattern. The result of UKA for medial unicompartmental knee osteoarthritis was excellent regardless of PF OA (K-L grade ≤ 2). Hence, the patients with medial unicompartmental OA combined with a moderate degree of anterior knee pain or patellofemoral arthritis should be viewed as appropriate candidates for medial UKA. III.

  13. Expected prevalence from the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening.

    Science.gov (United States)

    Barber Foss, Kim D; Myer, Gregory D; Chen, Stephen S; Hewett, Timothy E

    2012-01-01

    Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined. To determine the prevalence of specific patellofemoral disorders obtained using the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening. Descriptive epidemiology study. Preparticipation screening evaluations at a county public school district in Kentucky. A total of 419 unique middle and high school-aged female athletes. Participants were evaluated by physicians for anterior knee pain over 3 consecutive basketball seasons. Given the longitudinal nature of this study, some participants were tested longitudinally over multiple years. Over the course of 3 basketball seasons, 688 patient evaluations were performed. Of these, 183 (26.6%) were positive for anterior knee pain. A statistically significant difference was noted in the prevalence of anterior knee pain by school level, with 34.4% (n = 67) in high school-aged athletes versus 23.5% (n = 116) in middle school-aged athletes (P patellar tendinopathy, with 38 cases (9.7%) in high school-aged and 31 (3.1%) in middle school-aged athletes (P < .05). Anterior knee pain was present in 26.6% of the adolescent female athletes screened over 3 years. Symptoms of anterior knee pain likely persist after middle school-aged onset and reach peak prevalence during the high school years.

  14. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach.

    Science.gov (United States)

    Song, Si Young; Chang, Ho Geun; Byun, Jae Chul; Kim, Tae Young

    2012-03-01

    To determine the incidence, severity, and etiology of anterior knee pain after tibial intramedullary (IM) nailing using a medial paratendinous approach and to investigate the association between anterior knee pain and functional impairment. Retrospective study with current clinical and radiographic assessments. Level I trauma center. Forty-five patients with unilateral, tibial diaphyseal fractures treated with tibial IM nailing between August 2005 and January 2009. The mean follow-up was 22.3 months (range, 12-52 months). All patients underwent tibial IM nailing using a medial paratendinous approach. Anterior knee pain based on a visual analog scale and functional outcomes based on the Tegner activity score and the modified Lysholm score. Of the 45 patients, 16 (36%) were painless (N group), 16 (36%) had mild pain (M group), and 13 (28%) had moderate to severe pain (MS group). No group differences were found with respect to age, sex, body mass index, mode of injury, or type of fracture. With regard to nail prominence, superior nail prominence was greater in the MS group than in the other two groups (P = 0.042). There were no significant differences among the three groups in terms of anterior nail prominence (P = 0.221). The nail-apex distance in the MS group was significantly greater than in the other two groups (P = 0.033), and no significant difference was found between the N and M groups. The descending order of the activities with respect to severity of knee pain was kneeling, squatting, running, and stair ascending. Visual analog scale analysis revealed that the MS group had significantly more severe pain for all eight activities examined than the M group. At latest follow-up, the Tegner activity score was significantly lower in the MS group than in the other two groups (P = 0.008), and there were statistically significant intergroup differences in the modified Lysholm score (P Anterior knee pain after tibial IM nailing using a medial paratendinous approach

  15. Frequency of non-traumatic anterior knee pain in secondary school students

    International Nuclear Information System (INIS)

    Shafiq, W.; Ajmad, F.; Ahmed, A.; Fatima, M.

    2017-01-01

    To find out the frequency of non-traumatic anterior knee pain in secondary school students of Lahore, Pakistan. Methodology: This observational study was conducted among 350 students of secondary school of Lahore during a 3 months period. Both males and females of age 11-17 years were included in the study. A questionnaire was completed which included demographic data, Numeric Rating scale (NRS) and Kujala Scale. The data were being analyzed using SPSS version 21.0. Results: Out of 350 secondary school students, 145 (41%) had anterior knee pain (AKP). Twenty seven (19%) had pain in the left knee only, 54 (37%) had pain in right knee only while 64 (44%) had pain in both knees. The incidence of AKP was highest among 11 to 15 years old students. Moreover, the girls reported high frequency of AKP then the boys. The activities that were affected because of AKP included running, walking, stair climbing and jumping. Conclusion: Non-traumatic AKP is common among students of age 11-17 years, with a peak during adolescence (11-15). This pain not only affects the sports activities but also affects the activity of daily livings. (author)

  16. Incidence of non-traumatic anterior knee pain among 11 - 17-years ...

    African Journals Online (AJOL)

    Objective. To investigate the incidence of anterior knee pain, as well as the effect of sport participation, age of onset and gender differences on the condition. Design. Questionnaires (N = 2 414), each containing 20 questions, were distributed to 10 - 17-year-old learners at 8 primary and 5 high schools in the Empangeni/ ...

  17. Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Driban, Jeffrey B; Lohmander, Stefan; Frobell, Richard B

    2017-06-02

      After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.   To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.   Cross-sectional exploratory analysis of a randomized clinical trial.   Orthopaedic departments at 2 hospitals in Sweden.   As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied.   The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.   Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = -0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = -0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = -0.48, P = .02) but not lateral (β = -0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.   We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between

  18. Stability of capsule closure and postoperative anterior knee pain after medial parapatellar approach in TKA.

    Science.gov (United States)

    Keshmiri, Armin; Dotzauer, Fabian; Baier, Clemens; Maderbacher, Günther; Grifka, Joachim; Sendtner, Ernst

    2017-07-01

    Anterior knee pain after total knee arthroplasty (TKA) remains a widely discussed postoperative complication. In contrast to sports traumatology, the role of the dissected medial patellofemoral ligament (MPFL) using a medial parapatellar approach in TKA has not been discussed so far. In the present study, it was hypothesized that the attempted repair of the MPFL in TKA by simple closure of the joint capsule may not be successful in some cases, causing anterior knee pain. Furthermore, it was hypothesized, that the success of repair might be influenced by femoral component rotation. Forty patients received their TKA in a ligament-balanced and forty patients in a conventional measured-resection technique. After implantation of the TKA using a medial parapatellar approach, two titan clips were attached on both sides of the capsule incision. 3 days and 3 months after surgery, the dehiscence of the two clips was measured on skyline patella radiographs; additionally patellar tilt, shift, the Knee Society Score and the Feller Score were obtained. 48 patients showed an increase of capsule dehiscence. Patients with a capsule dehiscence of more than 4 mm showed significantly less improvement in the Feller score 3 months postoperatively than patients with a capsule dehiscence ≤4 mm. Regarding the radiological measurements and the clinical outcome, no significant difference between the ligament-balanced and the measured-resection group was found. The present results suggest that the successful repair of the MPFL after using a medial parapatellar approach in TKA could reduce the high rate of postoperative anterior knee pain. Furthermore, the appearance of capsule dehiscence and anterior knee pain does not seem to be dependent on the used operative technique.

  19. The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study.

    Science.gov (United States)

    Stefanik, Joshua J; Neogi, Tuhina; Niu, Jingbo; Roemer, Frank W; Segal, Neil A; Lewis, Cora E; Nevitt, Michael; Guermazi, Ali; Felson, David T

    2014-08-01

    To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage. The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain. There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested. Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.

  20. Influence of sagittal plane malpositioning of the patella on anterior knee pain after tibia intramedullary nailing.

    Science.gov (United States)

    Turkmen, Ismail; Saglam, Yavuz; Turkmensoy, Fatih; Kemah, Bahattin; Kara, Adnan; Unay, Koray

    2017-01-01

    Anterior knee pain (AKP) is one of the most common complications after tibia intramedullary surgery. We evaluated changes in patellar tendon length after tibia intramedullary nailing surgery using a transtendinous approach and assessed the importance of nail position in relation to the anterior tibial cortex and joint line. Two surgeons blinded to patients' pain status measured both the knee Insall-Salvati and Caton-Deschamps indexes on 30° flexion lateral knee X-rays of 33 patients. Superior nail prominence (the distance from the proximal tip of the nail to the tibial plateau) and anterior nail prominence (the distance from the anterior tip of the nail to the anterior tibial cortex) were measured on the CT. Clinical assessment showed that 10 patients (30 %) had AKP at the last follow-up. HSS and Lysholm scores and the incidence of AKP were similar between patients whose IM nails were removed and those who still had them. HSS score, Insall-Salvati, and Caton-Deschamps indexes were significantly lower in the operated extremity than in the healthy limb at last follow-up. No association was demonstrated between AKP and nail position in relation to the anterior tibial cortex or tibial plateau. According to our study, although the patellar tendon shortened significantly on the affected side compared with the contralateral side, these measurements did not correlate with the presence or absence of pain. AKP and functional knee scores after tibia IM nailing using a transtendinous approach were not associated with nail position in relation to the anterior tibial cortex or tibial plateau. Level 3 (Case control study).

  1. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain.

    Science.gov (United States)

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP.

  2. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    Directory of Open Access Journals (Sweden)

    Vicente Sanchis-Alfonso

    2016-01-01

    Full Text Available We present a case of a patient with chronic anterior knee pain (AKP recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP.

  3. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain

    OpenAIRE

    Doménech, J.; Sanchis-Alfonso, Vicente; Espejo Tort, Begoña

    2014-01-01

    Purpose. The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain. Methods. A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting. Pain was measured with the visual analogue scale and disability with the Lysholm scale. The psychological variables, such as anxiety, depression, pain coping strategies, c...

  4. No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years

    NARCIS (Netherlands)

    Breugem, Stefan J. M.; van Ooij, Bas; Haverkamp, Daniël; Sierevelt, Inger N.; van Dijk, C. Niek

    2014-01-01

    The presence of anterior knee pain remains one of the major complaints following total knee arthroplasty (TKA). Since the introduction of the mobile TKA, many studies have been performed and only a few show a slight advantage for the mobile. In our short-term follow-up study, we found less anterior

  5. Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty.

    Science.gov (United States)

    van Houten, Albert H; Heesterbeek, Petra J C; Wymenga, Ate B

    2016-08-01

    Incidence of anterior knee pain after total knee arthroplasty (TKA) is reported to be between 4 and 49 %. The incidence of AKP at long-term follow-up and possible determinants after cruciate cruciate-retaining TKA were investigated. A 10-year follow-up of a cohort of 55 patients (63 TKAs), who received the balanSys™ cruciate-retaining total knee system (Mathys Ltd, Bettlach, Switzerland) between 1999 and 2002, was performed. Patients had undergone the balanced gap technique, with either a fixed bearing or an AP-glide bearing. Standardised diagnostic questions regarding AKP were collected and categorised into two groups: those with and without AKP. The lateral patellar tilt, patellar displacement measurement and modified Insall-Salvati ratio were used for patella position evaluation on skyline radiographs. The Knee Society Score (KSS), the Knee Osteoarthritis Outcome Score (KOOS) and Numerical Rating Scales (NRS) for pain and satisfaction were obtained at follow-up. Sixteen patients in the study population experienced AKP. Incidence of AKP (fixed bearing 13/44; AP-glide bearing baring 3/17) was not dependent on type of insert (n.s.). There were no statistical differences in patella position and tibiofemoral contact point between the AKP group and the no AKP group (n.s.). KSS, KOOS, NRS-pain and NRS-satisfaction were significantly lower for the patients with AKP (all p years after balanced gap TKA. Postoperative patella positioning was not found to be a determinant for anterior knee pain after TKA. However, patellar displacement does not seem completely favourable. Moreover, type of bearing was not found a determinant for AKP at long-term follow-up. Lower quality prospective cohort study (<80 % follow-up, patients enrolled at different time points in disease), Level II.

  6. Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.

    Science.gov (United States)

    Elson, D W; Jones, S; Caplan, N; St Clair Gibson, A; Stewart, S; Kader, D F

    2013-12-01

    Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population. A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single blinded surgeon, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude. Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P = 0.007, χ(2) = 0.32) and the quadriceps tendon (P = 0.029, χ(2) = 0.26), but these associations were at best fair, which could be interpreted as clinically insignificant. Incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Assessment of anterior subcutaneous hypersignal on proton-density-weighted MR imaging of the knee and relationship with anterior knee pain.

    Science.gov (United States)

    Unlu, E N; Turhan, Y; Kos, D M; Safak, A A

    2017-04-01

    The purpose of this study was to evaluate the prevalence of anterior subcutaneous hypersignal indicating edema on proton-density (PD)-weighted MRI of the knee and to determine whether reporting anterior edema is clinically relevant. One hundred and ninety-one knee MRIs from 162 patients were reviewed for anterior subcutaneous edema. There were 92 men and 70 women with a mean age of 41.72years±13.92 (SD) (range, 15-80years) years and a mean body weight of 75.94kg±12.54 (SD) (range, 50-130kg). The MRI findings were compared with patient age, gender, body weight, history of repetitive microtrauma and clinical findings. Patellar and trochlear chondropathy, medial plica, joint effusion, synovitis, infrapatellar fat-pad signal intensity, suprapatellar fat-pad signal intensity with mass effect, quadriceps and patellar tendon abnormalities were also reviewed. An anterior hypersignal on PD-weighted MRI was detected in 158/191 MR examinations (82.7%) and 104 (84.6%) of these cases had histories of anterior knee pain. No correlation between anterior pain and anterior edema was found (P=0.42). Age (Panterior edema. Anterior edema may be a physiological phenomenon or degenerative change related to patient age, weight, and knee movement or mechanics. It should not be reported as a pathological finding on MRI unless clinical findings support regional infection or inflammation. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  8. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain

    OpenAIRE

    Tahririan, Mohammad Ali; Ziaei, Ehsan; Osanloo, Reza

    2014-01-01

    Background: Intramedullary nailing is the treatment of choice for the majority of tibial shaft fractures and anterior knee pain is the most common complication of this surgery; however, its etiology is still unknown. The purpose of this study was to assess the predicting factors related to anterior knee pain following tibial nailing. Materials and Methods: Patients with isolated, unilateral tibial shaft fracture who had undergone tibial nailing were identified retrospectively. Data includ...

  9. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome.

    Science.gov (United States)

    Ferrari, Deisi; Kuriki, Heloyse Uliam; Silva, Cristiano Rocha; Alves, Neri; Mícolis de Azevedo, Fábio

    2014-08-01

    To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Sensitivity and specificity analysis. Physical rehabilitation center and laboratory of biomechanics and motor control. Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Not applicable. The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (Ppain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Medial release and lateral imbrication for intractable anterior knee pain: diagnostic process, technique, and results

    Directory of Open Access Journals (Sweden)

    Meldrum AR

    2015-01-01

    Full Text Available Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbrication of the patellar retinaculum. Patients and methods: This case series presents the treatment of three knees in two patients (one bilateral in whom an all-inside arthroscopic medial release and lateral imbrication of the patellar retinaculum was performed. Subjective measurement of pain was the primary outcome measurement, and subjective patellofemoral instability was the secondary outcome measurement. Results: Subjectively the two patients had full resolution of their pain, without any patellofemoral instability. Conclusion: Medial release and lateral imbrication of the patellar retinaculum is a new surgical procedure that has been used in the treatment of intractable patellofemoral pain syndrome. This is the first report of its kind in the literature. While outcome measurements were less than ideal, the patients had positive outcomes, both functionally and in terms of pain. Keywords: anterior knee pain syndrome, chondromalacia patellae, runners knee, patellar chondropathy, patellofemoral dysfunction, patellofemoral tracking disorder

  11. Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella.

    Science.gov (United States)

    Metsna, Vahur; Vorobjov, Sigrid; Lepik, Katrin; Märtson, Aare

    2014-08-01

    Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6-20) and that of patients with AKP was 15 (6-20) (p = 0.04). Patients with OARSI scores of 13-24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0-2.3) than patients with OARSI scores of 0-12. The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.

  12. Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol.

    Science.gov (United States)

    Gadea, F; Monnot, D; Quélard, B; Mortati, R; Thaunat, M; Fayard, J M; Sonnery-Cottet, B

    2014-07-01

    Anterior knee pain (AKP) is a rare and difficult complication following anterior cruciate ligament (ACL) reconstruction. This disabling pain is persistent with conventional rehabilitation protocols. The aim of this work is to validate a new rehabilitation protocol that may improve the patients and allow return to daily activities including sports. Forty-three patients identified with functional AKP after ACL reconstruction was enrolled in the rehabilitation protocol between 2009 and 2011. The series included twenty-six patients with hamstring grafting and seventeen patients with patellar tendon transplant. This study compares the functional outcomes and pain scores before and after the isokinetic protocol until the last follow-up at an average of 25.7 months after surgery. The evaluation was performed according to the International Knee Documentation Committee (IKDC) and included a pain assessment using the visual analog scale. Statistical analysis used Student's t-test for unpaired data and the Pearson correlation test for the variables. The IKDC scores were compared by the Wilcoxon test. Functional outcomes and pain are significantly improved (ppain improved with 3.2 points on the visual analog scale (VAS). The results are correlated with the follow-up time (p=0.008) but not correlated with the delay between the surgery and the beginning of the isokinetic protocol. Isokinetic rehabilitation provides a significant improvement in the knee function as measured by the IKDC score and by the VAS, regardless of the painful period preceding the program. The function improvement continues after the end of the protocol, but the pain may not completely disappear. The isokinetic rehabilitation program may resume functional AKP related to muscular deficit and may be used as the starter of other physical therapy protocols. IV.

  13. How to Deal With Anterior Knee Pain in the Active Young Patient.

    Science.gov (United States)

    Sanchis-Alfonso, Vicente; Dye, Scott F

    Anterior knee pain (AKP) represents the most common reason to consult with a clinician who specializes in the knee. Despite the high incidence of the disorder, however, its etiology is still controversial. Many unnecessary surgeries that may damage the patient are done for this clinical entity. A PubMed search from 1995 through June 2016. Clinical review. Level 4. The etiology of AKP is multifactorial, and patients with AKP may therefore be divided into several subpopulations. The whole picture must be addressed for each patient to identify all potentially modifiable factors and to achieve better outcomes. Both pelvifemoral dysfunction and psychological factors that may affect the development and symptoms of AKP must be considered to identify therapeutic targets within the context of treatment. Patients presenting with AKP frequently respond well to load restriction that protects their knee and reduces pain during rehabilitation. Surgery should only be considered in very select cases. In a patient who has undergone previous patellar realignment surgery and experienced increased pain, iatrogenic medial patellar instability should be considered. The etiology of AKP is multifactorial, and several subpopulations of AKP patients exist and their treatment must be personalized. Normally, the focus is on the knee of a patient with AKP, and only that joint is examined. However, that focus can lead to overlooking other important etiological factors that may be present.

  14. The influence of isometric exercises of the quadriceps muscle on young female patients with anterior knee pain

    Directory of Open Access Journals (Sweden)

    Jacek Wilczyński

    2015-10-01

    Full Text Available Introduction: Anterior knee pain is a disease associated with abnormalities in the patellofemoral joint. It is a common reason for seeking advice from an orthopaedist. This problem is characterised by chronic pain in the anterior part of one or both knees. This issue often affects women, especially at a young age. The effect of this ailment is deterioration of the quality of life. This dysfunction significantly reduces abilities, and often prevents the performance of daily activities. Pain usually occurs during physical activity, but may also be accompanied by prolonged immobilisation of the knee joint. In defining the type of patellofemoral instability, orthopaedists use magnetic resonance imaging, arthroscopy, ultrasonography, and X-ray examination. A relatively effective method of treatment of pain in the patellofemoral joint is through isometric exercises of the quadriceps. They increase the strength of the quadriceps femoris muscle and reduce instability in the patellofemoral joint. Aim of the research: To evaluate the effectiveness of isometric exercises of the quadriceps muscle on young female patients with anterior knee pain. Material and methods : The study involved 30 women aged 13–44 years (mean age: 26.8 years, who had been diagnosed with pain in the front of the knee. Results and conclusions: Isometric exercises of the quadriceps muscle are an effective method of reducing anterior knee pain. Isometric exercises have a beneficial influence on improving physical activity, including performing basic activities of daily living. Student’s t distribution showed, that isometric exercises of the quadriceps muscle reduce pain at the front of the knee. Kruskal-Wallis test confirmed a significant reduction of anterior knee pain.

  15. [Etiological analysis and significance of anterior knee pain induced by gluteal muscles contracture].

    Science.gov (United States)

    Zhao, Gang; Liu, Yu-jie; Wang, Jun-liang; Qi, Wei; Qu, Feng; Yuan, Bang-tuo; Wang, Jiang-tao; Shen, Xue-zhen; Liu, Yang; Zhu, Juan-li

    2014-12-01

    To explore causes of gluteal muscle contracture induced anterior knee pain and curative effect of arthroscopic release. From March 2002 to August 2013,36 patients with gluteal muscle contracture induced anterior knee pain were treated, including 15 males, 21 females, aged from 9 to 40 years old with an average (18.7±7.2) years old; the courses of diseases ranged from 4 to 30 years. The clinical manifestations involved limited to symmelia, positive Ober sign, buttocks touch contracture belts, knee and patella slide to lateral when doing squat activities. All patients were performed gluteal muscle contracture release under arthroscopic. Postoperative complications were observed, Kujala scoring before and after operation was used for compare curative effect. All patients were followed up with an average of 29 months. The incision were healed well, and no complications were occurred. Postoperative Kujala score were improved more than preoperative. Gluteal muscle contracture release could alleviate hypertension of lateral patella, and palys an important role in preventing patellofemoral arthritis.

  16. Effect of medial–lateral malpositioning of the femoral component in total knee arthroplasty on anterior knee pain at greater than 8 years of follow-up

    NARCIS (Netherlands)

    van de Groes, S.A.W.; Koëter, S.; De Waal Malefijt, M.C.; Verdonschot, Nicolaas Jacobus Joseph

    2014-01-01

    Background The trochlea is often medialized after total knee arthroplasty (TKA) resulting in abnormal patellar tracking, which may lead to anterior knee pain. However, due to the difference in shape of the natural trochlea and the patellar groove of the femoral component, a medialization of the

  17. Advantage of minimal anterior knee pain and long-term survivorship of cemented single radius posterior-stabilized total knee arthroplasty without patella resurfacing.

    Science.gov (United States)

    Ji, Hyung-Min; Ha, Yong-Chan; Baek, Ji-Hoon; Ko, Young-Bong

    2015-03-01

    The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.

  18. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing?

    Science.gov (United States)

    Leliveld, M S; Verhofstad, M H J

    2012-06-01

    The purpose of this study was to determine the long-term incidence of infrapatellar nerve damage after tibial nailing and its relation to anterior knee pain. We retrospectively evaluated 71 patients in whom 72 isolated tibial shaft fractures were treated with an intramedullary nail. The mean follow-up time was 84 months. Twenty-seven patients (38%) complained of chronic anterior knee pain. Infrapatellar nerve damage was found in 43 patients (60%). Of the 27 patients with knee pain, 21 (78%) had sensory deficits in the distribution area of the infrapatellar nerve, compared to 22 of the 45 patients (49%) without knee pain (p=0.025). Patient and fracture characteristics showed no significant differences between the two groups. At time of follow-up a total of 33 nails were removed of which twelve were taken out because of knee pain. The pain persisted in seven of these twelve patients (58%). The incidence of iatrogenic damage to the infrapatellar nerve after tibial nailing is high and lasting. Injury to this nerve appears to be associated with anterior knee pain after tibial nailing. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain.

    Science.gov (United States)

    Tahririan, Mohammad Ali; Ziaei, Ehsan; Osanloo, Reza

    2014-01-01

    Intramedullary nailing is the treatment of choice for the majority of tibial shaft fractures and anterior knee pain is the most common complication of this surgery; however, its etiology is still unknown. The purpose of this study was to assess the predicting factors related to anterior knee pain following tibial nailing. Patients with isolated, unilateral tibial shaft fracture who had undergone tibial nailing were identified retrospectively. Data including age, sex, type of fracture, technique of surgery and location of the nail were collected and finally the association between the above variables and knee pain were analyzed via SPSS software. A total of 95 patients participated in the study. The mean age of the participants was 33.52 ± 1.62, 87 (91.6%) of whom were male and 74 (77.9%) had close fractures respectively. The method of surgery in 60 (63.2%) patients was paratendinous approach and in 35 (36.8%) was transtendinous. Twenty six (27.4%) of the patients had anterior knee pain. There were no significant differences between the two groups of patients with and without knee pain by age, sex, type of fracture and type of surgery (P = 0.952, 0.502, 0.212 and 0.745, respectively). Patients with protrusion of the nail from the anterior cortex had higher risk of developing knee pain after surgery (odds ratio: 2.76, confidence interval: 1.08, 7.08, P = 0.031). The results revealed a higher risk of developing anterior knee pain after tibial nailing in patients with protrusion of the nail from the anterior cortex.

  20. Patellar denervation in total knee arthroplasty without patellar resurfacing and postoperative anterior knee pain: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Li, Tao; Zhou, Lei; Zhuang, Qianyu; Weng, Xisheng; Bian, Yanyan

    2014-12-01

    The aim of this meta-analysis was to investigate whether patellar denervation with electrocautery (PD) after total knee arthroplasty (TKA) could reduce the postoperative anterior knee pain (AKP). Five randomized controlled trials (RCTs) with 572 patients and 657 knees were eligible for this meta-analysis. Our results showed that PD was associated with less AKP, lower visual analogue scale (VAS), higher patellar scores and better knee function compared with no patellar denervation (NPD). Complications did not differ significantly between the two groups. The existing evidence indicates that PD may be a better approach, as it improves both anterior knee pain and knee function after TKA. Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Patellar tracking and anterior knee pain are similar after medial parapatellar and midvastus approaches in minimally invasive TKA.

    Science.gov (United States)

    Pongcharoen, Boonchana; Pongcharoen, Boonchna; Yakampor, Thanasak; Charoencholvanish, Keerati

    2013-05-01

    Since the medial parapatellar (MPP) approach in conventional TKA can cause patellar maltracking and anterior knee pain, some orthopaedic surgeons use the midvastus (MV) approach instead of the MPP approach to reduce patellar maltracking. Minimally invasive surgical (MIS) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery. Thus, MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain. However, this presumption has not been confirmed. We asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA. We prospectively followed 59 patients (60 knees) treated with 60 primary cemented MIS TKAs from August 2009 to September 2010. We randomized the patients into two groups: 30 who had a limited MPP approach and 30 who had a mini-MV approach. We recorded the occurrence of anterior knee pain, patellar tilting, and subluxation. The minimum followup was 12 months (mean, 18.03 months; range, 12.00-25.08 months). We found no differences in anterior knee pain (two of 30, 7% versus two of 30, 7%), mean patellar tilt (3.4º ± 2.9º versus 3.0 ± 2.3º), and mean patellar subluxation (1.5 ± 1.1 mm versus 1.1 ± 0.7 mm) between the limited MPP and mini-MV groups, respectively. MIS TKA using either the MPP or MV approach has a low incidence of patellar maltracking and anterior knee pain.

  2. Increased interleukin 6 and tumour necrosis factor α expression in the infrapatellar fat pad of the knee joint with the anterior knee pain syndrome: a preliminary report.

    Science.gov (United States)

    Witoński, Dariusz; Wągrowska-Danilewicz, Małgorzata; Kęska, Rafał; Raczyńska-Witońska, Grażyna; Stasikowska-Kanicka, Olga

    2010-01-01

    The pathway of pain in the anterior knee pain syndrome remains unclear. It has been hypothesized that some biochemical mediators of inflammation, such as cytokines contribute to the process. The objective of this work was to evaluate the synovial membrane and the infrapatellar fat pad expression of the inflammatory mediators and potentially chondrodestructive cytokines interleukin 6 (IL-6) and tumour necrosis factor α (TNF-α) in the anterior knee pain syndrome, and to determine whether the cytokine expression counterpart with/corresponds to the amount of chondral damage in this syndrome. Ten consecutive patients with the anterior knee pain syndrome (group I) participated in the study. Patients with a history of trauma were excluded from this group. For comparison we used 10 patients with anterior cruciate ligament rupture or meniscal lesion with no history of pain in the anterior compartment (group II). Immunohistochemical techniques using a polyclonal rabbit anti-human antibody to IL-6 and a monoclonal mouse anti-human antibody to TNF-α were employed. The results show a statistically significant higher expression of IL-6 in infrapatellar fat pad (p anterior knee pain syndrome could be characterized by infrapatellar fat pad and synovial inflammation variations without the articular cartilage loss.

  3. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study.

    Science.gov (United States)

    Witvrouw, E; Lysens, R; Bellemans, J; Cambier, D; Vanderstraeten, G

    2000-01-01

    Many variables have retrospectively been associated with the presence of anterior knee pain. Very few prospective data exist, however, to determine which of these variables will lead to the development of anterior knee pain. It was our purpose in this study to determine the intrinsic risk factors for the development of anterior knee pain in an athletic population over a 2-year period. Before the start of training, 282 male and female students enrolled in physical education classes were evaluated for anthropometric variables, motor performance, general joint laxity, lower leg alignment characteristics, muscle length and strength, static and dynamic patellofemoral characteristics, and psychological parameters. During this 2-year follow-up study, 24 of the 282 students developed patellofemoral pain. Statistical analyses revealed a significant difference between those subjects who developed patellofemoral pain and those who did not concerning quadriceps and gastrocnemius muscle flexibility, explosive strength, thumb-forearm mobility, reflex response time of the vastus medialis obliquus and vastus lateralis muscles, and the psychological parameter of seeking social support. However, only a shortened quadriceps muscle, an altered vastus medialis obliquus muscle reflex response time, a decreased explosive strength, and a hypermobile patella had a significant correlation with the incidence of patellofemoral pain. We concluded that the latter four parameters play a dominant role in the genesis of anterior knee pain and we therefore deem them to be risk factors for this syndrome.

  4. A COMPARISON OF TWO TAPING TECHNIQUES (KINESIO AND MCCONNELL) AND THEIR EFFECT ON ANTERIOR KNEE PAIN DURING FUNCTIONAL ACTIVITIES

    Science.gov (United States)

    Babu, Jenie; Dmochowska, Katarzyna; Scariah, Shiju; Varughese, Jincy

    2013-01-01

    Background: Anterior knee pain is a clinical syndrome characterized by pain experienced perceived over the anterior aspect of the knee that can be aggravated by functional activities such as stair climbing and squatting. Two taping techniques commonly used for anterior knee pain in the clinic include the McConnell Taping Technique (MT) and the Kinesio Taping® Method (KT®). Objective: The purpose of this study was to compare the effectiveness of KT® and the MT versus no tape in subjects with anterior knee pain during a squat lift and stair climbing. Design: Pretest‐ posttest design. Participants: A total of 20 subjects (15 female, 5 male) with unilateral anterior knee pain were recruited. The mean age of the subjects was 24 (+/–3) years, with a mean weight of 160 (+/–28) pounds. Methods: Each participant was tested during two functional activities; a squat lift with a weighted box (10% of his/her body weight, plus the weight [8.5 pounds] of the box) and stair climbing under three conditions: 1) no tape, 2) MT and 3) KT®. Pain levels were assessed (verbally) using the 0‐10 Numeric Pain Intensity Scale. Results: The median (interquartile range [IQR]) pain during squat lift was 2 (2.75) for no tape, 1 (1) for KT®, and 0.5 (2) for McConnell, with no significant differences between the groups. During the stair activity the median (IQR) pain was 1.5 (2.75) for no tape, 1 (1.75) for KT®, and 1 (1.75) for MT with a significant difference (p=0.024) between the groups. Further analysis determined that the only a significant difference was (p=0.034) between the no tape and the KT® conditions. Conclusion: The results of this study found that both the KT® and the MT may be effective in reducing pain during stair climbing activities. Level of Evidence: Level 2, Prospective Cohort study PMID:23593548

  5. A comparison of two taping techniques (kinesio and mcconnell) and their effect on anterior knee pain during functional activities.

    Science.gov (United States)

    Campolo, Marc; Babu, Jenie; Dmochowska, Katarzyna; Scariah, Shiju; Varughese, Jincy

    2013-04-01

    Anterior knee pain is a clinical syndrome characterized by pain experienced perceived over the anterior aspect of the knee that can be aggravated by functional activities such as stair climbing and squatting. Two taping techniques commonly used for anterior knee pain in the clinic include the McConnell Taping Technique (MT) and the Kinesio Taping® Method (KT®). The purpose of this study was to compare the effectiveness of KT® and the MT versus no tape in subjects with anterior knee pain during a squat lift and stair climbing. Pretest- posttest design. A total of 20 subjects (15 female, 5 male) with unilateral anterior knee pain were recruited. The mean age of the subjects was 24 (+/-3) years, with a mean weight of 160 (+/-28) pounds. Each participant was tested during two functional activities; a squat lift with a weighted box (10% of his/her body weight, plus the weight [8.5 pounds] of the box) and stair climbing under three conditions: 1) no tape, 2) MT and 3) KT®. Pain levels were assessed (verbally) using the 0-10 Numeric Pain Intensity Scale. The median (interquartile range [IQR]) pain during squat lift was 2 (2.75) for no tape, 1 (1) for KT®, and 0.5 (2) for McConnell, with no significant differences between the groups. During the stair activity the median (IQR) pain was 1.5 (2.75) for no tape, 1 (1.75) for KT®, and 1 (1.75) for MT with a significant difference (p=0.024) between the groups. Further analysis determined that the only a significant difference was (p=0.034) between the no tape and the KT® conditions. The results of this study found that both the KT® and the MT may be effective in reducing pain during stair climbing activities. Level 2, Prospective Cohort study.

  6. The Effect of Kinesio Taping on Anterior Knee Pain Consistent With Patellofemoral Pain Syndrome: A Critically Appraised Topic.

    Science.gov (United States)

    Campbell, Samantha A; Valier, Alison R

    2016-08-01

    Patellofemoral pain syndrome (PFPS) occurs in 25% of adolescents and adults and is the leading cause of knee pain in runners. Pain is commonly felt when ascending or descending stairs, deep squatting, kneeling, or running. There is no consensus on the etiology of this condition, but insufficient hip strength, malalignment of the lower extremity, hyperpronation of the foot, and patellar incongruence have been suggested. Common treatments of PFPS include strengthening of quadriceps and hip muscles, McConnell taping, electrical stimulation, and foot orthotics, but effectiveness of these treatments is inconclusive. Kinesio Taping is an alternative taping technique for musculoskeletal injuries including PFPS. Although research suggests that Kinesio Taping decreases pain and improves range of motion for some musculoskeletal injuries, its effectiveness in decreasing pain in patients with PFPS in unknown. Furthermore, Kinesio Taping has not been compared with other taping techniques including McConnell taping. Focused Clinical Question: For patients with anterior knee pain consistent with PFPS, does treatment with Kinesio Taping decrease pain more than McConnell taping or no tape at all?

  7. Sport specialization's association with an increased risk of developing anterior knee pain in adolescent female athletes.

    Science.gov (United States)

    Hall, Randon; Barber Foss, Kim; Hewett, Timothy E; Myer, Gregory D

    2015-02-01

    To determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes. Retrospective cohort epidemiology study. Female basketball, soccer, and volleyball players (N = 546) were recruited from a single county public school district in Kentucky consisting of 5 middle schools and 4 high schools. A total of 357 multisport and 189 single-sport (66 basketball, 57 soccer, and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain (PFP) on physical exam. Testing consisted of a standardized history and physician-administered physical examination to determine the presence of PFP. This study compared self-reported multisport athletes with sport-specialized athletes participating in only 1 sport. The sports-participation data were normalized by sport season, with each sport accounting for 1 season of exposure. Incidence rate ratios and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multisport athletes. Specialization in a single sport increased the relative risk of PFP incidence 1.5-fold (95% CI 1.0-2.2, P = .038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/ patellar tendinopathy (95% CI 1.5-10.1, P = .005) and Osgood Schlatter disease (95% CI 1.5-10.1, P = .005) demonstrated a 4-fold greater relative risk in single-sport compared with multisport athletes. Incidence of other specific PFP diagnoses such as fat pad, plica, trauma, pes anserine bursitis, and iliotibial-band tendonitis was not different between single-sport and multisport participants (P > .05). Early sport specialization in female adolescents is associated with increased risk of anterior knee-pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared with multisport athletes.

  8. Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis

    NARCIS (Netherlands)

    Breugem, Stefan J. M.; Sierevelt, Inger N.; Schafroth, Matthias U.; Blankevoort, Leendert; Schaap, Gerard R.; van Dijk, C. Niek

    2008-01-01

    Anterior knee pain is one of the major short-term complaints after TKA. Since the introduction of the mobile-bearing TKA, numerous studies have attempted to confirm the theoretical advantages of a mobile-bearing TKA over a fixed-bearing TKA but most show little or no actual benefits. The concept of

  9. Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener.

    Science.gov (United States)

    Ittenbach, Richard F; Huang, Guixia; Barber Foss, Kim D; Hewett, Timothy E; Myer, Gregory D

    2016-01-01

    A screening instrument's ability to provide clinicians with consistent and reproducible information is crucial to intervention. Despite widespread acceptance and clinical use of the Kujala Anterior Knee Pain Scale (AKPS) in orthopedics and sports medicine, few studies have reported on its reliability and no such studies have concentrated on child or adolescent samples exclusively, segments of the population for which this instrument is often used. The purpose of the current study was to describe and report on the reliability and validity of the AKPS for use with high school female athletes participating in interscholastic athletics. The study was a secondary analysis of prospective epidemiologic data using established scale validation methods. The records of 414 female athletes 11.0 to 18.1 years of age (Mean 13.9 yrs, SD = 1.7 yrs) were used for analysis. Four different approaches to scoring and scale reduction of the AKPS were evaluated, including the original, ordinal 13-item form, a modified, ordinal 6-item form, a modified, dichotomous 13-item form, and a modified, dichotomous 6-item form. Three different types of reliability (internal consistency, equivalence across forms, standard error of measurement) and one type of validity (criterion-related) were estimated for the AKPS in the current sample. The four scoring formats of the AKPS scale were found to have high internal consistency (αcoef = 0.83 to 0.91), equivalence across the short and long forms (r = 0.98), acceptable standard errors of measurement (0.82 to 3.00), and moderate to high criterion related validity-as determined by physican's diagnosis: 0.92 (13-item form), 0.90 (6-item form). The Kujala AKPS is a valid and reliable measure of anterior knee pain and appropriate for use as an epidemiologic screening tool with adolescent female athletes.

  10. Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener.

    Directory of Open Access Journals (Sweden)

    Richard F Ittenbach

    Full Text Available A screening instrument's ability to provide clinicians with consistent and reproducible information is crucial to intervention. Despite widespread acceptance and clinical use of the Kujala Anterior Knee Pain Scale (AKPS in orthopedics and sports medicine, few studies have reported on its reliability and no such studies have concentrated on child or adolescent samples exclusively, segments of the population for which this instrument is often used. The purpose of the current study was to describe and report on the reliability and validity of the AKPS for use with high school female athletes participating in interscholastic athletics. The study was a secondary analysis of prospective epidemiologic data using established scale validation methods. The records of 414 female athletes 11.0 to 18.1 years of age (Mean 13.9 yrs, SD = 1.7 yrs were used for analysis. Four different approaches to scoring and scale reduction of the AKPS were evaluated, including the original, ordinal 13-item form, a modified, ordinal 6-item form, a modified, dichotomous 13-item form, and a modified, dichotomous 6-item form. Three different types of reliability (internal consistency, equivalence across forms, standard error of measurement and one type of validity (criterion-related were estimated for the AKPS in the current sample. The four scoring formats of the AKPS scale were found to have high internal consistency (αcoef = 0.83 to 0.91, equivalence across the short and long forms (r = 0.98, acceptable standard errors of measurement (0.82 to 3.00, and moderate to high criterion related validity-as determined by physican's diagnosis: 0.92 (13-item form, 0.90 (6-item form. The Kujala AKPS is a valid and reliable measure of anterior knee pain and appropriate for use as an epidemiologic screening tool with adolescent female athletes.

  11. Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Papadopoulos, Costas; Constantinou, Antonis; Cheimonidou, Areti-Zoi; Stasinopoulos, Dimitrios

    2017-04-01

    To cross-culturally adapt and validate the Greek version of the Kujala anterior knee pain scale (KAKPS). The Greek KAKPS was translated from the original English version following standard forward and backward translation procedures. The survey was then conducted in clinical settings by a questionnaire comprising the Greek KAKPS and patellofemoral pain syndrome (PFPS) severity scale. A total of 130 (62 women and 68 men) Greek-reading patients between 18 and 45 years old with anterior knee pain (AKP) for at least four weeks were recruited from physical therapy clinics. To establish test-retest reliability, the patients were asked to complete the KAKPS at initial visit and 2-3 days after the initial visit. The Greek version of the PFPS severity scale was also administered once at initial visit. Internal consistency of the translated instrument was measured using Cronbach's α. An intraclass correlation coefficient was used to assess the test-retest reliability of the KAKPS. Concurrent validity was measured by correlating the KAKPS with the PFPS severity scale using Pearson's correlation coefficient. The results showed that the Greek KAKPS has good internal consistency (Cronbach's α = 0.942), test-retest reliability (ICC = 0.921) and concurrent validity (r > 0.7). This study has shown that the Greek KAKPS has good internal consistency, test-retest reliability and concurrent validity when correlated with the PFPS severity scale in adult patients with AKP for at least four weeks. Implications for rehabilitation The Greek version of the KAKPS has been found to be reliable and valid when used in adult patients with AKP for at least four weeks. The results of the psychometric characteristics were compatible with those of the original English version. The KAKPS could be applied in a Greek-speaking population to assess functional limitations and symptoms in patients aged 18-45 years old with AKP for at least four weeks.

  12. The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review.

    Science.gov (United States)

    Rooney, A; Wahba, A J; Smith, T O; Donell, S T

    2015-06-01

    Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy. The review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach. Twenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function. Truly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Effect of virgin olive oil versus piroxicam phonophoresis on exercise-induced anterior knee pain

    Directory of Open Access Journals (Sweden)

    Babak Nakhostin-Roohi

    2016-08-01

    Full Text Available Objective: The main purpose of this study was to evaluate the effects of virgin olive oil phonophoresis on female athletes' anterior knee pain (AKP. Materials and Methods: A double blinded randomized clinical trial was conducted. Ninety-three female athletes suffering from AKP voluntarily participated in this study. Patients were randomly assigned into olive oil (n=31, piroxicam (n=31 or base gel phonophoresis (n=31 groups. At the baseline visit, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC questionnaire was filled by subjects who were then treated with olive oil, piroxicam or pure phonophoresis for 12 sessions. After 6 and 12 sessions of physiotherapy, subjects filled the questionnaire again. Main outcomes were significant improvement in pain, stiffness, physical function, and total WOMAC scores. Results: Although, there was a significant reduction in symptoms of AKP at the end of the therapy in all groups (p< 0.05, but in olive oil group, this improvement was seen after 6 sessions of treatment (p< 0.001. A significant difference between olive oil group and piroxicam and/or phonophoresis group was observed after 6 sessions of therapy (p< 0.05. Conclusion: It could be proposed that phonophoresis with virgin olive oil is as effective as piroxicam gel on lowering WOMAC scores of AKP in female athletes and also has several beneficial properties including faster effect and shorter duration of therapy. The exact mechanism of beneficial action of virgin olive oil on AKP is not clear and requires further studies.

  14. The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain

    Directory of Open Access Journals (Sweden)

    Dominique C. Leibbrandt

    2017-03-01

    Full Text Available Background: Anterior knee pain (AKP or patellofemoral pain syndrome is common and may limit an individual’s ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded. Objectives: The aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP. Methods: A systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP. Results: Two systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment. Conclusion: A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.

  15. Analysis of patient-reported anterior knee pain scale: implications for scale development in children and adolescents

    Science.gov (United States)

    Barber Foss, Kim D.; Gupta, Resmi; Hewett, Timothy E.; Ittenbach, Richard F.

    2014-01-01

    Purpose The purpose of this investigation was to estimate and document the reliability and validity of the Anterior Knee Pain Scale (AKPS) and to estimate its relative prediction accuracy of anterior knee pain in young females. Methods Data from a prospective, epidemiologic study to diagnose patellofemoral knee pain among female athletes (n = 499) using the Anterior Knee Pain Scale (AKPS). Data were treated in 4 phases (descriptive phase, reliability phase, scale refinement phase) and a final validation stage that was focused on an effort to test and document the validation of the AKPS short form and perform head-to-head comparisons of the 6-item short form with the original, 13-item form. Results The AKPS was reduced from 13 items (αCoeff = 0.77, σSEM = 0.004) to 6 items (αCoeff = 0.78, σSEM = 0.004). Point-biserial correlations with patel-lofemoral pain diagnosis were comparable: r [498] = 0.70 (R2 = 0.49, short form) and r [498] = 0.71 (R2 = 0.51, long form), as was sensitivity: 84 % (short form) and 80 % (long form), and specificity: 89 % (short form) and 90 % (long form; AUC = 0.94 both). Conclusion The current analyses indicate that a subset of measures from the AKPS is responsive to patellofemoral pain symptoms and may support screening for related diagnoses. A simpler and quicker scale optimized for diagnostic accuracy could reduce the demand on patients, clinicians and research teams focused on the identification and management of patellofemoral pain. PMID:24781273

  16. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review

    Directory of Open Access Journals (Sweden)

    Thomas Martin J

    2010-09-01

    Full Text Available Abstract Background Patellofemoral osteoarthritis (PFOA is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP in younger adults and subsequent PFOA. Methods The search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to December 2009, reference lists of potentially eligible studies and selected reviews. Full text articles in any language, - identified via English titles and abstracts, were included if they were retrospective or prospective in design and contained quantitative data regarding structural changes indicative of PFOA, incident to original idiopathic AKP. Eligibility criteria were applied to titles, abstracts and full-texts by two independent reviewers. Data extraction included study location, design, date, sampling procedure, sample characteristics, AKP/PFOA definitions, follow-up duration and rate, and main findings. Foreign language articles were translated into English prior to examination. Results Seven articles satisfied eligibility (5 English, 2 German. Only one case-control study directly investigated a link between PFOA and prior AKP, providing level 3b evidence in favour of an association (OR 4.4; 95%CI 1.8, 10.6. Rough estimates of the annual risk of PFOA from the remaining six small, uncontrolled, observational studies (mean follow-up range: 5.7 to 23 years ranged from 0% to 3.4%. This was not the primary aim of these studies, and limitations in design and methodology mean this data should be interpreted with caution. Conclusions There is a paucity of high-quality evidence reporting a link between AKP and PFOA. Further, well-designed cohort studies may be able to fill this evidence gap.

  17. Secondary Patellar Resurfacing as a Rescue Procedure for Persistent Anterior Knee Pain After Primary Total Knee Arthroplasty: Do Our Patients Really Improve?

    Science.gov (United States)

    Toro-Ibarguen, Ainhoa Nekane; Navarro-Arribas, Rafael; Pretell-Mazzini, Juan; Prada-Cañizares, Alfonso Carlos; Jara-Sánchez, Fernando

    2016-07-01

    Secondary patellar resurfacing (SPR) is a procedure that can be used in patients with persistent anterior knee pain (AKP) after a primary total knee arthroplasty. The aim of our study was to analyze the clinical and functional outcomes as well as the complications of this procedure and identify predictive factors for a favorable outcome. Forty-six patients who underwent SPR for persistent AKP after primary total knee arthroplasty were retrospectively studied. The patient's mean age was 68 years (range, 36-86 years). The average follow-up time after SPR was 74 months (range, 24-197 months). Demographic data, Knee Society Score scale, range of motion, pain improvement (Visual Analogue Scale), overall satisfaction, and complications were recorded. The statistical analysis was performed using STATA tm/SE v10. There was an improvement of the Knee Society scale (from 54 ± 11 to 64 ± 16 points; P pain improvement, and 65% of patients were not satisfied. Four patients showed complications, and in 2 cases, reoperation was necessary. We did not find any preoperative predictive factor for a favorable outcome after SPR. Despite improvement of the Knee Society scale, many patients continue with AKP and are dissatisfied with this procedure; therefore, we do not recommend it in this clinical scenario. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Arthroscopic deepening trochleoplasty for chronic anterior knee pain after previous failed conservative and arthroscopic treatment. Report of two cases.

    Science.gov (United States)

    Blønd, Lars

    2017-01-01

    A proportion of patients having years of chronic anterior knee pain(AKP) that have not responded to non-operative modalities. Trochlear dysplasia have been found to be a cause for AKP. By restoring the anatomy with a trochleoplasty procedure the patellofemoral joint is unloaded. This study is a prospective 2year follow-up study, based on two cases with chronic AKP for several years and having severe trochlear dysplasia and both were successfully treated by arthroscopic deepening trochleoplasty. Case one was a 46year old women with chronic anterior knee pain (AKP). Imaging showed lateral trochlear inclination angle of 2°, trochlear asymmetry 0.36, central height 81% and medial height 83%. Thepreoperative Kujala score was 70 and Knee injury and Osteoarthritis Outcome Score (KOOS) subscale for pain was 67. Case two was a 26year old man troubled by AKP and knee knee joint effusion for >8years without any instability in the history. Imaging showed lateral trochlear inclination angle of 6°, trochlear asymmetry 0.25, central height 76% and medial height 78%. The preoperative Kujala score was 49 and KOOS subscale for pain was 72. The postoperative Kujala score was for case one 82 and for case two 81. The postoperative KOOS subscale for pain was for case one 89 and for case two 92. Improvement in the KOOS subscale for sport and recreational activities and quality of living were also found. This is the first case report to demonstrate that patient having had years of chronic AKP and trochlear dysplasia can be successfully treated by arthroscopic trochleoplasty. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing.

    Science.gov (United States)

    Jankovic, Andrija; Korac, Zelimir; Bozic, Nenad-Bozo; Stedul, Ivan

    2013-09-01

    We evaluated the incidence and aetiology of anterior knee pain (AKP) in a series of patients that underwent intramedullary nailing for stabilisation of tibial fractures. During the preparation of the entry site no excision of the infrapatellar fat was allowed and electrical haemostasis was kept at the lowest level. Medullary canal was reamed and the nails inserted in position of knee flexion over 100 degrees. All fractures were fixed using medial paratendinous approach. Functional outcome was measured using Lysholm knee score. The knee range of movement and return to previous level of activity were also documented and analysed. Mean follow up was 38.9 months (range 12-84 months). In total 60 patients with 62 tibial shaft fractures were analysed. The mean age at the time of final follow up was 49.4 years (range 20-87). In 22 (35.5%) a newly developed and persisting pain in the anterior region of the operated knee was reported. According to VAP scale, the pain was mild (VAS 1-3) in 12 cases (19.4%) and moderate (VAS 4-6) in 10 (16.1%). In 16 cases (73%) the pain was noticed 6-12 months after injury and subjectively related to return to full range of working and recreational activities. The mean Lysholm knee score in the group without AKP was 90.8. In the AKP group with mild pain it was 88.4 and in the group with moderate AKP it was 79.9. Complete return to previous professional and recreational activities occurred in 49/60 patients (81.7%). Content with the treatment regarding expectations in recovery dynamics and return to desired level of activity was present in 98.3% of patients; one patient was unsatisfied with the treatment. Our results indicate that respecting the physiological motion of Hoffa pad and menisci during knee flexion, accompanied with atraumatic mobilisation of retrotendinous fat, reduces incidence and severity of anterior knee pain following intramedullary fixation of tibial shaft fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    Science.gov (United States)

    Almeida, Gabriel Peixoto Leão; Carvalho E Silva, Ana Paula de Moura Campos; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. [The relationship between anterior knee pain occurring after tibial intramedullary nailing and the localization of the nail in the proximal tibia].

    Science.gov (United States)

    Uzümcügil, Onat; Doğan, Ahmet; Yalçinkaya, Merter; Kabukçuoğlu, Yavuz S

    2009-01-01

    We investigated the relationship between the development of postoperative anterior knee pain and the location of the nail in the proximal tibia in patients treated with locked intramedullary nailing for tibial diaphyseal fractures. Thirty patients were selected among those who underwent locked intramedullary nailing for tibial diaphyseal fractures, with exclusion of all other factors that might be associated with postoperative anterior knee pain. In all the patients, intramedullary nailing was performed using the transtendinous approach and both proximal and distal locking. The patients were evaluated in two groups: 10 patients (3 women, 7 men; mean age 38 + or - 14 years) had anterior knee pain, whereas 20 patients (5 women, 15 men; mean age 35 + or - 12 years) did not. The distances from the nail to the tibial plateau and anterior tibial cortex were measured on the lateral x-rays after a mean follow-up of 56.6 months and 45.2 months in patients with and without anterior knee pain, respectively. The two groups were similar with respect to gender and follow-up period (p>0.05). The mean distances from the nail to the tibial plateau and anterior tibial cortex were -11.5 + or - 7.9 mm and 3.7 + or - 5.4 mm, respectively, in patients with anterior knee pain. The corresponding distances were -8.8 + or - 7.3 mm and 6.5 + or - 4.7 mm in patients without knee pain. Neither of the distances showed a significant difference between the two groups (p>0.05). Our findings suggest that the distances from the nail to the tibial plateau and anterior tibial cortex do not have any role in the development of postoperative anterior knee pain.

  2. Gait metric profile of 157 patients suffering from anterior knee pain. A controlled study.

    Science.gov (United States)

    Assa, Tal; Elbaz, Avi; Mor, Amit; Chechik, Ofir; Morag, Guy; Salai, Moshe; Segal, Ganit; Haim, Amir

    2013-01-01

    Gait metric alterations have been previously reported in patients suffering from anterior knee pain (AKP). Characterization of simple and measureable gait parameters in these patients may be valuable for assessing disease severity as well as for follow-up. Previous gait studies in this population have been comprised of relatively small cohorts and the findings of these studies are not uniform. The objective of the present study was to examine spatio-temporal gait parameters in patients with AKP in comparison to symptom-free controls. Furthermore, the study aimed to examine the relationship between self-reported disease severity and the magnitude of gait abnormalities. 157 patients with AKP were identified and compared to 31 healthy controls. Patients were evaluated with a spatiotemporal gait analysis via a computerized mat, the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and the Short Form (SF)-36 health surveys. AKP patients walked with significantly lower velocity (15.9%) and cadence (5.9%), shorter step length (9.5%), stride length (9.6%), and showed significant differences in all gait cycle phases (Ppain (96%), functional limitation (94%), and poorer perception of mental quality of life (30%) (P<0.05 for all). Significant differences were found between the spatiotemporal gait profile of AKP patients and symptom-free matched controls. In addition, an association was found between subjective disease severity and gait abnormalities. These findings suggest the usefulness of gait parameters, alongside with the use of self-evaluation questionnaires, in identifying deviations of these patients from healthy population. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. Value of SPECT-CT Imaging for Middle-Aged Patients with Chronic Anterior Knee Pain.

    Science.gov (United States)

    Ro, Du Hyun; Lee, Ho-Young; Chang, Chong Bum; Kang, Seung-Baik

    2015-07-26

    Single-photon emission computed tomography-computed tomography (SPECT-CT) is a highly sensitive tool for detecting bone metabolism. We determined whether subchondral bone metabolism, as indicated by SPECT-CT in the patellofemoral (PF) joint, predicts response to conservative management in middle-aged patients with chronic anterior knee pain (AKP), and whether SPECT-CT results correlate with arthroscopic assessments of chondral lesions in the PF joint. The study group comprised 74 middle-aged patients with chronic AKP. All of the patients underwent SPECT-CT, and the results were graded along a scale of 0 to 3°. After 8 weeks of conservative management, they were grouped as responders (n = 40) or non-responders (n = 34) according to symptom improvement. We compared the median scintigraphic uptake of the PF joint between the two groups, and evaluated the positive predictive value (PPV) of uptake for treatment response in each patient. In non-responders, cartilage condition was assessed during arthroscopy, and the correlation of scintigraphic uptake with severity of the chondral lesion was assessed. The median scintigraphic uptake in the patella was higher in non-responders than in responders (2 vs. 1). Among patients with higher patella uptake (grade 2 or 3), the PPV for non-response to conservative therapy was 62-67 %, whereas it was 24-25 % in patients with lower uptake (grade 0 or 1). Patella uptake corresponded strongly with arthroscopic assessment of patellar chondral lesions; the correlation was less strong for the femoral trochlea. Increased subchondral bone metabolism in the patella is associated with responsiveness to conservative therapy. SPECT-CT can benefit clinicians by predicting the treatment response from conservative management.

  4. MRI evaluation of anterior knee pain: predicting response to nonoperative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Wittstein, Jocelyn R.; Garrett, William E. [Duke University Medical Center, Division of Orthopaedic Surgery, Durham, NC (United States); O' Brien, Seth D. [Brooke Army Medical Center, Department of Radiology, San Antonio, TX (United States); Vinson, Emily N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2009-09-15

    Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 {+-} 0.68, 13.01 {+-} 0.82, and 16.07 {+-} 1.16 mm, respectively (data are mean {+-} standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options. (orig.)

  5. Evaluation and management of knee pain in young athletes: overuse injuries of the knee

    OpenAIRE

    Patel, Dilip R.; Villalobos, Ana

    2017-01-01

    Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athlet...

  6. Acute Effects of Contract-Relax Stretching vs. TENS in Young Subjects With Anterior Knee Pain: A Randomized Controlled Trial.

    Science.gov (United States)

    Valenza, Marie C; Torres-Sánchez, Irene; Cabrera-Martos, Irene; Valenza-Demet, Gerald; Cano-Cappellacci, Marcelo

    2016-08-01

    Valenza, MC, Torres-Sánchez, I, Cabrera-Martos, I, Valenza-Demet, G, and Cano-Cappellacci, M. Acute effects of contract-relax stretching vs. TENS in young subjects with anterior knee pain: A randomized controlled trial. J Strength Cond Res 30(8): 2271-2278, 2016-The aim of this study was to examine the immediate effects on pressure point tenderness, range of motion (ROM), and vertical jump (VJ) of contract-relax stretching vs. transcutaneous electrical nerve stimulation (TENS) therapy in individuals with anterior knee pain (AKP). Eighty-four subjects with AKP were randomly assigned to 1 of 3 different intervention groups: a contract-relax stretching group (n = 28), a TENS intervention group (n = 28), and a control group (n = 28). The participants included in the sample were both sex (37.5% men vs. 62.5% women) at a mean age of 21 years, with mean values of height and weight of 169 cm and 64 kg, respectively. The main outcome measures were knee ROM, pressure pain threshold (PPT), and VJ. The participants were assessed at baseline and immediately after treatment. In the case of VJ, at baseline, immediately after the intervention, at 3 and at 6 minutes posttreatment. The data analysis showed that PPT scores of participants in the stretching and TENS group significantly increased from pretest to posttest (p ≤ 0.05). A significant increase pre- to posttreatment in ROM (p < 0.001) was also observed in both treatment groups. In VJ measures, TENS and stretching groups showed significant differences between preintervention and all postintervention values (p ≤ 0.05), whereas no significant differences were found in the control group. In conclusion, the results show significant pre-to-post-treatment effects in PPT, ROM, and VJ from both contract-relax stretching and TENS in young subjects with AKP.

  7. Knee pain (image)

    Science.gov (United States)

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  8. Anterior approach for knee arthrography

    International Nuclear Information System (INIS)

    Zurlo, J.V.; Towers, J.D.; Golla, S.

    2001-01-01

    Objective. To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy.Design. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected.Results and conclusion. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort. (orig.)

  9. Anterior knee pain following anterior cruciate ligament reconstruction does not increase the risk of patellofemoral osteoarthritis at 15- and 20-year follow-ups.

    Science.gov (United States)

    Culvenor, A G; Øiestad, B E; Holm, I; Gunderson, R B; Crossley, K M; Risberg, M A

    2017-01-01

    To prospectively evaluate the relationship between the presence or persistence of anterior knee pain (AKP) during the first 2-years following anterior cruciate ligament reconstruction (ACLR) and patellofemoral osteoarthritis (PFOA) at 15- and 20-years. This study was ancillary to a long-term prospective cohort study of 221 participants following bone-patellar-tendon-bone ACLR. AKP was assessed at 1- and 2-years post-ACLR using part of the Cincinnati knee score with an additional pain location question (persistence defined as presence at both follow-ups). Radiographic PFOA (definite patellofemoral osteophyte) and symptomatic PFOA (patellofemoral osteophyte, with knee pain during past 4 weeks) was assessed at 15- and 20-years follow-up. We used generalized linear models with Poisson regression to assess the relationship between AKP and PFOA. Of the 181 participants (82%) who were assessed at 15-years post-ACLR (age 39 ± 9 years; 42% female), 36 (24%) and 33 (22%) had AKP at 1- and 2-years, respectively, while 14 (8%) reported persistent AKP. Radiographic and symptomatic PFOA was observed at 15-years in 130 (72%) and 70 (39%) participants, respectively, and at 20-years in 115 (80%) and 60 (42%) participants, respectively. Neither the presence nor persistence of AKP at 1- and/or 2-years post-ACLR was associated with significantly higher risk of radiographic or symptomatic PFOA at 15- or 20-years (risk ratios <2.1). Although AKP and PFOA were prevalent, AKP does not appear to be associated with long-term PFOA following ACLR. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  10. Sports Specialization is Associated with An Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes

    Science.gov (United States)

    Hall, Randon; Foss, Kim Barber; Hewett, Timothy E.; Myer, Gregory D.

    2014-01-01

    Objectives This study sought to determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes. Design Retrospective cohort epidemiology study. Methods Female basketball, soccer and volleyball players (N=546) were recruited from a single county public school district in Kentucky consisting of five middle schools and four high schools. A total of 357 multi-sport, and 189 single sport (66 basketball, 57 soccer and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain on physical exam. Testing consisted of completion of a standardized history and physician-administered physical examination to determine the presence of patellofemoral pain (PFP). This study compared self-reported multi-sport athletes with sport specialized athletes participating in only one sport. The sports participation data was normalized by sport season with each sport accounting for one season of exposure. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multi-sport athletes. Results Specialization in a single sport increased the relative risk of PFP incidence by 1.5 fold (95% CI 1.0 to 2.2; p=0.038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/patellar tendinopathy (95% CI 1.5 to 10.1; p=0.005) and Osgood Schlatter Disease (95% CI 1.5 to 10.1; p=0.005) demonstrated a four-fold greater relative risk in single sport compared to multiple sport athletes. Other specific PFP diagnoses such as Fat Pad, Plica, Trauma, Pes Anserine Bursitis and IT Band Tendonitis incidence were not different between single sport and multiple sport participants (p>0.05). Conclusion Early sport specialization in female adolescents is associated with increased risk of anterior knee pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared to multi

  11. The relationship between pain catastrophizing, kinesiophobia and subjective knee function during rehabilitation following anterior cruciate ligament reconstruction and meniscectomy: A pilot study.

    Science.gov (United States)

    Tichonova, Ana; Rimdeikienė, Inesa; Petruševičienė, Daiva; Lendraitienė, Eglė

    2016-01-01

    Psychological responses to the initial injury and rehabilitation might be an important additional determinant of functional level outcomes after knee surgery. The objectives of this study were (1) to measure pain catastrophizing and kinesiophobia levels and (2) determine their association with self-reported subjective knee function during rehabilitation, following anterior cruciate ligament reconstruction (ACLR) and meniscectomy. The study involved 41 participants. The levels of catastrophizing (Pain Catastrophizing Scale [PCS]), kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]), pain (Numeric Pain Rating Scale [NRS]), and subjective knee function (the Knee Injury and Osteoarthritis Outcome Score [KOOS]) were assessed before and after completion of 14-session rehabilitation program. The mean level of catastrophizing changed from 5.8 (SD, 0.9) to 4.2 (SD, 0.5) during rehabilitation (Ppain, function in daily living, knee-related quality of life subscales before and after rehabilitation (PPain catastrophizing and kinesiophobia decreased during rehabilitation. A higher pain catastrophizing level correlated with a greater level of knee pain during activities, more difficulties experienced during daily activities before and after rehabilitation. A high level of kinesiophobia correlated with more difficulties experienced in daily activities and poorer knee-related quality of life before and after rehabilitation. Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  12. Traduction inter-culturelle et validation du Kujala Anterior Knee Pain Scale (AKPS) en français

    OpenAIRE

    Kaux, Jean-François; Bornheim, Stephen; Remy, Gaël; DELVAUX, François; Beaudart, Charlotte; Van Beveren, Julien; Croisier, Jean-Louis; Bruyère, Olivier

    2016-01-01

    Introduction : Le syndrome fémoro-patellaire est l'un des problèmes de genou les plus répandus qui se caractérise par une douleur antérieure du genou dans des activités mettant en charge l'articulation fémoro-patellaire. Le Kuala Anterior Knee Pain Scale (Kujala AKPS) est un questionnaire utilisé pour évaluer les symptômes subjectifs, tels que les limitations fonctionnelles et la douleur antérieure du genou. Le questionnaire a déjà été traduit et validé en portugais brésilien, en persan, en c...

  13. Effects of Experimental Anterior Knee Pain on Muscle Activation During Landing and Jumping Performed at Various Intensities.

    Science.gov (United States)

    Park, Jihong; Denning, W Matt; Pitt, Jordan D; Francom, Devin; Hopkins, J Ty; Seeley, Matthew K

    2017-01-01

    Although knee pain is common, some facets of this pain are unclear. The independent effects (ie, independent from other knee injury or pathology) of knee pain on neural activation of lower-extremity muscles during landing and jumping have not been observed. To investigate the independent effects of knee pain on lower-extremity muscle (gastrocnemius, vastus medialis, medial hamstrings, gluteus medius, and gluteus maximus) activation amplitude during landing and jumping, performed at 2 different intensities. Laboratory-based, pretest, posttest, repeated-measures design, where all subjects performed both data-collection sessions. Thirteen able-bodied subjects performed 2 different land and jump tasks (forward and lateral) under 2 different conditions (control and pain), at 2 different intensities (high and low). For the pain condition, experimental knee pain was induced via a hypertonic saline injection into the right infrapatellar fat pad. Functional linear models were used to evaluate the influence of experimental knee pain on muscle-activation amplitude throughout the 2 land and jump tasks. Experimental knee pain independently altered activation for all of the observed muscles during various parts of the 2 different land and jump tasks. These activation alterations were not consistently influenced by task intensity. Experimental knee pain alters activation amplitude of various lower-extremity muscles during landing and jumping. The nature of the alteration varies between muscles, intensities, and phases of the movement (ie, landing and jumping). Generally, experimental knee pain inhibits the gastrocnemius, medial hamstring, and gluteus medius during landing while independently increasing activation of the same muscles during jumping.

  14. Anterior knee pain without trauma in the ER: Chronic Osgood-Schlatter disease in an adult patient

    OpenAIRE

    Ertan, Cem; Ertan, Dilek

    2014-01-01

    AbstractOsgood-Sclatter’s disease is the apophysitis of the tibial tuberosity and is a common disease of the adolescents. It causes knee pain and may result in enlargement of the tuber tibialis. Here we present a 39 years old male patient with knee pain and no recent trauma who ended up with diagnosis of Osgood-Sclatter’s disease.Key words: Osgood–Schlatter disease , knee pain ÖzetOsgood-Sclatter hastalığı tuberositasis tibia’nın apofiziti olup, ergenlerde sık görülen bir durumdur. Diz ağrısı...

  15. Lumbar manipulation and exercise in the management of anterior knee pain and diminished quadriceps activation following acl reconstruction: a case report.

    Science.gov (United States)

    Jayaseelan, Dhinu J; Courtney, Carol A; Kecman, Michael; Alcorn, Daniel

    2014-12-01

    Quadriceps weakness is a common finding following knee injuries or surgery, and can be associated with significant functional limitations. This weakness or muscle inhibition may be due to central inhibitory mechanisms, rather than local peripheral dysfunction. Lumbopelvic manipulation has been shown to effect efferent muscle output by altering nociceptive processing. The purpose of this report is to describe the physical therapy management of anterior knee pain and chronic quadriceps weakness utilizing side-lying rotational lumbar thrust manipulation and therapeutic exercise for an individual eight months status-post ACL reconstruction. A 20 year-old male presented to physical therapy eight months following anterior cruciate ligament (ACL) reconstruction of the left knee with primary complaints of residual anterior knee pain and quadriceps weakness. The subject was treated with a multimodal approach using side-lying rotational lumbar thrust manipulation in addition to therapeutic exercise. The subject was seen in physical therapy for eight sessions over eight weeks. Lower Extremity Functional Scale (LEFS) scores improved from 58/80 to 72/80, quadriceps force, measured by hand-held dynamometry (HHD), was improved from 70.6 lbs to 93.5 lbs and the subject was able to return to pain free participation in recreational sports. Therapeutic exercises can facilitate improved quadriceps strength, however, in cases where quadriceps weakness persists and there is concurrent pain, other interventions should be considered. In this case, lower quarter stabilization exercise and lumbar thrust manipulation was associated with improved functional outcomes in a subject with anterior knee pain and quadriceps weakness. Side-lying rotational lumbar thrust manipulation may be a beneficial adjunctive intervention to exercise in subjects with quadriceps weakness. 5, Single case report.

  16. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K

    2012-01-01

    imaging (MRI) scan was performed shortly after the injury, and at 2 weeks, 1 month and 2 months. The patients reported the level of pain every day and filled in a Knee injury and Osteoarthritis Outcome Score sheet in connection with MRI. For every MRI of the knee, volume of bone bruise was calculated...

  17. Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty: a 15-year follow-up.

    Science.gov (United States)

    Hamilton, T W; Pandit, H G; Maurer, D G; Ostlere, S J; Jenkins, C; Mellon, S J; Dodd, C A F; Murray, D W

    2017-05-01

    It is not clear whether anterior knee pain and osteoarthritis (OA) of the patellofemoral joint (PFJ) are contraindications to medial unicompartmental knee arthroplasty (UKA). Our aim was to investigate the long-term outcome of a consecutive series of patients, some of whom had anterior knee pain and PFJ OA managed with UKA. We assessed the ten-year functional outcomes and 15-year implant survival of 805 knees (677 patients) following medial mobile-bearing UKA. The intra-operative status of the PFJ was documented and, with the exception of bone loss with grooving to the lateral side, neither the clinical or radiological state of the PFJ nor the presence of anterior knee pain were considered a contraindication. The impact of radiographic findings and anterior knee pain was studied in a subgroup of 100 knees (91 patients). There was no relationship between functional outcomes, at a mean of ten years, or 15-year implant survival, and pre-operative anterior knee pain, or the presence or degree of cartilage loss documented intra-operatively at the medial patella or trochlea, or radiographic evidence of OA in the medial side of the PFJ. In 6% of cases there was full thickness cartilage loss on the lateral side of the patella. In these cases, the overall ten-year function and 15-year survival was similar to those without cartilage loss; however they had slightly more difficulty with descending stairs. Radiographic signs of OA seen in the lateral part of the PFJ were not associated with a definite compromise in functional outcome or implant survival. Severe damage to the lateral side of the PFJ with bone loss and grooving remains a contraindication to mobile-bearing UKA. Less severe damage to the lateral side of the PFJ and damage to the medial side, however severe, does not compromise the overall function or survival, so should not be considered to be a contraindication. However, if a patient does have full thickness cartilage loss on the lateral side of the PFJ they may

  18. Evaluation and management of knee pain in young athletes: overuse injuries of the knee.

    Science.gov (United States)

    Patel, Dilip R; Villalobos, Ana

    2017-07-01

    Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athletes, the most common underlying reason is overuse injury. In this paper, we have reviewed selected conditions that case knee pain in athletes, including anterior knee pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johanssen syndrome, juvenile osteochondritis dissecans (JOCD), bipartite patella, plica syndrome, and tendonitis around the knee.

  19. Medial release and lateral imbrication for intractable anterior knee pain: diagnostic process, technique, and results

    OpenAIRE

    Reed, Jeremy; Meldrum,Alexander; Dash,Megan

    2015-01-01

    Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbric...

  20. Nonsurgical Management of Knee Pain in Adults.

    Science.gov (United States)

    Jones, Brandon Q; Covey, Carlton J; Sineath, Marvin H

    2015-11-15

    The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis.

  1. LINGUISTIC AND CULTURAL ADAPTATION AND VALIDATION OF THE KUJALA QUESTIONNAIRE AMONG PATIENTS WITH PAIN IN THE ANTERIOR PART OF KNEE JOINT

    Directory of Open Access Journals (Sweden)

    I. A. Kuznetsov

    2017-01-01

    Full Text Available Objective: to carry out linguistic and cultural adaptation and validation of the Kujala questionnaire that is today one of the most popular orthopedic tools used to evaluate the severity of pain in the anterior part of knee joint.Subjects and methods. In accordance with protocols on this type of investigations, the questionnaire was first translated directly and then back. Furthermore, an intermediate Russian-language version of the Kujala questionnaire was tested in 15 patients, followed by error correction and approval of its final Russian-language version. A study group included 50 patients who complained of obvious pain in the anterior part of knee joint and answered the questionnaire twice (for its test-retest reliability every two or three days.Results and discussion. The intraclass correlation coefficient (ICC equal to 0.948 (95% confidence interval, 0.025–0.967 indicated a high test-retest reliability of the Russian-language version of the Kujala questionnaire. Cronbach's alpha coefficient of 0.956 corresponded to a high level of internal consistency, which also suggested that the proposed version of the questionnaire had a high reliability. The criterion-related validity assessment, by calculating the Spearman correlation coefficient between the results of primary and repeated surveys using the Russian-language version of the Kujala questionnaire, as well as between the Russian- language versions of the Kujala questionnaire and the SF-36, showed their high correlation.Conclusion. The findings indicate that the Russian-language version of the Kujala questionnaire is a valid and reliable tool for subjective assessment of the severity of pain in the anterior part of knee joint.

  2. Knee pain in competitive swimming.

    Science.gov (United States)

    Rodeo, S A

    1999-04-01

    The high volume of training in competitive swimming results in cumulative overload injuries. Knee pain ranks second to shoulder pain as a common complaint in competitive swimmers. Most knee pain occurs on the medial side of the knee and, most commonly, in breaststroke swimmers; however, knee pain may accompany all strokes. This article reviews the incidence of knee pain, the biomechanic and anatomic factors predisposing to injury, specific injury patterns, injury diagnosis, and the treatment and prevention of injury to the knee in swimmers.

  3. An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain.

    Science.gov (United States)

    Patil, Sunit; Dixon, John; White, Lisa C; Jones, Alex P; Hui, Anthony C W

    2011-10-01

    Idiopathic anterior knee pain in teenagers and young adults is a common condition. Patellar maltracking has been considered as a causative factor. The aim of our study was to investigate whether there was a difference in the timing of electromyographic (EMG) activity in the medial and lateral hamstring and quadriceps muscles of patients with anterior knee pain compared to asymptomatic control participants. This was a cross sectional observational study measuring EMG activation patterns. Two groups of participants were tested, one patient (mean age 15 years, n = 20) and one asymptomatic control (mean age 16 years, n = 17). Surface EMG (sampling rate 1000 Hz) was recorded from vastus medialis obliqus, vastus lateralis, and the medial and lateral hamstrings during three repetitions of maximal voluntary isometric contractions. The relative timing of the medial and lateral quadriceps and hamstrings was evaluated. The mean (95% confidence interval) difference between the groups in the lateral-medial hamstring onset timing was 53.8(1.9 to 105.6)ms during the maximal contraction. An independent t test showed that this difference was statistically significant (p = 0.043). The differences between the groups in the relative VMO to VL onset did not reach statistical significance. The results of this study suggest that the lateral hamstrings contract significantly earlier in patients with AKP compared to healthy controls for this small cohort. This altered activation pattern could produce external rotation of the tibia on the femur and cause lateral patella tracking. Copyright © 2010 Elsevier B.V. All rights reserved.

  4. Magnification bone scan of knees for knee pain evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myoung Hoon; Park, Chan H.; Yoon, Seok Nam; Hwang, Kyung Hoon [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    2001-07-01

    Knee pain is one of the common complaints of patients seen in our orthopedic clinic. Routine anterior and posterior views of whole body bone scan (WBBS) is often not sufficient in the evaluation of these patients. An ideal bone scan using pinhole collimator or single photon emission tomography (SPECT), however, is impractical and time consuming in busy nuclear medicine department with limited resources. Therefore, the aim of the study is to assess limited bone scan of knees with magnification (LNSKM) for knee pain evaluation. Technical aspect of LBSKM and diagnostic efficacy are discussed on this poster. Adult patients with knee pain were reffered for LBSKM from an orthopedic surgen specializing knees. Four hundred fifteen LBSKMs were performed since 1999. patients were given 740 MBq (20mCi) Tc-99m MDP intravenously and 3 hours later LBSKM was performed using a low energy high resolution parallel hole collimator and Siemens Orbitor camera. (Simens medical systems. Inc., Hoffman Estates, III., USA). Anterior view of the knees was taken for 5 min, without magnification and both lateral views of symptomatic knees were obtained with electronic magnification (1.25, upto 2.0) for 8 min each. Disease processes such as DJD, traumatic arthritis, P-F tendonitis, SONK, meniscus tear are detected and illustrated along with normal knee scan finding. We believe LBSKM may not be as good as SPECT or pinhole imaging of the knees in the evaluation of knee pain but superior to routine WBBS in the nuclear medicine department with limited resources of instrumentation and manpower.

  5. The relationship between pain catastrophizing, kinesiophobia and subjective knee function during rehabilitation following anterior cruciate ligament reconstruction and meniscectomy: A pilot study

    Directory of Open Access Journals (Sweden)

    Ana Tichonova

    2016-01-01

    Conclusions: Pain catastrophizing and kinesiophobia decreased during rehabilitation. A higher pain catastrophizing level correlated with a greater level of knee pain during activities, more difficulties experienced during daily activities before and after rehabilitation. A high level of kinesiophobia correlated with more difficulties experienced in daily activities and poorer knee-related quality of life before and after rehabilitation.

  6. Limb symmetry during double-leg squats and single-leg squats on land and in water in adults with long-standing unilateral anterior knee pain; a cross sectional study.

    Science.gov (United States)

    Severin, Anna C; Burkett, Brendan J; McKean, Mark R; Wiegand, Aaron N; Sayers, Mark G L

    2017-01-01

    The presence of pain during movement typically results in changes in technique. However, the physical properties of water, such as flotation, means that water-based exercise may not only reduce compensatory movement patterns but also allow pain sufferers to complete exercises that they are unable to perform on land. The purpose of this study was to assess bilateral kinematics during double-leg squats and single-leg squats on land and in water in individuals with unilateral anterior knee pain. A secondary aim was to quantify bilateral asymmetry in both environments in affected and unaffected individuals using a symmetry index. Twenty individuals with unilateral knee pain and twenty healthy, matched controls performed body weight double- and single-leg squats in both environments while inertial sensors (100 Hz) recorded trunk and lower body kinematics. Repeated-measures statistics tested for environmental effects on movement depths and peak angles within the anterior knee pain group. Differences in their inter-limb symmetry in each environments was compared to the control group using analysis of variance tests. Water immersion allowed for greater movement depths during both exercises (double-leg squat: +7 cm, p  = 0.032, single-leg squat: +9 cm, p  = 0.002) for the knee pain group. The double-leg squat was symmetrical on land but water immersion revealed asymmetries in the lower body frontal plane movements. The single-leg squat revealed decreased hip flexion and frontal plane shank motions on the affected limb in both environments. Water immersion also affected the degree of lower limb asymmetry in both groups, with differences also showing between groups. Individuals with anterior knee pain achieved increased squat depth during both exercises whilst in water. Kinematic differences between the affected and unaffected limbs were often increased in water. Individuals with unilateral anterior knee pain appear to utilise different kinematics in the affected

  7. Kissing knees - factors behind the attraction. Knee abduction in individuals with anterior cruciate ligament injury.

    OpenAIRE

    Cronström, Anna

    2017-01-01

    Anterior cruciate ligament (ACL) injury and patellofemoral pain (PFP) are common sports-related knee injuries. Their consequences include compromised health of the effected individual and substantial financial costs for society. Increased knee abduction or a knee medial to foot position (KMFP), so called “kissing knees”, during weight-bearing activities is reported to be more common in patients with ACL injury or PFP than in non-injured individuals and is also reported to be associated with g...

  8. HIGH REPETITION JUMP TRAINING COUPLED WITH BODY WEIGHT SUPPORT IN A PATIENT WITH KNEE PAIN AND PRIOR HISTORY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORT.

    Science.gov (United States)

    Elias, Audrey R C; Kinney, Anthony E; Mizner, Ryan L

    2015-12-01

    Patients frequently experience long-term deficits in functional activity following anterior cruciate ligament reconstruction, and commonly present with decreased confidence and poor weight acceptance in the surgical knee. Adaptation of neuromuscular behaviors may be possible through plyometric training. Body weight support decreases intensity of landing sufficiently to allow increased training repetition. The purpose of this case report is to report the outcomes of a subject with a previous history of anterior cruciate ligament (ACL) reconstruction treated with high repetition jump training coupled with body weight support (BWS) as a primary intervention strategy. A 23-year old female, who had right ACL reconstruction seven years prior, presented with anterior knee pain and effusion following initiation of a running program. Following visual assessment of poor mechanics in single leg closed chain activities, landing mechanics were assessed using 3-D motion analysis of single leg landing off a 20 cm box. She then participated in an eight-week plyometric training program using a custom-designed body weight support system. The International Knee Documentation Committee Subjective Knee Form (IKDC) and the ACL-Return to Sport Index (ACL-RSI) were administered at the start and end of treatment as well as at follow-up testing. The subject's IKDC and ACL-RSI scores increased with training from 68% and 43% to 90% and 84%, respectively, and were retained at follow-up testing. Peak knee and hip flexion angles during landing increased from 47 ° and 53 ° to 72 ° and 80 ° respectively. Vertical ground reaction forces in landing decreased with training from 3.8 N/kg to 3.2 N/kg. All changes were retained two months following completion of training. The subject experienced meaningful changes in overall function. Retention of mechanical changes suggests that her new landing strategy had become a habitual pattern. Success with high volume plyometric training is

  9. [A man with a painful knee with restricted flexion

    NARCIS (Netherlands)

    Valkering, L.J.; Zengerink, M.; Kampen, A. van

    2015-01-01

    A 39-year-old man presented with knee pain and limited knee flexion. MRI showed a mucoid degeneration of the anterior cruciate ligament (celery stalk sign). This rare condition can be treated with arthroscopic debridement with volume reduction of the anterior cruciate ligament. In severe cases,

  10. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders

    1998-01-01

    and with weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation. CONCLUSIONS: Knee...... pain is a common symptom in athletes. The prevalence is associated with the type, amount and duration of sports participation....

  11. Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study.

    Science.gov (United States)

    Dunn, Warren R; Spindler, Kurt P; Amendola, Annunziato; Andrish, Jack T; Kaeding, Christopher C; Marx, Robert G; McCarty, Eric C; Parker, Richard D; Harrell, Frank E; An, Angel Q; Wright, Rick W; Brophy, Robert H; Matava, Matthew J; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Wolcott, Michelle L; Vidal, Armando F; Wolf, Brian R

    2010-09-01

    Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years. A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors. Cohort study (prevalence); Level of evidence, 2. In 2007, the Multicenter Orthopaedic Outcomes Network (MOON) database began to prospectively collect surgeon-reported magnetic resonance imaging bone bruise status. A multivariable analysis was performed to (1) determine if a bone bruise, among other preoperative factors, is associated with more knee symptoms/pain and (2) examine the association of factors related to bone bruise. To evaluate the association of a bone bruise with knee pain/symptoms, linear multiple regression models were fit using the continuous scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscales and the Short Form 36 (SF-36) bodily pain subscale as dependent variables. To examine the association between a bone bruise and risk factors, a logistic regression model was used, in which the dependent variable was the presence or absence of a bone bruise. Baseline data for 525 patients were used for analysis, and a bone bruise was present in 419 (80%). The cohort comprises 58% male patients, with a median age of 23 years. The median Marx activity level was 13. Factors associated with more pain were higher body mass index (P pain at the time of index anterior cruciate ligament reconstruction. None of the factors included in the SF-36 bodily pain model were found to be significant. After controlling for other baseline factors, the following factors were associated with a bone bruise: younger age (P = .034) and not jumping at the time of injury (P = .006

  12. Effects of Lumbar Core Stability Exercise Programme on Knee Pain, Range of Motion, and Function Post Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Priyanka Panchal

    2017-12-01

    Conclusion: Institutional conventional exercise protocol is effective in reducing pain and improving the ROM post and lumbar core stability exercise programme is effective in improving function, post ACL reconstruction.

  13. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait.

    Science.gov (United States)

    Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T; Li, Guoan; Lewis, Cara L

    2017-01-01

    Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis.

  14. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait.

    Directory of Open Access Journals (Sweden)

    Jing-Sheng Li

    Full Text Available Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis.

  15. Anterior cingulotomy for intractable pain

    Directory of Open Access Journals (Sweden)

    Nitin Agarwal, MD

    2016-12-01

    Full Text Available Conservative therapy is often the first-line treatment for many symptoms of various disease processes, including pain. Nevertheless, if pharmacological or medical management fails for those patients with severe and chronic pain, a surgical strategy may be a reasonable option. First performed for psychiatric disorders, cingulotomy now has been recognized as a viable option for the management of pain. The authors review the literature on anterior cingulotomy for intractable pain to provide guidelines for management and expected outcomes.

  16. Experimental knee pain reduces muscle strength

    DEFF Research Database (Denmark)

    Henriksen, Marius; Mortensen, Sara Rosager; Aaboe, Jens

    2011-01-01

    Pain is the principal symptom in knee pathologies and reduced muscle strength is a common observation among knee patients. However, the relationship between knee joint pain and muscle strength remains to be clarified. This study aimed at investigating the changes in knee muscle strength following...... experimental knee pain in healthy volunteers, and if these changes were associated with the pain intensities. In a crossover study, 18 healthy subjects were tested on 2 different days. Using an isokinetic dynamometer, maximal muscle strength in knee extension and flexion was measured at angular velocities 0....... Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P muscle strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension...

  17. Knee orthoses for treating patellofemoral pain syndrome.

    Science.gov (United States)

    Smith, Toby O; Drew, Benjamin T; Meek, Toby H; Clark, Allan B

    2015-12-08

    Patellofemoral pain syndrome (PFPS) is a painful musculoskeletal condition, which is characterised by knee pain located in the anterior aspect (front) and retropatellar region (behind) of the knee joint. Various non-operative interventions are suggested for the treatment of this condition. Knee orthoses (knee braces, sleeves, straps or bandages) are worn over the knee and are thought to help reduce knee pain. They can be used in isolation or in addition to other treatments such as exercise or non-steroidal anti-inflammatory medications. To assess the effects (benefits and harms) of knee orthoses (knee braces, sleeves, straps or bandages) for treating PFPS. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (11 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 5), MEDLINE (1946 to 8 May 2015), EMBASE (1980 to 2015 Week 18), SPORTDiscus (1985 to 11 May 2015), AMED (1985 to 8 May 2015), CINAHL (1937 to 11 May 2015), PEDro (1929 to June 2015), trial registries and conference proceedings. Randomised and quasi-randomised controlled clinical trials evaluating knee orthoses for treating people with PFPS. Our primary outcomes were pain and function. Two review authors independently assessed studies for eligibility, assessed study risk of bias and extracted data. We calculated mean differences (MD) or, where pooling data from different scales, standardised mean differences (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% CIs for binary outcomes. We pooled data using the fixed-effect model. We included five trials (one of which was quasi-randomised) that reported results for 368 people who had PFPS. Participants were recruited from health clinics in three trials and were military recruits undergoing training in the other two trials. Although no trials recruited participants who were categorised as elite or professional athletes, military training

  18. An Intact Anterior Cruciate Ligament at the Time of Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty Was Associated With Reduced Patient Satisfaction and Inferior Pain and Stair Function.

    Science.gov (United States)

    Jacobs, Cale A; Christensen, Christian P; Karthikeyan, Tharun

    2016-08-01

    Patients with an intact anterior cruciate ligament (ACL) at the time of ACL-sacrificing total knee arthroplasty (TKA) have been suggested to have inferior outcomes compared with those with a dysfunctional ACL. However, to date, no published clinical studies have evaluated the potential link between the condition of the ACL at the time of posterior cruciate ligament-retaining TKA and postoperative pain, function, and satisfaction. As such, the purpose of this study was to compare subjective function, movement-elicited pain, pain at rest, and patient satisfaction between those with an intact or dysfunctional ACL. We identified 562 posterior cruciate ligament-retaining TKAs with complete intraoperative and postoperative data. Patients were categorized based on the condition of the ACL at the time of TKA as either being intact or dysfunctional (absent or lax). Knee Society Function Scores, movement-elicited pain, pain at rest, and patient satisfaction were then compared between groups. At mean follow-up of 5.1 years, a significantly lower proportion of patients in the intact group were satisfied with their operation (intact: 391/453 [86.3%] vs dysfunctional: 102/109 [93.6%], P = .0496). Inspection of the individual activities revealed that the groups did not differ in walking ability or pain when walking; however, the intact group reported significantly reduced ability to navigate stairs with greater pain during that activity. The lack of difference in pain at rest between groups suggests that pain and functional impairments during more demanding activities such as navigating stairs may be associated with the lost function of the ACL rather than by altered central pain processing. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Role of MRI in evaluation of painful knee

    Directory of Open Access Journals (Sweden)

    Rajpal Yadav, Sushil G Kachewar

    2014-03-01

    Full Text Available Introduction: Requests for knee Magnetic Resonance Imaging (MRI are most often made when the patient presents with a painful knee. This pain might be due to trauma or infection or inflammation. Complete clinical examination is not possible in such situations as the patients cannot co-operate due to severe pain. There comes the role of noninvasive multiplanar imaging. Hence this study was undertaken to evaluate how MRI can evaluate painful knee. Methods: 50 consecutive patients who were referred for MRI evaluation of painful knee were included in this study. Specific findings that explained the cause of pain were compiled. Results: In this present study of 50 patients, and 17 were females (34% and 33 were males (66%.The mean age was 36.70± 13.14 years. Traumatic causes outnumbered non traumatic etiologies of painful knee. Injury to the anterior cruciate ligament (ACL was the commonest soft tissue abnormality encountered. Partial tears were more common than complete tears. Tibial attachment was commonly affected than femoral attachment. Injured posterior horn of the medial meniscus and medial collateral ligament, were the commonest associated findings. Conclusion: MRI evaluation in patients with painful knee is of vital importance, as MRI can demonstrate the exact nature and extent of bony as well as soft tissue abnormality. Multiplanar imaging capacity and noninvasive nature of MRI enable a satisfactory diagnosis in such patients in whom a complete clinical examination is almost impossible due to pain.

  20. Septic arthritis of the knee following anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Matjaz Sajovic

    2009-04-01

    Full Text Available Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23% with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks, bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.

  1. Reconstruction of the anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Nikolić Dragan

    2006-01-01

    Full Text Available Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type. In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG or a graft of the patellar ligament (B-Pt-B. Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft in 139 of the knees. Chronic injuries were revealed in 132 (94.9% of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9% of the knees, pain in 72 (51.7%, effluents in 24 (17.2%, and blockages in 13 (9.3%. Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in

  2. Experimental knee pain evoke spreading hyperalgesia and facilitated temporal summation of pain

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Henriksen, Marius; Danneskiold-Samsøe, Bente

    2013-01-01

    OBJECTIVES: This study evaluated the deep-tissue pressure pain sensitivity and temporal summation of pain within and around healthy knees exposed to experimental pain. DESIGN: The study was designed as a randomized crossover trial, with each subject tested on 1 day. SETTING: All tests were carried...... occasions: baseline, immediately after the injection, and when pain had vanished. Assessments sites were located in the peripatellar region, vastus lateralis, and tibialis anterior muscles. RESULTS: The experimental knee pain model demonstrated 1) hyperalgesia to pressure stimulation on the infrapatellar...... fat pad during experimental pain, and 2) facilitated temporal summation of pressure pain at the infrapatellar fat pad and knee-related muscles. CONCLUSION: The increased sensitivity and temporal summation found in this study were exclusive to deep -tissue with no contralateral decreased pain...

  3. Intramedullary Tibial Nailing Reduces the Attachment Area and Ultimate Load of the Anterior Medial Meniscal Root: A Potential Explanation for Anterior Knee Pain in Female Patients and Smaller Patients.

    Science.gov (United States)

    LaPrade, Matthew D; LaPrade, Christopher M; Hamming, Mark G; Ellman, Michael B; Turnbull, Travis Lee; Rasmussen, Matthew T; Wijdicks, Coen A; LaPrade, Robert F

    2015-07-01

    Intramedullary (IM) nailing is the treatment of choice among orthopaedic surgeons for tibial shaft fractures. However, because of the close proximity of the nail's insertion site to the anterior medial (AM) meniscal root on the tibial plateau, there is increased risk of iatrogenic injury to the meniscal root during nailing. To quantify the area of the AM meniscal root footprint damaged by IM tibial reaming and determine its subsequent effects on the ultimate failure load in female versus male knees. Controlled laboratory study. Twelve matched pairs (6 male and 6 female pairs; average age, 50.2 years) of human cadaveric knees were randomly assigned to native and reamed groups. In the reamed group, knees were reamed within the "safe zone" according to current guidelines for IM tibial nail insertion (3 mm lateral to the center of the tibial tubercle and adjacent to the anterior margin of the tibial plateau). The attachment areas and ultimate failure load were quantified and compared with paired knees in the native group. Intra-articular reaming within the "safe zone" for IM tibial nail insertion did not significantly decrease the AM root attachment area or ultimate failure load in male specimens, as only 2 of the 6 knees were damaged by reaming. In contrast, all 6 of the AM roots in the female knees were damaged by reaming, and on average, reaming decreased the female AM root attachment area by 19% and significantly decreased ultimate failure load by 37% (P = .028). There was a strong negative correlation (R(2) = 0.77) between reamed tunnel-AM root overlap area and medial-lateral width in female but not in male knees. Standard reaming for an IM tibial nail induced significant damage to the AM meniscal root in smaller, female specimens, whereas larger, male specimens were not affected. These findings may suggest that improvements in current guidelines and surgical techniques are warranted to prevent iatrogenic injury to the AM meniscal root during intramedullary

  4. Clinical characteristics of pain originating from intra-articular structures of the knee joint in patients with medial knee osteoarthritis.

    Science.gov (United States)

    Ikeuchi, Masahiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Tani, Toshikazu

    2013-01-01

    Although disease progression of osteoarthritis has been well documented, pain pathophysiology is largely unknown. This study was designed with two purposes: 1) to characterize patients with knee pain predominantly originating from intra-articular structures and 2) to describe the location and pattern of their pain. 103 patients with medial knee osteoarthritis underwent an intra-articular injection of local anesthetics (joint block). At least 70% pain relief was defined as positive for the joint block, while less than 50% as negative. Pain characteristics in patients positive for joint block were evaluated in detail using a knee pain map. Sixty three knees (61%) were positive and 33 knees (32%) were negative. Patients negative for the joint block were significantly higher age, suffered for longer time, and complained more diffuse pain. Although pain at anterior medial area during walk was the most common finding, pain characteristics differed among different knee areas. The characteristics of joint pain are widely variable even in patients with similar radiological features. Extra-articular sources are not negligible especially in older patients with a long history of diffuse pain. Differences in pain characteristics among knee areas should be taken into account when examining the pain source.

  5. Is impaired knee confidence related to worse kinesiophobia, symptoms, and physical function in people with knee osteoarthritis after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Hart, Harvi F; Collins, Natalie J; Ackland, David C; Crossley, Kay M

    2015-09-01

    To compare knee confidence and kinesiophobia (fear of re-injury) in those with and without knee osteoarthritis following anterior cruciate ligament reconstruction, and determine whether poorer knee confidence is associated with greater kinesiophobia, worse knee-related symptoms, and functional impairments in those with knee osteoarthritis. Cross-sectional. Sixty-six individuals, 5-12 years following anterior cruciate ligament reconstruction, with (n=30) and without (n=36) knee osteoarthritis were included. Knee injury and Osteoarthritis Outcome Score quality-of-life question (Q3), assessed knee confidence and Tampa Scale of Kinesiophobia assessed kinesiophobia. In the osteoarthritis group, knee-related symptoms (International Knee Documentation Committee and Anterior Knee Pain Scale), self-reported function (Knee injury and Osteoarthritis Outcome Score activities daily living), sport/recreation (Knee injury and Osteoarthritis Outcome Score-sport and recreation), and performance-based function (hopping, one leg rise tasks) were assessed. Between-group differences in knee confidence and kinesiophobia were evaluated with the Chi square test and analysis of variance, respectively. In the osteoarthritis group, between-group differences (none, mild/moderate and severe/extreme problems with knee confidence) in kinesiophobia, symptoms and function were determined with analysis of variances: pconfidence (p=0.010) and greater kinesiophobia (p=0.006) than those without osteoarthritis. In those with knee osteoarthritis, poorer knee confidence was significantly associated with worse symptoms (Anterior Knee Pain Scale, p=0.001; International Knee Documentation Committee, p<0.001), kinesiophobia (p=0.030), Knee injury and Osteoarthritis Outcome Score-activities of daily living (p=0.005), Knee injury and Osteoarthritis Outcome Score-sport and recreation (p=0.001), single-leg hop (p=0.011), side-to-side hop (p=0.013) and one leg rise (p=0.001). Psychological impairments are evident

  6. Slightly flexed knee position within a standard knee coil: MR delineation of the anterior cruciate ligament

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    Niitsu, M.; Itai, Y. [Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki 305 (Japan); Ikeda, K. [Department of Orthopedic Surgery, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki 305 (Japan)

    1998-02-01

    The purpose of this study was to assess the value of positioning the knee slightly flexed within a standard MR knee coil in delineation of the anterior cruciate ligament (ACL). Within the confined space of a commercially available knee coil, knee could bend as much as 30 , average 17 of flexion. Sets of oblique sagittal MR images were obtained at both fully extended and slightly flexed positions. Twenty-two normal knees and 18 knees with ACL tears were examined and paired MR images were evaluated by two observers. Compared with knee extension, the MR images for knee flexion provided better clarity in 57 % of reviews of full length of the ACL and 53 % of the femoral attachment. In the extended position the anterior margin of the ligament was obscured due to partial averaging with the intercondylar roof. We recommend examining the knee in an achievable flexed position within the standard knee coil. (orig.) With 3 figs., 1 tab., 6 refs.

  7. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  8. Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation.

    Science.gov (United States)

    Kanamoto, Takashi; Tanaka, Yoshinari; Yonetani, Yasukazu; Kita, Keisuke; Amano, Hiroshi; Kusano, Masashi; Hirabayashi, Shinji; Horibe, Shuji

    2015-11-01

    Anterior knee pain related to the donor site is a frequent complication of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone autograft tissue. Even when hamstring tendon (HT) grafts are used instead, symptoms such as mild pain and discomfort can still occur. The purpose of this study was to elucidate the pathophysiology of anterior knee symptoms after ACLR with HT autografts. Fifty-seven patients (22 men and 35 women; mean age, 24.7 years) who underwent anatomic double-bundle ACLR with HT autografts were examined 6 months post-operatively. The presence of anterior knee symptoms, anterior knee laxity, range of motion, and muscle strength were assessed. Changes in patellar tendon and infrapatellar fat pad (IFP) morphology and blood flow were also evaluated using ultrasound. Potential variables affecting the presence of anterior knee symptoms were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors. Six months post-operatively, the total incidence of anterior knee symptoms was 56.1 % (32/57). According to univariate analysis, age, quadriceps strength, and increased blood flow in the IFP were significantly associated with the presence of anterior knee symptoms. Multivariate logistic regression analysis revealed that increased blood flow in the IFP was an independent factor for the presence of anterior knee symptoms (odds ratio 5.0; 95 % confidence interval 1.3-19.9). There were no significant findings inside the patellar tendon. Increased blood flow in the IFP was identified as an independent factor for the presence of anterior knee symptoms 6 months after ACLR with HT autografts. The ultrasound evaluation can help to define precisely the origin of anterior knee symptoms after ACLR with HT autografts. Case series with no comparison groups, Level IV.

  9. Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation.

    Science.gov (United States)

    Franco, Carlo D; Buvanendran, Asokumar; Petersohn, Jeffrey D; Menzies, Robert D; Menzies, Linda Pham

    2015-01-01

    Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner. The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steel wires were placed along the course of each primary innervation, and radiographs were obtained. Literature review revealed a lack of consensus on the number and origin of nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and a lateral articular nerve branch from the common peroneal nerve. Nerve branches showed variable proximal trajectories but constant distal points of contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropriate for radiofrequency neurotomy. The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation. To optimize clinical outcome, well-aligned radiographs are critical to guide lesion placement.

  10. Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair.

    Science.gov (United States)

    Zhang, Shaodong; Wu, Xiaotao; Liu, Lei; Wang, Chen

    2017-01-01

    To investigate the effects of intramedullary nail removal after tibial fracture repair. Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) ≥ 4) and mild/no knee pain (VAS knee and ankle pain, the range of motion of the knee and ankle, and Johner-Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Fifty-seven patients were followed for a mean of 8.4 (2-17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions ( p anterior border of tibia (knee pain. Knee pain VAS scores significantly lowered 6 weeks postoperatively and at the last follow-up, compared to before the operation ( p pain VAS scores, range of motion, and Johner-Wruhs criteria ( p > 0.05). For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau (anterior border of the tibia (pain significantly.

  11. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury?

    Science.gov (United States)

    Myer, Gregory D; Ford, Kevin R; Di Stasi, Stephanie L; Foss, Kim D Barber; Micheli, Lyle J; Hewett, Timothy E

    2015-01-01

    Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. The 'PFP cohort' consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The 'ACL cohort' included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p15 Nm of knee abduction load

  12. Effects of an unloader knee brace on knee-related symptoms and function in people with post-traumatic knee osteoarthritis after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Hart, Harvi F; Crossley, Kay M; Ackland, David C; Cowan, Sallie M; Collins, Natalie J

    2016-01-01

    This pilot study evaluated the immediate and four-week effects of an unloader knee brace on knee-related symptoms and performance-based function in people with knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). Individuals with knee OA, five to 20years post-ACLR, were recruited for two within-subject randomized studies: immediate effects (n=18) and four-week effects (n=11). Patient-reported knee-related symptoms (knee pain, perceived task difficulty, confidence, stability) were assessed during hop for distance and step-down tests, while performance-based function was assessed with hopping distance under three conditions: i) no brace; ii) unadjusted brace (sagittal plane support); and iii) adjusted brace (sagittal plane support with varus/valgus readjustment). Participants in the four-week brace effect study were randomized to wear the unadjusted or adjusted brace for four weeks after baseline (no brace) testing, and repeated tests in their allocated brace at four-week follow-up. Friedman tests evaluated differences between the three brace conditions for each variable for the immediate brace effect study (pknee confidence during hop for distance, and knee pain during step-down. Following the four-week brace intervention, the allocated brace improved knee confidence, perceived task difficulty and stability during hop for distance; and knee pain, perceived task difficulty, confidence, and stability during step-down. The unloader knee brace, adjusted or unadjusted, has the potential to improve knee-related symptoms associated with knee OA after ACLR. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. [Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block].

    Science.gov (United States)

    del Fresno Cañiaveras, J; Campos, A; Galiana, M; Navarro-Martínez, J A; Company, R

    2008-11-01

    To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

  14. Correlation between dynamic postural stability and muscle strength, anterior instability, and knee scale in anterior cruciate ligament deficient knees.

    Science.gov (United States)

    Park, Won-Hah; Kim, Do-Kyung; Yoo, Jae Chul; Lee, Yong Seuk; Hwang, Ji-Hye; Chang, Moon Jong; Park, Yong Serk

    2010-08-01

    The purpose of this study was to assess the correlations between dynamic postural stability and muscle strength, anterior instability, and knee scores in anterior cruciate ligament (ACL) deficient knees. We examined 40 male patients with ACL injury prior to surgery. Maximal torques of flexors and extensors of the injured knee at 60 and 180 degrees /s were evaluated using an isokinetic testing device. Anterior translations of the tibia were measured using a KT-2000 arthrometer, and dynamic postural stabilities were measured during single-leg stance using the Biodex Stability System (BSS). Knee statuses were evaluated using Lysholm and International Knee Documentation Committee (IKDC) knee scores. Correlations between dynamic postural stability and muscle strength, anterior instability, and knee scores were determined. Significant correlations were found between maximal torques of the extensor of injured knees at 60 and 180 degrees /s (r = -0.52, p = 0.048 and r = -0.46, p = 0.019, respectively) and dynamic postural stability, and maximal torques of flexors of injured knees showed similar relations (r = -0.51, p = 0.0048 and r = -0.47, p = 0.016, respectively). Lysholm and IKDC knee scores were also found to be correlated with dynamic postural stability (r = -0.49, p = 0.001 and r = -0.52, p = 0.005, respectively). However, no correlation was found between grade of anterior translation measured using the KT-2000 arthrometer and dynamic postural stability (p = 1.0). Dynamic postural stability determined using the BSS appears to be influenced by muscle strength, as determined by isokinetic testing, but not with grade of anterior translation measured using a KT-2000 arthrometer. Subjective knee scores appear to improve in parallel with dynamic postural stability.

  15. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function

    Directory of Open Access Journals (Sweden)

    Gabriel Peixoto Leão Almeida

    2016-04-01

    Full Text Available OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS. METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19, functional capacity (r = -0.08; p = 0.72, FPPA (r = -0.28; p = 0.19 or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35. CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

  16. Anterior tibial laxity using the GNRB® device in healthy knees.

    Science.gov (United States)

    Alqahtani, Y; Murgier, J; Beaufils, P; Boisrenoult, P; Steltzlen, C; Pujol, N

    2018-01-01

    GRNB® is a non-radiating power tool that allows the evaluation of the anterior tibial translation. The pressure exerted by the system against the patella and the body mass index (BMI) could affect the anterior tibial translation when we repeat the measurements in healthy knees. We retrospectively evaluated the measurements of anterior knee laxity in healthy knees carried out by the GNRB® in 69 consecutive patients who underwent anterior cruciate ligament (ACL) repair in the contralateral knee. Two measurements were carried out, the initial measurements (M1), and then repeated at a mean of seven months (M2) (4.9 to 13months). There were 38 women and 31 men with an average age of 31years. In healthy knees, the Mean average anterior translation was 5.4±4mm with an average patellar force of 35.8 at time M1. The average anterior translation was 4.9±4mm with an average patellar force of 47 at time M2. There was a significant difference between the measurements M1 and M2 (P<0.03). The tightening force was significantly different between the two sets of measurements (P<10-7). There was a negative correlation between the pressure applied on the patella and anterior knee laxity (P<0.01). The pressure force exerted on the patella during GNRB® affects the measurement of anterior laxity in healthy knees. This raises the problem of the reproducibility of the measurements during repeated examinations at different times. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone autograft in ACL deficient Knee

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    Navin Kumar Karn

    2015-12-01

    Full Text Available Background & Objectives: Injury to Anterior Cruciate Ligament (ACL reconstruction has increased because of increased interest in sports. There are various grafts used for reconstruction of ACL, for example, Bone Patellar Tendon Bone, Hamstring etc. The study was conducted to evaluate the results of Bone Patellar Tendon Bone graft used for reconstruction of Anterior Cruciate Ligament.Materials & Methods: 40 patients with chronic ACL deficient knee presenting to Neuro Hospital from July 2011 to June 2013 were included in the study. The patients with intraarticular fracture of knee, severe OA knee, local active or suspected infection and systemic disease that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee in all the cases. The patient was followed till 2 year with specified programme of rehabilitation. The pain was assessed using VAS and the function of the knee was assessed using Modified WOMAC knee index.Results: The long term satisfactory results in terms of functional stability, symptom relief and return to preinjury level of activity was seen in 32 cases (80%. Two knees got infected out of which one required arthroscopic debridement. Mean visual analogue scale was 8 and modified WOMAC knee score was 3 at 2 year follow up.Conclusion: Bone patellar tendon bone graft is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.JCMS Nepal. 2015;11(3:12-15.

  18. Knee function after anterior cruciate ligament reconstruction with patellar or hamstring tendon: a meta-analysis.

    Science.gov (United States)

    Shi, Dong-Liang; Yao, Zhen-Jun

    2011-12-01

    There is currently no consensus regarding the best graft type for anterior cruciate ligament reconstruction. Therefore, the aim of this study was to investigate the effects of patellar and hamstring tendon grafts on long-term knee function after anterior cruciate ligament reconstruction. This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and August 2011 comparing knee function after anterior cruciate ligament reconstruction using patellar tendon grafts with knee function after reconstruction with hamstring tendon grafts were pooled. Six studies were included in the final meta-analysis. Anterior cruciate ligament reconstruction using hamstring tendon grafts resulted in greater pain upon kneeling than reconstruction using patellar tendon grafts (P = 0.001). However, both grafts resulted in similar levels of anterior tibial translation, and similar results regarding isokinetic extension/flexion tests, Lysholm scores, and the stair-hop test (P > 0.05). Anterior cruciate ligament reconstruction using patellar or hamstring tendon grafts results in similar long-term knee function.

  19. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

    DEFF Research Database (Denmark)

    Henriksen, Marius; Nielsen, Thomas Graven; Aaboe, Jens

    2010-01-01

    Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease...... progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients....

  20. Assessment and treatment of knee pain in the child and adolescent athlete.

    Science.gov (United States)

    Yen, Yi-Meng

    2014-12-01

    Knee pain in children and adolescents is one of the most prevalent complaints in a pediatric practice, accounting for at least a third of musculoskeletal complaints. Accurate diagnosis requires an understanding of knee anatomy and patterns of knee injuries and skill in physical examination. This review covers the most common causes of knee pain in children and adolescents, including overuse issues, such as Osgood-Schlatter and osteochondritis dissecans, as well as traumatic injuries, including tibial spine fractures and anterior cruciate ligament injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. The Benefits of an In-Office Arthroscopy in the Diagnosis of Unresolved Knee Pain

    Directory of Open Access Journals (Sweden)

    Garrett L. Chapman

    2018-01-01

    Full Text Available We report a patient who developed persistent knee pain with mechanical symptoms after an uncomplicated patellofemoral arthroplasty. The etiology of his knee pain remained inconclusive following magnetic resonance imaging due to metallic artifact image distortion. With the use of an in-office needle arthroscopy, an immediate and definitive diagnosis was obtained, preventing an unnecessary surgery for a diagnostic arthroscopy. We discovered a lateral meniscus tear, an anterior cruciate ligament tear, and a medial femoral condyle chondral defect for which the patient underwent arthroscopic partial meniscectomy, ligament reconstruction, and osteochondral allograft transplantation, with resolution of his knee pain.

  2. Anterior vs Posterior Periarticular Multimodal Drug Injections: A Randomized, Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty.

    Science.gov (United States)

    Laoruengthana, Artit; Rattanaprichavej, Piti; Rasamimongkol, Supachok; Galassi, Monton

    2017-07-01

    Currently, various techniques are used to overcome postoperative pain after total knee arthroplasty. A local analgesic infiltration with periarticular multimodal drug injection (PMDI) is favorable because of its simplicity, safety, and efficacy. The present study compared the efficacy of a PMDI at the anterior vs posterior compartments. Forty-six patients were randomized to receive the PMDI at either the anterior or posterior compartment, with the contralateral knee receiving the PMDI at the opposite compartment. The PMDI injected to the posterior capsule, medial and lateral meniscal remnant, was defined as the posterior compartment injection, whereas the injection to the medial retinaculum, quadriceps muscle, pes anserinus, and retropatellar fat pad was defined as the anterior compartment injection. Pain scores at rest, knee flexion angle, quadriceps function, and drainage blood loss were evaluated in both groups. The anterior PMDI group had significantly lower pain scores at rest during 96 hours postoperatively. On the day of discharge, 19 patients (41.3%) favored the knee with the anterior PMDI, which was superior to 9 patients (19.6%) who favored the knee with the posterior PMDI. The anterior PMDI demonstrated a superior recovery of quadriceps function during the same period, but there was no significant difference in terms of other parameters. The PMDI at the anterior compartment can reduce pain after total knee arthroplasty with potentially better quadriceps function compared with that in the PMDI at the posterior compartment. We recommend infiltrating the anterior compartment with a greater amount of PMDI than the posterior compartment. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Evaluation of anterior stability of knee joint following arthroscopic ACL reconstruction with patellar ligament.

    Science.gov (United States)

    Fibiger, Wojciech; Kukiełka, Radosław T Kukiełka

    2011-01-01

    The aim of the study was to investigate and assess anterior stability of the knee joint before and during 12-month rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament with the central third of the patellar ligament and stabilization with interference screws (Kenneth-Jones method) and to analyse the effectiveness of the surgery and rehabilitation by patient self-assessment of pain and crepitation in the patello-femoral joint. The study involved a group of 46 patients after arthroscopic ACL reconstruction with the patellar ligament performed in 2005 and 2006. All patients underwent examinations of anterior stability of the knee joint using a KT-1000/S arthrometer. Stability measurements were performed on both knees on the day before surgery, and at 3, 6 and 12 months after the operation. Additionally, the patients subjectively evaluated post-operative pain and crepitation in the patello-femoral joint at 3, 6 and 12 months. Knee stability after ACL reconstruction according to the Mazurkiewicz scale using a KT-1000 arthrometer was rated as good and excellent, while the patients subjectively assessed the treatment process in terms of pain and crepitation in the patello-femoral joint at 12 months after the operation as excellent (10.8%), good (74%), and satisfactory (15.2%). Arthroscopic ACL reconstruction with the central third of the patellar ligament and stabilization with interference screws fully restored the lost stability of the knee, but the possibility of pain and crepitations in the patello-femoral joint needs to be taken into account. In the course of rehabilitation, it is natural that an ACL graft may extend as a result of remodeling and the impact of rehabilitation being administered.

  4. A prospective study on knee pain and its risk factors.

    Science.gov (United States)

    Miranda, H; Viikari-Juntura, E; Martikainen, R; Riihimäki, H

    2002-08-01

    To evaluate the effects of work-related and individual factors as well as physical activity and sports on the incidence and persistence of knee pain among a working population. Employees of a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic Questionnaire) on musculoskeletal pain and its possible risk factors at the baseline of this study. A cohort of 2122 workers free of knee pain and another cohort of 333 workers with severe knee pain were followed up for one year. The effects of the risk factors on the incidence and persistence of knee pain were studied using multivariable logistic regression models. A total of 214 (10%) workers developed knee pain during the follow-up. Significant predictors of incident knee pain in the multivariable model were higher age, overweight, smoking, and previous knee injuries. Also, working with the trunk forward flexed in kneeling or standing position and physically strenuous work were non-significant predictors of incident knee pain. Of those 333 workers with severe knee pain at baseline, 220 (66%) still reported severe knee pain after one year. Higher age and job dissatisfaction increased the risk of persistent symptoms. General physical exercise and different sports activities did not predict the incidence or persistence of knee pain. In this large prospective study, the risk factors for self-reported knee pain seemed to be highly similar to the risk factors for knee osteoarthritis (OA) reported in other papers. Age, previous knee injuries, overweight, and knee-straining work were those risk factors, which contributed to the incidence of knee pain. Psychosocial elements of work were more involved in the persistence of the symptoms in the knee.

  5. Cerebral Cortical Thickness in Chronic Pain Due to Knee Osteoarthritis: The Effect of Pain Duration and Pain Sensitization.

    Directory of Open Access Journals (Sweden)

    Hamza M Alshuft

    Full Text Available This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis.Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years, and 30 healthy controls (age = 62.7± 7.4, 17 females.Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected. Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected with no changes surviving multiple test correction.With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role.

  6. Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation.

    Science.gov (United States)

    Czamara, Andrzej; Królikowska, Aleksandra; Szuba, Łukasz; Widuchowski, Wojciech; Kentel, Maciej

    2015-02-01

    Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport.

  7. Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study

    DEFF Research Database (Denmark)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik

    2012-01-01

    Objective: To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty.Design: A prospective, single-blinded, randomized, cross-over study.Setting: A fast-track orthopaedic arthroplasty unit at a university hospital...... in knee pain at rest (P = 0.475), or knee pain during the knee extension strength measurements (P = 0.422) were not different between treatments.Conclusions: In contrast to observations in experimental knee effusion models and inflamed knee joints, knee joint icing for 30 minutes shortly after total knee.......Participants: Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty.Interventions: The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30...

  8. Solitary Osteochondroma of the Tibial Tuberosity Mimicking Osgood-Schlatter Lesion: A Rare Cause of Anterior Knee Pain in Adolescents: A Case Report

    Directory of Open Access Journals (Sweden)

    Balaji G

    2016-07-01

    Full Text Available Osteochondroma arising from the tibial tuberosity is very rare. We report such a case which mimicked OsgoodSchlatter’s disease in an adolescent. A 12 years-old boy presented with swelling over his right proximal tibia of one year duration associated with pain in the last three months. Examination revealed a 4 x 2cm bony mass arising from the proximal tibia. Radiographs revealed an osteochondroma of the tibial tuberosity. Computer tomography and magnetic resonance imaging confirmed the continuity of the medulla of the bony mass to that of the parent bone. Excision biopsy was done. At the final follow up, he was asymptomatic and returned back to his daily activities. We present this case for its rarity, challenges involved in diagnosis and the difficulties encountered in planning the surgery because of involvement of the apophysis and extensor mechanism attachment in a skeletally immature boy.

  9. Solitary Osteochondroma of the Tibial Tuberosity Mimicking Osgood-Schlatter Lesion: A Rare Cause of Anterior Knee Pain in Adolescents: A Case Report.

    Science.gov (United States)

    Balaji, G; Palaniappan, P; Nema, S; Menon, J

    2016-07-01

    Osteochondroma arising from the tibial tuberosity is very rare. We report such a case which mimicked OsgoodSchlatter's disease in an adolescent. A 12 years-old boy presented with swelling over his right proximal tibia of one year duration associated with pain in the last three months. Examination revealed a 4 x 2cm bony mass arising from the proximal tibia. Radiographs revealed an osteochondroma of the tibial tuberosity. Computer tomography and magnetic resonance imaging confirmed the continuity of the medulla of the bony mass to that of the parent bone. Excision biopsy was done. At the final follow up, he was asymptomatic and returned back to his daily activities. We present this case for its rarity, challenges involved in diagnosis and the difficulties encountered in planning the surgery because of involvement of the apophysis and extensor mechanism attachment in a skeletally immature boy.

  10. Techniques for assessing knee joint pain in arthritis

    Directory of Open Access Journals (Sweden)

    Fu Yu

    2007-03-01

    Full Text Available Abstract The assessment of pain is of critical importance for mechanistic studies as well as for the validation of drug targets. This review will focus on knee joint pain associated with arthritis. Different animal models have been developed for the study of knee joint arthritis. Behavioral tests in animal models of knee joint arthritis typically measure knee joint pain rather indirectly. In recent years, however, progress has been made in the development of tests that actually evaluate the sensitivity of the knee joint in arthritis models. They include measurements of the knee extension angle struggle threshold, hind limb withdrawal reflex threshold of knee compression force, and vocalizations in response to stimulation of the knee. A discussion of pain assessment in humans with arthritis pain conditions concludes this review.

  11. Is knee pain during adolescence a self-limiting condition?

    DEFF Research Database (Denmark)

    Rathleff, Michael S.; Rathleff, Camilla R.; Olesen, Jens L.

    2016-01-01

    BACKGROUND: The prevalence of adolescent knee pain is 33%, and patellofemoral pain (PFP) is the most common diagnosis with a nontraumatic onset. The 2-year prognosis of adolescent PFP compared with other types of knee pain is unknown. PURPOSE: To investigate the 2-year prognosis of knee pain among...... adolescents with and without a diagnosis of PFP. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 2011, a cohort of 2200 adolescents aged 15 to 19 years answered an online questionnaire on musculoskeletal pain. Of these, 504 reported knee pain, and 153 of these were clinically diagnosed with PFP....... After 2 years, the 504 adolescents, as well as 252 randomly selected adolescents who did not report knee pain in 2011, were contacted again. Primary outcome at follow-up was the proportion of adolescents with knee pain during the last week prior to follow-up. RESULTS: Overall, 55.9% (95% CI, 50...

  12. Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain.

    Science.gov (United States)

    Silva, Danilo de Oliveira; Briani, Ronaldo Valdir; Pazzinatto, Marcella Ferraz; Ferrari, Deisi; Aragão, Fernando Amâncio; Azevedo, Fábio Mícolis de

    2015-11-01

    Stair ascent is an activity that exacerbates symptoms of individuals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls; and (ii) to analyze loading rates in these subjects, during stair climbing. Twenty-nine individuals with patellofemoral pain and twenty-five control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial.

    Science.gov (United States)

    Ferber, Reed; Bolgla, Lori; Earl-Boehm, Jennifer E; Emery, Carolyn; Hamstra-Wright, Karrie

    2015-04-01

    Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Randomized controlled clinical trial. Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P KNEE group. Both groups increased in strength (P KNEE group. Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.

  14. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

    DEFF Research Database (Denmark)

    Henriksen, Marius; Nielsen, Thomas Graven; Aaboe, Jens

    2010-01-01

    Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease...

  15. Medial Overhang of the Tibial Component Is Associated With Higher Risk of Inferior Knee Injury and Osteoarthritis Outcome Score Pain After Knee Replacement

    DEFF Research Database (Denmark)

    Nielsen, Christian S; Nebergall, Audrey; Huddleston, James

    2018-01-01

    BACKGROUND: The aim of this prospective multicenter study is to investigate the association among (1) tibial site-specific overhang of medial, anterior, and lateral overhang in relation to Knee Injury and Osteoarthritis Outcome Score pain 1 year after surgery (1 Y KOOS pain) and (2) the malalignm...

  16. Taping reduces pain and disability in patients with knee osteoarthritis.

    NARCIS (Netherlands)

    Ende, E. van den

    2004-01-01

    Question: Is taping of the knee effective in improving pain and disability in patients with osteoarthritis of the knee? Design Randomised controlled trial. Setting University and private practices in Melbourne, Australia. Patients: Volunteers who responded to advertisements in local newspapers.

  17. Care-seeking behaviour of adolescents with knee pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Skuldbøl, Sune Kjems; Rasch, Mads Nyhuus

    2013-01-01

    Knee pain is common during adolescence. Adolescents and their parents may think that knee pain is benign and self-limiting and therefore avoid seeking medical care. However, long-term prognosis of knee pain is not favourable and treatment seems to offer greater reductions in pain compared...... to a "wait-and-see" approach. The purpose of this study was to describe the determinants of care-seeking behaviour among adolescents with current knee pain and investigate what types of treatment are initiated....

  18. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Mandeep S Dhillon

    2011-01-01

    Full Text Available Injury to the anterior cruciate ligament (ACL not only causes mechanical instability but also leads to a functional deficit in the form of diminished proprioception of the knee joint. "Functional" recovery is often incomplete even after "anatomic" arthroscopic ACL reconstruction, as some patients with a clinically satisfactory repair and good ligament tension continue to complain of a feeling of instability and giving way, although the knee does not sublux on clinical testing. Factors that may play a role could be proprioceptive elements, as the intact ACL has been shown to have significant receptors. Significant data have come to light demonstrating proprioceptive differences between normal and injured knees, and often between injured and reconstructed knees. ACL remnants have been shown to have proprioceptive fibers that could enhance functional recovery if they adhere to or grow into the reconstructed ligament. Conventionally the torn remnants are shaved off from the knee before graft insertion; modern surgical techniques, with remnant sparing methods have shown better outcomes and functional recovery, and this could be an avenue for future research and development. This article analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability. The types of mechanoreceptors, their distribution and presence in ACL remnants is reviewed, and suggestions are made to minimize soft tissue shaving during ACL reconstruction to ensure a better functional outcome in the reconstructed knee.

  19. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty.

    Science.gov (United States)

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty.

  20. Painful locking of the knee due to bucket handle tear of

    Directory of Open Access Journals (Sweden)

    HE Rui

    2011-04-01

    Full Text Available 【Abstract】 A case of swelling and anterior painful knee due to tear of mediopatellar plica is reported. The patient also felt clunk of the patellofemoral joint and knee locking. Under arthroscopic examination, a thick and fibrous plica was found medial to patellar, and a bucket tear along the plica from medial patellar retinaculum to infrapatellar fat pad. Polarized microscopic examination showed collagen fiber fragment and loss of light reflecting property. Neuroimmunohistology suggested up-regulation of synovial plica innervation in the area around the crack. This may be related to the pain. The bucket tear of mediopatellar plicacaused pain and lock of knee are more common than previously reported. Key words: Knee injuries; Arthroscopy; Patellofemoral joint

  1. Dynamic weight-bearing assessment of pain in knee osteoarthritis

    DEFF Research Database (Denmark)

    Klokker, Louise; Christensen, Robin; Wæhrens, Eva E

    2016-01-01

    BACKGROUND: The Osteoarthritis Research Society International (OARSI) has suggested to asses pain after specific activities consistently in clinical trials on knee OA. The Dynamic weight-bearing Assessment of Pain (DAP) assesses pain during activity (30 s of performing repeated deep knee-bends from...... Coefficients. We hypothesized that no correlations would be excellent (

  2. Anterior insular cortex is necessary for empathetic pain perception.

    Science.gov (United States)

    Gu, Xiaosi; Gao, Zhixian; Wang, Xingchao; Liu, Xun; Knight, Robert T; Hof, Patrick R; Fan, Jin

    2012-09-01

    Empathy refers to the ability to perceive and share another person's affective state. Much neuroimaging evidence suggests that observing others' suffering and pain elicits activations of the anterior insular and the anterior cingulate cortices associated with subjective empathetic responses in the observer. However, these observations do not provide causal evidence for the respective roles of anterior insular and anterior cingulate cortices in empathetic pain. Therefore, whether these regions are 'necessary' for empathetic pain remains unknown. Herein, we examined the perception of others' pain in patients with anterior insular cortex or anterior cingulate cortex lesions whose locations matched with the anterior insular cortex or anterior cingulate cortex clusters identified by a meta-analysis on neuroimaging studies of empathetic pain perception. Patients with focal anterior insular cortex lesions displayed decreased discrimination accuracy and prolonged reaction time when processing others' pain explicitly and lacked a typical interference effect of empathetic pain on the performance of a pain-irrelevant task. In contrast, these deficits were not observed in patients with anterior cingulate cortex lesions. These findings reveal that only discrete anterior insular cortex lesions, but not anterior cingulate cortex lesions, result in deficits in explicit and implicit pain perception, supporting a critical role of anterior insular cortex in empathetic pain processing. Our findings have implications for a wide range of neuropsychiatric illnesses characterized by prominent deficits in higher-level social functioning.

  3. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt; Axe, Michael J; Buchanan, Thomas S; Snyder-Mackler, Lynn

    2016-01-01

    Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb

  4. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  5. Effects of Anterior Knee Displacement during Squatting on Patellofemoral Joint Stress.

    Science.gov (United States)

    Kernozek, Thomas W; Gheidi, Naghmeh; Zellmer, Matthew; Hove, Jordan; Heinert, Becky L; Torry, Michael R

    2017-04-19

    Squatting is a common rehabilitation training exercise for Patellofemoral pain syndrome (PFPS). Patellofemoral joint stress (PFJS) during squatting with more anterior knee displacement has not been systematically investigated. The aim was to compare PFJS during squatting using two techniques: Squat while keeping the knees before the toes (SBT) and squat while allowing the knees to go past the toes (SPT). University research laboratory. Twenty-five healthy females (Age: 22.69 ± 0.74 yrs.; Height: 169.39 ± 6.44 cm; Mass: 61.55 ± 9.74 kg) participated. Three dimensional kinematic and kinetic data were collected at 180 and 1800 Hz respectively. A musculoskeletal model was used to calculate muscle forces through static optimization. These muscle forces were used in a patellofemoral joint model to estimate PFJS. The magnitudes of PFJS, reaction force and quadriceps force were higher (P technique. Knee flexion, hip flexion, and ankle dorsiflexion angles were reduced when using the SBT technique. Findings provide some general support for minimizing forward knee translation during squats for patients that may have PFPS.

  6. Immediate postoperative anterior knee stability: double- versus triple-bundle anterior cruciate ligament reconstructions.

    Science.gov (United States)

    Mae, Tatsuo; Shino, Konsei; Matsumoto, Norinao; Yoneda, Kenji; Yoshikawa, Hideki; Nakata, Ken

    2013-02-01

    The purpose of this study was to compare the triple-bundle (TB) anterior cruciate ligament (ACL) reconstruction with the double-bundle (DB) ACL reconstruction in immediate postoperative anterior knee stability. This study involved 133 patients who had undergone the anatomic ACL reconstruction with autogenous hamstring tendon unilaterally. Then 83 patients (mean age, 28.8 years) underwent the DB between November 2004 and December 2005, and 50 patients (mean age, 29.6 years) underwent the TB ACL reconstruction between January and December 2006. The 2 femoral tunnels were created in the ideal ACL attachment area, whereas 2 tibial tunnels for the DB and 3 tunnels for the TB were created in the ACL footprint. The 2 doubled tendon grafts were fixed with EndoButton-CL (Smith & Nephew Endoscopy, Andover, MA) on the femur. The grafts were fixed to the tibia using a Double Spike Plate and a screw under the total initial tension of 20 N at 20° of flexion, after meticulous in situ pretensioning using a tensioning boot. Then immediate postoperative anterior knee laxity in response to 89 N of anterior load was measured by one experienced examiner (T.M.) with the KT-2000 Knee Arthrometer (MEDmedtric, San Diego, CA) under general anesthesia at 30° of knee flexion with muscle relaxants. The measured anterior laxity was 3.4 ± 1.2 mm in the DB and 2.5 ± 0.7 mm in the TB ACL reconstruction, a statistically significant difference. The side-to-side difference of the laxity was -3.2 ± 1.6 mm in the DB and -4.2 ± 2.0 mm in the TB, again a significant difference. TB ACL reconstruction resulted in better immediate postoperative anterior knee stability than DB ACL reconstruction under 89 N of anterior tibial load (P = .031). Level III, therapeutic retrospective comparative study. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. Effect of compression therapy on knee swelling and pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Jensen, Niels J F; Andersen, Ida

    2013-01-01

    PURPOSE: Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect...... could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function. METHODS: In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking...... or no stocking from the first postoperative day and the following 4 weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function. RESULTS: Seventy per cent of the swelling had occurred before application of the stocking the day...

  8. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ventura, Alberto; Legnani, Claudio; Terzaghi, Clara; Iori, Stefano; Borgo, Enrico

    2017-03-01

    The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency. Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components. KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components. IV.

  9. Return to Preinjury Sports Participation Following Anterior Cruciate Ligament Reconstruction: Contributions of Demographic, Knee Impairment, and Self-report Measures

    Science.gov (United States)

    Lentz, Trevor A.; Zeppieri, Giorgio; Tillman, Susan M.; Indelicato, Peter A.; Moser, Michael W.; George, Steven Z.; Chmielewski, Terese L.

    2013-01-01

    STUDY DESIGN Cross-sectional cohort. OBJECTIVES (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. BACKGROUND Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. METHODS Ninety-four patients (60 men; mean age, 22.4 years) 1 year post–anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into “yes return to sports” or “no return to sports” groups based on their answer to the question, “Have you returned to the same level of sports as before your injury?” Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-characteristic curves determined the discriminatory accuracy of the identified clinical variables. RESULTS Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee

  10. [Knee pain and associated occupational factors: a systematic review].

    Science.gov (United States)

    Cozzensa da Silva, Marcelo; Fassa, Anaclaudia Gastal; Rodrigues Domingues, Marlos; Kriebel, David

    2007-08-01

    In order to collect information on knee pain and associated occupational factors, a systematic review was conducted using the MEDLINE, LILACS, SciELO, and Free Medical Journals databases, from 1990 to 2006. Key words were: gonalgia, knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, and osteoarthritis. Equivalent terms in Portuguese and Spanish were also used. From the initial 2,263 studies gathered, only 26 met the review's inclusion criteria. Knee pain prevalence in the previous 12 months ranged from 11.2% to 60.9%. The main associated factors were: female gender, older age, high body mass index, kneeling working position, and lifting at work.

  11. Knee Injuries and Disorders

    Science.gov (United States)

    ... cartilage in the knee gradually wears away, causing pain and swelling. Injuries to ligaments and tendons also cause knee problems. A common injury is to the anterior cruciate ligament (ACL). You usually injure your ACL ...

  12. Body mass index, pain and function in individuals with knee ...

    African Journals Online (AJOL)

    Background: Obesity is a risk factor for progression of knee osteoarthritis (OA), and high body mass index (BMI) may interfere with treatment effectiveness on pain and function in individuals with knee OA. This study investigated the effects of BMI on pain and function during a four‑week exercise programme in patients with ...

  13. Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

    Directory of Open Access Journals (Sweden)

    Clare Ardern

    2009-07-01

    Full Text Available The hamstring tendons are an increasingly popular graft choice for anterior cruciate ligament reconstruction due to preservation of quadriceps function and the absence of anterior knee pain post-operatively. Two commonly used hamstring grafts are a quadruple strand semitendinosus graft (4ST and a double strand semitendinosus-double strand gracilis graft (2ST-2G. It has been suggested that concurrent harvest of the semitendinsous and gracilis tendons may result in sub-optimal hamstring strength recovery as the gracilis may play a role in reinforcing the semitendinosus particularly in deep knee flexion angles. The objective of this systematic review was to synthesize the findings of available literature and determine whether semitendinosus and gracilis harvest lead to post-operative hamstring strength deficits when compared to semitendinosus harvest alone. Seven studies were identified which compared hamstring strength outcomes between the common hamstring graft types. The methodological quality of each paper was assessed, and where possible effect sizes were calculated to allow comparison of results across studies. No differences were reported between the groups in isokinetic hamstring strength. Deficits in hamstring strength were reported in the 2ST-2G groups when compared to the 4ST groups in isometric strength testing at knee flexion angles ≥70°, and in the standing knee flexion angle. Preliminary evidence exists to support the hypothesis that harvesting the semitendinosus tendon alone is preferable to harvesting in combination with the gracilis tendon for minimizing post-operative hamstring strength deficits at knee flexion angles greater than 70°. However, due to the paucity of research comparing strength outcomes between the common hamstring graft types, further investigation is warranted to fully elucidate the implications for graft harvest.

  14. Role of magnetic resonance imaging in the evaluation of articular cartilage in painful knee joint

    Directory of Open Access Journals (Sweden)

    Digish Shah

    2014-01-01

    Full Text Available Aim: The aim of this study was to determine the role of the magnetic resonance imaging (MRI in patients with atraumatic knee pain. Background and Objectives: Knee pain is one of the most common problems faced by people from time immemorial. There is a wide range of disease ranging from traumatic to degenerative causing knee pain in which articular cartilage is involved. Over the past 15 years, MRI has become the premier, first-line imaging study that should be performed in the evaluation of the painful knee in particular in tears of menisci, cruciate and collateral ligaments, osteochondral abnormalities (chondromalacia, osteoarthritis and osteochondral defects, synovial cysts and bone bruises. MRI, by virtue of its superior soft-tissue contrast, lack of ionizing radiation and multiplanar capabilities, is superior to more conventional techniques for the evaluation of articular cartilage. Materials and Methods: A prospective study was carried out on 150 patients in the Department of Radio-diagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from June 2011 to May 2013. Patients having fracture or dislocations of the knee joint were also excluded from the study. Detailed clinical history, physical and systemic examination findings of all patients were noted in addition to the laboratory investigations. All patients were subjected to radiograph of knee anterior-posterior and lateral view. MRI was performed with Siemens 1.5 Tesla MAGNETOM Avanto machine. Results: In our study of 150 patients with knee pain, articular cartilage defect was found in 90 patients (60%. Out of 90 patients with articular cartilage defect, 30 patients (20% had full thickness cartilage defects. Subchondral marrow edema was seen beneath 30 patients (20% with articular cartilage defects. 32 patients (21.1% had a complex or macerated meniscal tear. Complete anterior cruciate ligament tear was found in seven

  15. Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population.

    Science.gov (United States)

    Mouton, Caroline; Theisen, Daniel; Meyer, Tim; Agostinis, Hélène; Nührenbörger, Christian; Pape, Dietrich; Seil, Romain

    2015-08-01

    Excessive physiological anterior and rotational knee laxity is thought to be a risk factor for noncontact anterior cruciate ligament (ACL) injuries and inferior reconstruction outcomes, but no thresholds have been established to identify patients with increased laxity. (1) To determine if the healthy contralateral knees of ACL-injured patients have greater anterior and rotational knee laxity, leading to different laxity profiles (combination of laxities), compared with healthy control knees and (2) to set a threshold to help discriminate anterior and rotational knee laxity between these groups. Case-sectional study; Level of evidence, 3. A total of 171 healthy contralateral knees of noncontact ACL-injured patients (ACL-H group) and 104 healthy knees of control participants (CTL group) were tested for anterior and rotational laxity. Laxity scores (measurements corrected for sex and body mass) were used to classify knees as hypolax (score 1). Proportions of patients in each group were compared using χ(2) tests. Receiver operating characteristic curves were computed to discriminate laxity between the groups. Odds ratios were calculated to determine the probability of being in the ACL-H group. The ACL-H group displayed greater laxity scores for anterior displacement and internal rotation in their uninjured knee compared with the CTL group (P knees of patients with noncontact ACL injuries display different laxity values both for internal rotation and anterior displacement compared with healthy control knees. The identification of knee laxity profiles may be of relevance for primary and secondary prevention programs of noncontact ACL injuries. © 2015 The Author(s).

  16. Diagnostic criterial to differentiate medial meniscal injury from degenerative changes on {sup 99m}Tc-MDP knee SPECT in patients with chronic knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Paeng, Jin Chul; Chung, June Key; Kang, Won Jun; So, Young; Lee, Dong Soo; Lee, Myung Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of); Yoo, Jae Ho; Lee, Myung Chul [Seoul National University Nuclear Medicine, Seoul (Korea, Republic of); Jeong, Hwan Jeong [Wonkwang University College of Medicine, Iksan (Korea, Republic of)

    2003-04-01

    In patients with chronic knee pain, the diagnostic performance of {sup 99m}Tc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake in increased in medial compartment. A total of 49 knee SPECT of the patients with chronic(more than 3 months) knee pain, which showed increased {sup 99m}Tc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion, I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improve diagnostic performance, especially, specificity. In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

  17. Isolated knee pain: a case report highlighting regional interdependence.

    Science.gov (United States)

    Vaughn, Daniel W

    2008-10-01

    Case report. A number of pain referral patterns for sacroiliac dysfunction have been reported in the literature. However, very little has been written about pain localized to the knee joint for cases involving sacroiliac dysfunction. A 25-year-old female runner was self-referred to physical therapy for medial knee pain of 4(1/2) weeks' duration without a significant onset event. The pain completely curtailed her training for the Boston Marathon. Examination of the patient's knee and hip did not reveal any abnormal findings and there was no reproduction of pain with any test procedures except for medial knee joint tenderness to palpation. Additional, more proximal examination suggested significant asymmetry of sacral bony landmarks of the pelvic girdle without significant findings on the provocation tests of the sacroiliac joint. A single session of manual therapy procedures directed to the pubic symphysis and sacroiliac joint ipsilateral to the side of knee pain was provided. The patient was able to return to running without further incident of knee pain after a single therapy session. This case suggests the importance of regional interdependence in the examination of patients with an apparently common clinical problem. Furthermore, the case describes a previously unreported presentation of local knee pain possibly attributable to sacroiliac joint dysfunction.

  18. Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics : a musculoskeletal simulation study

    NARCIS (Netherlands)

    Marra, Marco Antonio; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan A.W.; Janssen, Dennis W.; Koopman, Bart F.J.M.; Wymenga, Ate B.; Verdonschot, Nico J.J.

    2017-01-01

    Purpose: In total knee arthroplasty (TKA), the posterior tibial slope is not always reconstructed correctly, and the knee ligaments may become too tight in flexion. To release a tight flexion gap, surgeons can increase the posterior tibial slope using two surgical resection techniques: the anterior

  19. A CLINICAL STUDY OF ARTHROSCOPIC MANAGEMENT OF ANTERIOR C RUCIATE LIGAMENT INJURIES OF KNEE JOINT

    Directory of Open Access Journals (Sweden)

    Paragjyoti

    2015-09-01

    Full Text Available BACKGROUND : Anterior C ruciate L igament (ACL tear is a common sports injury of the knee. There are a lot of controversies related to the management of this injury and more than 2000 papers have been published on the various aspects of the topic. Arthroscopic reconstruction of the ACL with autogenous graft material is widely used nowadays. The two most commonly used grafts are the central one - third of the patellar ligament (bone - tendon - bone, BTB and the hamstring tendon ( S emitendinosus - gracilis, STG construct but the former graft leads to increased donor site morbidity & hurdles in postoperative rehab & pain. The aim of the study is to study the Arthroscopic management of anterior cruciate ligament injury of knee joint using quadrupled hamstring graft. METHOD: The study was carried out on 30 cases of anterior cruciate ligament injury of knee joint attending the OPD and emergency of department of Orthopaedics, Silchar Medical College & Hospital who met the inclusion criteria. An informed consent was obtained from each patient prior to participation in the study. All the patients were examined in detail and worked up to obtain pre - anaesthetic clearance. X - rays and MRI were done routinely in all the cases. Clinical and radiological parameters were recorded. Arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft was done in all the patients. Concomitant meniscal inju ries were treated according to the merit of the injury. Patients were followed up at regular intervals and outcome variables were assessed and recorded. RESULTS: Results of our study clearly showed that arthroscopic ACL reconstruction using quadrupled hamstring graft is a safe, effective and reproducible procedure in restoring knee function with minimal donor site morbidity. At follow up evaluation, all patients had good outcomes in terms of clinical stability, range of motion and general symptoms. CONCLUSION: From the results in this study

  20. Effectiveness of Different Pain Control Methods in Patients with Knee Osteoarthritis after Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jin-Lain Ming

    2017-01-01

    Full Text Available The number of patients with knee osteoarthritis has increased in tandem with population aging. Consequently, the number of knee arthroplasties has also risen. The postoperative pain is the biggest challenge faced by patients soon after knee arthroplasty; therefore, this study is among different methods for post-knee arthroplasty pain control. A prospective longitudinal research design was employed; 177 adult patients who proposed for primary knee arthroplasty were enrolled and recruited. The patients were divided into conventional Group 1 (n=120 and patient-controlled analgesia (PCA Group 2 (n=57 according to the treatment methods they received. All patients experience the highest pain level on the day of their surgery; women complained of higher pain levels than men did, while the PCA group had lower postoperative pain. Meanwhile, patients with general anesthesia experienced more pain than those with spinal anesthesia in postoperative period. Patients with a higher postoperative pain index have a smaller optimal knee flexion angle. The PCA group had lower postoperative pain; all patients experienced the highest pain level on the day of their surgery. The results of this study could serve as a reference for nurses where PCA ensures a better postoperative pain control and therefore facilitates recovery and improves the quality of nursing.

  1. Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Samani, Afshin; Olesen, Jens Lykkegaard

    2013-01-01

    This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS).......This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS)....

  2. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament.

    Science.gov (United States)

    Tian, Shaoqi; Wang, Bin; Wang, Yuanhe; Ha, Chengzhi; Liu, Lun; Sun, Kang

    2016-08-05

    Relative young and more active patients with osteoarthritis (OA) of the isolated medial femorotibial compartment in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the early clinical outcomes of combined Oxford unicompartmental knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and isolated OA of the medial compartment. Twenty-eight patients were included into the study. All patients were treated by combined Oxford UKA and ACL reconstruction. Plain radiographs in the antero-posterior and lateral view and long-leg standing radiographs were routinely performed prior to and after surgery. Stress radiographs in valgus were additionally available in order to verify the well-preserved lateral compartment. The varus deformity of the knee prior to surgery and the valgus degree after surgery, the posterior slope of the tibial component and the range of motion (ROM) of the knee after surgery were measured and recorded. Clinical evaluations include Oxford Knee Score (OKS), Knee Society Score (KSS-clinical score; KSS-function score) and Tegner activity score. All the patients were followed up for 52 ± 8 months. The leg alignment showed 3.1 ± 0.6° of varus deformity prior to surgery and 4.0 ± 0.7° of valgus after surgery. The OKS, KSS and Tegner activity score improved significantly after surgery (P < 0.05). The mean ROM of the operated knee was 123.5 ± 2.8° at the last follow-up. The posterior slope of the tibial component was 3.9 ± 1.2°. A significant correlation was found between them according to the Pearson's correlation (r = 0.39, P = 0.03). There were 2 patients (7 %) with the complication of mobile bearing dislocation, and a second operation of replacing a thicker mobile bearing was performed for them. The early clinical data have shown that combined surgery of UKA and ACL reconstruction has revealed promising

  3. Beyond Pain Relief: Total Knee Replacement Surgery | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Relief: Total Knee Replacement Surgery Follow us Beyond Pain Relief: Total Knee Replacement Surgery Photo: AdobeStock With total knee replacement surgery, researchers are looking beyond simply reducing pain. The hope is to return patients to the ...

  4. An Elderly Man with a Swollen Knee,Significant Ecchymosis, and Minimal Knee Pain.

    Science.gov (United States)

    Aamodt, David; Serou, Michael; Neitschman, Harold

    2017-01-01

    A 72-year-old man presents with left knee pain and swelling over several days. The pain and swelling started after he felt a "pop" when bending to pick up an object off the floor. His past medical history is significant for type 2 diabetes mellitus. Physical exam revealed significant ecchymosis on the anterolateral aspect of the thigh. There was a minimal amount pain upon knee flexion.

  5. Dietary Fiber Intake in Relation to Knee Pain Trajectory.

    Science.gov (United States)

    Dai, Zhaoli; Lu, Na; Niu, Jingbo; Felson, David T; Zhang, Yuqing

    2017-09-01

    Dietary fiber may reduce knee pain, in part by lowering body weight and reducing inflammation. In this study, we assessed whether fiber intake was associated with patterns of knee pain development. In a prospective, multicenter cohort of 4,796 men and women ages 45-79 years with or at risk of knee osteoarthritis, participants underwent annual followups for 8 years. Dietary fiber intake was estimated using a validated food frequency questionnaire at baseline. Group-based trajectory modeling was used to identify Western Ontario and McMaster Universities Osteoarthritis Index pain trajectories, which were assessed for associations with dietary fiber intake using polytomous regression models. Of the eligible participants (4,470 persons and 8,940 knees, mean ± SD age 61.3 ± 9.1 years, 58% women), 4.9% underwent knee replacement and were censored at the time of surgery. Four distinct knee pain patterns were identified: no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%). Dietary total fiber was inversely related to membership in the moderate or severe pain groups (P ≤ 0.006 for trend for both). Subjects in the highest versus those in the lowest quartile of total fiber intake had a lower risk of belonging to the moderate pain pattern group (odds ratio [OR] 0.76 [95% confidence interval (95% CI) 0.61-0.93]) and severe pain pattern group (OR 0.56 [95% CI 0.41-0.78]). Similar results were found with grain fiber and these 2 pain pattern groups. Our findings suggest that a high intake of dietary total or grain fiber, particularly the recommended daily fiber average intake of 25 gm per day, is associated with a lower risk of developing moderate or severe knee pain over time. © 2016, American College of Rheumatology.

  6. The effects of experimental knee pain on lower limb corticospinal and motor cortex excitability.

    Science.gov (United States)

    Rice, David Andrew; Graven-Nielsen, Thomas; Lewis, Gwyn Nancy; McNair, Peter John; Dalbeth, Nicola

    2015-08-12

    Notable weakness of the quadriceps muscles is typically observed as a consequence of knee joint arthritis, knee surgery and knee injury. This is partly due to ongoing neural inhibition that prevents the central nervous system from fully activating the quadriceps, a process known as arthrogenic muscle inhibition (AMI). To investigate the mechanisms underlying AMI, this study explored the effects of experimental knee pain on lower limb corticospinal and motor cortex excitability. Twenty-four healthy volunteers participated in this study. In experiment 1, experimental knee pain was induced by the injection of hypertonic saline into the infrapatellar fat pad (n = 18). In experiment 2, isotonic saline was injected into the fat pad as a non-painful control (n = 8). Pain intensity was measured on a 10-cm electronic visual analogue scale. Transcranial magnetic stimulation and electromyography were used to measure lower limb motor-evoked potential amplitude and short-interval intracortical inhibition before and after the injection. The peak VAS score following hypertonic saline (5.0 ± 0.5 cm) was higher than after isotonic saline (p knee pain that was not apparent during the control condition. Biceps femoris and tibialis anterior motor-evoked potential amplitude did not change following injection (all p >0.05). There was no change in short-interval intracortical inhibition measured from vastus lateralis following injection (both p >0.05). Quadriceps corticospinal excitability increases during experimental knee pain, providing no evidence for a supraspinal contribution to quadriceps AMI.

  7. Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study

    DEFF Research Database (Denmark)

    W-Dahl, Annette; Toksvig-Larsen, Sören; Roos, Ewa

    2009-01-01

    including the hip and ankle joints. Knee pain was measured by the subscale pain (0 - 100, worst to best scale) of the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at one year follow-up. To estimate the association between knee alignment and knee pain multivariate regression...... on for knee OA by high tibial osteotomy. METHODS: 182 patients (68% men) mean age 53 years (34 - 69) with varus alignment having tibial osteotomy by the hemicallotasis technique for medial knee OA were consecutively included. Knee alignment was assessed by the Hip-Knee-Ankle (HKA) angle from radiographs...

  8. Progress towards understanding anterior knee pain after total knee arthroplasty

    NARCIS (Netherlands)

    Breugem, S.J.M.

    2014-01-01

    Met het onderzoek dat beschreven is in dit proefschrift wordt beoogd een beter begrip te krijgen van voorste kniepijn (VKP) na plaatsing van een totale knieprothese (TKP). Dit is gedaan door de volgende vragen te beantwoorden: Welke structuren voor in de knie spelen een rol bij de aanwezigheid van

  9. Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

    OpenAIRE

    Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

    2015-01-01

    [Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used t...

  10. Nocturnal knee pain increases with the severity of knee osteoarthritis, disturbing patient sleep quality.

    Science.gov (United States)

    Sasaki, Eiji; Tsuda, Eiichi; Yamamoto, Yuji; Maeda, Shugo; Inoue, Ryo; Chiba, Daisuke; Okubo, Noriyuki; Takahashi, Ippei; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

    2014-07-01

    Sleep disturbances frequently accompany chronic pain from osteoarthritis (OA). Effective management of sleep disturbances may require successful treatment of chronic pain, a key factor in the clinical evaluation of knee OA. However, the relationship between the severity of knee OA and sleep quality is unclear. Our purpose was to correlate the prevalence of nocturnal knee pain with different OA severity levels and to determine its influence on sleep quality. Subjects included 1,214 local volunteers with mean ± SD age 58.1 ± 13.0 years. The existence and severity of knee OA were determined by the Kellgren/Lawrence (K/L) grade, and joint space widths were measured. The presence of nocturnal knee pain and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed by self-completed questionnaires. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index. Knee-related factors affecting sleep quality were detected using statistical methods. The prevalence of nocturnal knee pain was 3.6%, 6.9%, 19.4%, 32.7%, and 75.0% in K/L grades 0, 1, 2, 3, and 4, respectively. Also, prevalence significantly increased with OA severity (P Sleep problems also increased with K/L grade (P = 0.038), and KOOS quality of life (QOL) was significantly lower in those with OA and sleep problems. Logistic regression showed that sleep problems were related to joint space narrowing (P = 0.016) and nocturnal knee pain (P = 0.039). Severe OA also disturbed onset and maintenance of sleep. The prevalence of nocturnal knee pain and sleep problems increased with the severity of OA, impacting QOL. These results suggest the necessity of appropriate nocturnal pain control. Copyright © 2014 by the American College of Rheumatology.

  11. Experimental quadriceps muscle pain impairs knee joint control during walking

    DEFF Research Database (Denmark)

    Henriksen, Marius; Alkjaer, Tine; Lund, Hans

    2007-01-01

    Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate...... the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects......, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function...

  12. Anserina Bursitis—A Treatable Cause of Knee Pain in Patients with Degenerative Arthritis

    Science.gov (United States)

    Brookler, Morton I.; Mongan, Edward S.

    1973-01-01

    The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient. PMID:4731586

  13. The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Christanell Franz

    2012-11-01

    Full Text Available Abstract Background Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated. Method Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups: • Control group (8 patients: standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion, electrical stimulation, aquatics and proprioceptive training. • The EMG BFB group (8 patients: EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks. Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD Test, range of motion (ROM and integrated EMG (iEMG for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales. Results At 6 weeks, passive knee extension (p  0.01 differences were found between the two groups for the assessment of knee function, swelling and pain. Conclusion The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional

  14. Correlates of knee laxity change in early rehabilitation after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Morrissey, M C; Hudson, Z L; Drechsler, W I; Coutts, F J; King, J B; McAuliffe, T B

    2000-10-01

    Factors other than ligament graft length (knee ROM, knee swelling, initial knee laxity) may need to be accounted for in interpreting changes in knee laxity during rehabilitation following anterior cruciate ligament reconstruction (ACLR) surgery. Twenty-three patients recovering from ACLR surgery (16 M, 7 F, age mean = 30) were tested at 2 and 6 weeks after ACLR with knee laxity measured using th Knee Signature System arthrometer, passive ROM with a standard goniometer and swelling by measuring knee circumference at the mid-patella level using a cloth measuring tape. Spearman correlation coefficients (in parentheses) were calculated using rankings of the change in the injured minus uninjured knee laxity as the dependent variable and the following independent variables: pre-test injured minus uninjured knee laxity (ranked; -0.457; statistically significant two-tailed P guide rehabilitation after ACLR.

  15. Differences in Clinical Pain and Experimental Pain Sensitivity Between Asian Americans and Whites With Knee Osteoarthritis.

    Science.gov (United States)

    Ahn, Hyochol; Weaver, Michael; Lyon, Debra E; Kim, Junglyun; Choi, Eunyoung; Staud, Roland; Fillingim, Roger B

    2017-02-01

    Ethnicity has been associated with clinical and experimental pain responses. Whereas ethnic disparities in pain in other minority groups compared with whites are well described, pain in Asian Americans remains poorly understood. The purpose of this study was to characterize differences in clinical pain intensity and experimental pain sensitivity among older Asian American and non-Hispanic white (NHW) participants with knee osteoarthritis (OA). Data were collected from 50 Asian Americans ages 45 to 85 (28 Korean, 9 Chinese, 7 Japanese, 5 Filipino, and 1 Indian) and compared with 50 age-matched and sex-matched NHW individuals with symptomatic knee OA pain. The Western Ontario and McMaster Universities Osteoarthritis Index and Graded Chronic Pain Scale were used to assess the intensity of clinical knee pain. In addition, quantitative sensory testing was used to measure experimental sensitivity to heat-induced and mechanically induced pain. Asian American participants had significantly higher levels of clinical pain intensity than NHW participants with knee OA. In addition, Asian American participants had significantly higher experimental pain sensitivity than NHW participants with knee OA. These findings add to the growing literature regarding ethnic and racial differences in clinical pain intensity and experimental pain sensitivity. Asian Americans in particular may be at risk for clinical pain and heightened experimental pain sensitivity. Further investigation is needed to identify the mechanisms underlying ethnic group differences in pain between Asian Americans and NHWs, and to ensure that ethnic group disparities in pain are ameliorated.

  16. CRPS Knee: How frequently encountered in differential diagnosis of Knee pain?

    Science.gov (United States)

    Aggarwal, Aakanksha; Agarwal, Anil

    2018-04-13

    We have read with great interest the paper by Catelijne M. van Bussel [1] recently published in Pain Practice. I wish to congratulate the authors for their valuable contributions. In the said article, 12 patients who had complex regional pain syndrome confined to the knee have been included. Though reports have been published involving primarily the knee after total knee arthroplasty [2,3] the incidence of CRPS knee following trauma or otherwise is not well appreciated. We would have appreciated if presence or absence of any inciting event for the development CRPS knee in these 12 patients could be mentioned, which could be helpful in a better diagnosis and management of the patients with CRPS knee. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  17. Radiological Evaluation of Cystic Lesions Presenting as Painful Knee

    Directory of Open Access Journals (Sweden)

    Rajpal Yadav

    2014-06-01

    Conclusion:Painful knee can be a presenting symptom of many cystic lesions of knee. Ultrasound can show the cystic abnormality, but it is only the Magnetic Resonance Imaging which can demonstrate the complete entity. [Cukurova Med J 2014; 39(3.000: 550-558

  18. Socioeconomic inequalities in knee pain, knee osteoarthritis, and health-related quality of life

    DEFF Research Database (Denmark)

    Kiadaliri, A. A.; Gerhardsson de Verdier, Maria; Turkiewicz, Aleksandra

    2017-01-01

    Objectives: To determine socioeconomic inequalities in frequent knee pain (FKP), knee osteoarthritis (OA), and associated health-related quality of life (HRQoL) in Sweden. Method: In 2007 a postal questionnaire about knee pain was sent to a random sample of 10 000 residents of Malmö, Sweden (7402...... individuals responded). Subjects reporting pain with duration ≥ 4 weeks in one or both knees in the past 12 months were classified as having FKP. A random sample of 1527 subjects with and without FKP attended a clinical and radiographic knee examination and responded to generic and disease-specific HRQo......L questionnaires. We used the individuals’ level of education and occupation as socioeconomic status (SES) measures, and we calculated the relative index of inequality (RII) using Poisson regression with robust standard errors adjusted for age and gender. We applied weighting to account for a possible selection...

  19. Combined Anterior Cruciate Ligament Reconstruction and High Tibial Osteotomy in Anterior Cruciate Ligament-Deficient Varus Knees

    Directory of Open Access Journals (Sweden)

    Ayman M. Ebied

    2017-12-01

    Conclusion: The combined procedure of ACL reconstruction and high tibial osteotomy restored knee stability and reduced pain over the medial compartment. Although the combined procedure has a longer period of rehabilitation than an isolated ACL reconstruction, the elimination of lateral thrust and preservation of articular cartilage of the medial compartment are of paramount importance to the future of these knees.

  20. Association of pain in knee osteoarthritis with distinct patterns of synovitis.

    Science.gov (United States)

    de Lange-Brokaar, B J E; Ioan-Facsinay, A; Yusuf, E; Visser, A W; Kroon, H M; van Osch, G J V M; Zuurmond, A-M; Stojanovic-Susulic, V; Bloem, J L; Nelissen, R G H H; Huizinga, T W; Kloppenburg, M

    2015-03-01

    To determine possible patterns of synovitis on contrast-enhanced magnetic resonance imaging (CE-MRI) and its relation to pain and severity in patients with radiographic knee osteoarthritis (OA). In total, 86 patients (mean age 62 years, 66% women, median body mass index 29 kg/m(2) ) with symptomatic knee OA (Kellgren/Lawrence radiographic score 3) were included. T1-weighted, gadolinium-chelate-enhanced MRI with fat suppression was used to semiquantitatively score the extent of synovitis at 11 knee sites (total score range 0-22). Self-reported pain was assessed with 3 standardized questionnaires. Principal components analysis (PCA) was used to investigate patterns (the location and severity) of synovitis. Subsequently, these patterns were assessed for associations with pain measures and radiographic severity in adjusted logistic regression models. Synovitis was observed in 86 patients and was found to be generally mild on CE-MRI (median total synovitis score 7, range 0-16). The median pain scores were 53 (range 0-96) on the visual analog scale for pain, 51.4 (range 2.8-97.2) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, 35 (range 0-75) on the Intermittent and Constant Osteoarthritis Pain (ICOAP) score for constant pain, and 40.6 (range 0-87.5) on the ICOAP score for intermittent pain. PCA resulted in extraction of 3 components, explaining 53.4% of the variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with scores on the KOOS pain subscale and the ICOAP constant pain subscale. Component 2 was characterized by synovitis at 4 sites (mainly the site adjacent to the anterior cruciate ligament), but was not associated with pain measures or with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly at the loose body site), was associated with radiographic severity. Different patterns of synovitis in knee OA were observed. The pattern that included

  1. Lateral trunk motion and knee pain in osteoarthritis of the knee: a cross-sectional study

    NARCIS (Netherlands)

    van der Esch, M.; Steultjens, M.P.M.; Harlaar, J.; van den Noort, J.C.; Knol, D.L.; Dekker, J.

    2011-01-01

    Background: Patients with osteoarthritis of the knee may change their gait in an attempt to reduce loading of the affected knee, thereby reducing pain. Especially changes in lateral trunk motion may be potentially effective, since these will affect the position of the centre of mass relative to the

  2. Core stability, knee muscle strength, and anterior translation are correlated with postural stability in anterior cruciate ligament-reconstructed patients.

    Science.gov (United States)

    Cinar-Medeni, Ozge; Baltaci, Gul; Bayramlar, Kezban; Yanmis, Ibrahim

    2015-04-01

    The purpose of this study was to investigate the relationship of postural stability and lower extremity performance with core stability, knee laxity, and muscle strength in patients with anterior cruciate ligament reconstruction. Twenty-eight anterior cruciate ligament-reconstructed subjects were included in the study. Anterior knee laxity tests, isokinetic knee muscle strength tests, and core stability tests were performed. Single-limb postural stability was assessed in both eyes-open and eyes-closed positions on a static surface and an eyes-open condition on a foam surface. A single-legged hop test was performed to assess lower extremity performance. To detect differences between the operated and healthy leg, a Mann-Whitney U test was performed, and a correlation analysis was performed using the Spearman correlation coefficient. Knee muscle strength and laxity were different between the operated and healthy legs (P stability scores correlated with core stability tests (P core stability, decreased knee muscle strength, and increased knee laxity correlated with single-limb postural stability. Better hop performance was demonstrated with better knee flexor and extensor muscle strength and was independent from core stability.

  3. Isometric exercises with elements postisometric relaxation to eliminate the knee joint contracture after arthroscopic plastics of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    O.V. Pylypenko

    2014-02-01

    Full Text Available Purpose : to determine the efficiency of isometric exercises and post isometric relaxation of character for removal and prevention of contractures and recovery of motor function after arthroscopic reconstruction of the anterior cruciate ligament in the late postoperative period. Material: The study involved 22 patients aged less than 40 years. Results: The results showed that the level of pain decreased equally in patients of main and control group from 3 to 0 points, the performance difference in the amplitude of the bending of the knee joint during the goniometry in the treatment group was 70 in the control group – 30 and the extension 10 – fixed, reaching 5 hyperextension and not changed in the control group. Conclusions: The use of isometric exercises and post isometric relaxation prevent postoperative contracture of the knee joint. Methods of their application are recommended for use in the comprehensive rehabilitation of patients after arthroscopic plastics anterior cruciate ligament.

  4. Comparing Two Observational Systems in the Assessment of Knee Pain

    Directory of Open Access Journals (Sweden)

    Shannon Fuchs-Lacelle

    2003-01-01

    Full Text Available OBJECTIVE: Research has demonstrated the utility of the Pain Behavior Measurement (PBM system as a pain index. PBM involves the recording of sighing, rubbing, grimacing, guarding and bracing. A modification of this system has been proposed, focusing on the occurrence of joint flexing, rubbing, unloading the joint, guarding and rigidity, specifically for patients with knee pain. The aim of the present study was to compare the original PBM to the modified version in a sample of knee replacement patients to assess the utility of the more specialized approach. It was expected that the more discomforting physiotherapy activities (knee bending and quadriceps exercises would result in more pain behaviours than intermediate activities (walking and standing, which, in turn, would result in more pain behaviours than reclining. The extent to which each system reflected this expected pattern was examined.

  5. Knee extension and flexion: MR delineation of normal and torn anterior cruciate ligaments

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji [Univ. of Tsukuba, Ibaraki (Japan)

    1996-03-01

    Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45{degrees} of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion. The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion. Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs. 13 refs., 7 figs., 1 tab.

  6. Risk factors for knee instability after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ahn, Ji Hyun; Lee, Sung Hyun

    2016-09-01

    The objective of this study was to estimate risk factors that influence postoperative instability after anterior cruciate ligament (ACL) reconstruction using multivariate logistic regression analysis. A total of 152 consecutive patients with symptomatic ACL insufficiency underwent arthroscopic ACL reconstruction between 2005 and 2011. Loss to follow-up and previous ligament reconstruction were exclusion criteria, resulting in 131 patients remaining for this retrospective study. The median follow-up was 55 months (range 25-100 months). Patients were sorted into two groups by anterior translation on stress radiograph and pivot shift test grade and were analysed for the statistical significance of various risk factors including age at surgery, gender, body mass index, preoperative instability, time from injury to surgery, single-bundle reconstruction with preserved abundant remnant versus double-bundle reconstruction with scanty remnant, and concomitant ligament, meniscus, and articular cartilage injury with use of multivariate logistic regression analysis. Time from injury to surgery over 12 weeks was found to be a significant risk factor for postoperative instability [p ligament (MCL) was also a risk factor (p = 0.02, adjusted OR 13.60; 95 % CI 1.24-148.25). The other variables were not found to be a significant risk factor. Among the risk factor variables, concomitant grade 2 MCL injury and surgical delay of more than 12 weeks from injury were significant risk factors for postoperative knee instability after ACL reconstruction. The overall results suggest that surgery <12 weeks from injury and meticulous attention to concomitant MCL injury should be considered. Retrospective case-control study, Level III.

  7. The Functional Abilities and Maximal Vertical Jumping Height in Coper and Non-coper Anterior Cruciate Ligament-Deficient Knee

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    Amin Norouzi Fashkhami

    2014-06-01

    Full Text Available Objectives: The aim of the present study was to compare the performance of the vertical jump task and the level of disability between the coper and non-coper athletes with an anterior cruciate ligament-minus knee. Methods: Thirty-four professional male athletes with isolated complete anterior cruciate ligament-tear (age 20-29 years and 6-12 months time past injury were recruited in this study. The subjects were allocated into the coper (n=17 and non-coper (n=17 groups according to their history of having giving way and feeling an instability in their injured knee. The maximum vertical jump height was recorded by a 6-camera Vicon motion analysis system. The functional outcomes of the subjects were assessed with use of the Persian versions of the International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score and Tegner Questionnaires. Results: The results revealed that the coper ACK-deficient knee subjects had a significantly higher International Knee Documentation Committee score as well as two subscales of the KOOS questionnaire including the sports (P=0.001 and the quality of life (P=0.016 than non-copers. However, the subscales of pain (P=0.0137, symptoms (P=0.353 and the activities of daily living (P=0.133 of the KOOS questionnaire did not show any significant differences between the coper and non-coper ACL-deficient knee subjects. In addition, the maximum jumping height was significantly higher in the copers too (P=0.008. Discussion: While the pain, symptoms and daily activities were not different between the two groups, a higher level of the functional abilities, sports activities, quality of life and the maximum jumping height were shown in the coper ACL-deficient knee subjects when compared to the non-copers. A deliberate evaluation of the functional abilities in ACL-deficient knee subjects might play a key role in distinguishing the coper and non-coper ACL-deficient knee subjects.

  8. Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee

    OpenAIRE

    Škráčková, Barbora

    2017-01-01

    Title: Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee Objectives: The purpose of the theoretical part of the thesis is to introduce the issue of soft tissue injury of the knee joint, especially anterior cruciate ligament. Acquaintance with conservative and surgical treatment, physical therapy and physiotherapeutical care after ligament reconstruction surgery. The special part of the thesis presents casuistry of physiotherapy care of ...

  9. Dynamic weight-bearing assessment of pain in knee osteoarthritis

    DEFF Research Database (Denmark)

    Klokker, Louise; Christensen, Robin; Osborne, Richard

    2015-01-01

    PURPOSE: To evaluate the reliability, agreement and smallest detectable change in a measurement instrument for pain and function in knee osteoarthritis; the Dynamic weight-bearing Assessment of Pain (DAP). METHODS: The sample size was set to 20 persons, recruited from the outpatient osteoarthritis...

  10. Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes

    OpenAIRE

    Smith, Matthew V.; Nepple, Jeffrey J.; Wright, Rick W.; Matava, Matthew J.; Brophy, Robert H.

    2016-01-01

    Background: Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. Hypothesis: In elite football players undergoing knee magnetic resonance imaging at the National Football League’s Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. S...

  11. Half of 12-15-year-olds with knee pain still have pain after one year

    DEFF Research Database (Denmark)

    Rathleff, Camilla Rams; Olesen, Jens Lykkegaard; Roos, Ewa M.

    2013-01-01

    Adolescent knee pain is considered benign and presumed to disappear without treatment. However, this has never been investigated. The purpose of this study was to 1) compare leisure time sports participation, health-related quality of life (HRQoL) and body mass index between adolescents...... with and without self-reported knee pain, 2) investigate how many adolescents still have knee pain after one year and 3) identify risk factors for one-year persistence of knee pain....

  12. Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing

    Science.gov (United States)

    Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

    2014-01-01

    Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N

  13. The remains of anterior cruciate ligament graft tension after cyclic knee motion

    NARCIS (Netherlands)

    Arnold, MR; Lie, DTT; Verdonschot, N; de Graaf, R; Amis, AA; van Kampen, A

    Background: There is sometimes a return of excess knee laxity after anterior cruciate ligament reconstruction. One of the contributing factors might be a loss in graft tension. It is unknown whether the tension imposed on an anterior cruciate ligament graft degrades with time and, if so, the effect

  14. Pain following double-bundle anterior cruciate ligament reconstruction: Correlation with morphological graft findings and dynamic contrast-enhanced MRI

    International Nuclear Information System (INIS)

    Lin, Y.-C.; Mhuircheartaigh, J.N.; Cheung, Y.-C.; Juan, Y.-H.; Chiu, C.-H.; Yeh, W.-L.; Wu, J.S.

    2014-01-01

    Aim: To determine the relationship between knee pain following anterior cruciate ligament (ACL) graft placement with morphological graft findings and dynamic contrast enhancement as assessed at MRI. Material and methods: Following institutional review board approval, 37 consecutive patients with double-bundle ACL reconstruction were enrolled. Thirteen patients had pain and 24 were asymptomatic. Imaging was performed using a 1.5 T MRI machine an average of 7.6 months after surgery. Graft-related (increase signal intensity, abnormal orientation, discontinuity, cystic degeneration, anterior translation of lateral tibia, arthrofibrosis), and non-graft related causes of knee pain (meniscal tear, cartilage injury, loose bodies, and synovitis) were evaluated. During dynamic contrast enhancement analysis, peak enhancement (ePeak) was calculated by placing a region of interest at the osteoligamentous interface of each bundle. Student's t-test was used for continuous variables analysis and chi-square or Fisher's exact test was used for categorical variables analysis. Results: There was no difference between symptomatic and asymptomatic patients regarding morphological graft-related or non-graft-related causes of knee pain. For dynamic contrast enhancement analysis, symptomatic patients had significantly lower ePeak values than asymptomatic patients in the anteromedial (p = 0.008) and posterolateral (p = 0.001) bundles or when using the higher ePeak value in either bundle (p = 0.003). Conclusion: Morphological ACL graft findings as assessed at MRI could not be used to distinguish between symptomatic and asymptomatic patients. However, lower ePeak values had a significant association with knee pain. This may indicate poor neovascularization of the graft, potentially leading to graft failure. - Highlights: • Morphologic graft findings of MRI are poorly associated with knee pain. • Lower contrast enhancement values are significantly associated with knee pain

  15. Electromyographic preactivation pattern of the gluteus medius during weight-bearing functional tasks in women with and without anterior knee pain Padrão de pré-ativação eletromiográfica do glúteo médio durante atividades funcionais com descarga de peso em mulheres com e sem dor anterior do joelho

    Directory of Open Access Journals (Sweden)

    Theresa H. Nakagawa

    2011-02-01

    Full Text Available BACKGROUND: Proximal factors have been proposed to influence the biomechanics of the patellofemoral joint. A delayed or diminished gluteus medius (GM activation, before the foot contact on the ground during functional activities could lead to excessive femur adduction and internal rotation and be associated with anterior knee pain (AKP. There are few studies on this topic and the results were inconclusive, therefore, it is necessary to investigate the GM preactivation pattern during functional activities. OBJECTIVE: To compare the GM electromyographic (EMG preactivation pattern during walking, descending stairs and in single leg jump task in women with and without AKP. METHODS: Nine women clinically diagnosed with AKP and ten control subjects with no history of knee injury participated in this study. We evaluated GM EMG linear envelope before the foot contact on the ground during walking and GM onset time and EMG linear envelope during descending stairs as well as in a single leg vertical jump. Mann-Whitney U tests were used to determine the between-group differences in GM EMG preactivation pattern. RESULTS: No between-group differences were observed in GM linear envelope during walking (P=0.41, GM onset time and linear envelope during descending stairs (P=0.17 and P=0.15 and single leg jump (P=0.81 and P=0.33. CONCLUSIONS: Women with AKP did not demonstrated altered GM preactivation pattern during functional weight bearing activities. Our results did not support the hypothesis that poor GM preactivation pattern could be associated with AKP.CONTEXTUALIZAÇÃO: Tem sido proposto que fatores proximais influenciam a biomecânica da articulação fêmoro-patelar. Um atraso ou diminuição da ativação do glúteo médio (GM antes do contato do pé no solo, durante atividades funcionais, poderia levar a adução e rotação interna excessiva do fêmur e provocar a dor anterior do joelho (DAJ. Existem poucos estudos sobre o assunto, e os resultados n

  16. Synovial hemangiohamartoma presenting as knee pain, swelling and a soft tissue mass: a case report

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    Senol Serkan

    2012-07-01

    Full Text Available Abstract Introduction We present a case of a patient with juxtaarticular hemangiohamartoma with a synovial extension associated with hemorrhagic synovitis and recurrent spontaneous hemarthrosis. Case presentation A 21-year-old Caucasian woman was admitted to our hospital complaining of pain and swelling at her knee for 6 months. In the magnetic resonance imaging, T2-weighted and fat-suppressed scans revealed a mass with high signal intensity just posterior to the patellar tendon. We performed an excisional biopsy of the mass through an anterior longitudinal incision. Excised material included arterial and venous vascular structures, which were found to be spread among the fat, connective and peripheral nerve tissues microscopically. Conclusion Although hemangiohamartomas are not true neoplasms, they may cause knee pain, swelling and hemarthrosis that warrant surgical resection. This lesion, although rare, should be considered in the differential diagnosis, especially in teenagers and young adults.

  17. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Lind, T

    2014-01-01

    BACKGROUND: Total knee arthroplasty (TKA) is associated with varying degrees of pain. A considerable proportion (25-40%) of patients experience severe pain, despite a comprehensive multimodal analgesic regimen. We hypothesized that adductor canal block (ACB) would reduce pain in this patient...... category compared with placebo. METHODS: Fifty patients with severe pain, defined as having a visual analogue scale (VAS) pain score of >60 during active flexion of the knee on the first or the second postoperative day after TKA, were included in this randomized, double-blind, placebo-controlled trial. All......% of the patients had no effect during active flexion. At rest, however, only 8% had more than mild pain after ACB compared with 57% at inclusion. CONCLUSIONS: ACB reduced VAS with 32 mm, during active flexion of the knee, in patients with severe pain after TKA, but a large proportion (78%) still had at least...

  18. Knee extensors kinetic chain training in anterior cruciate ligament deficiency.

    Science.gov (United States)

    Perry, Mark C; Morrissey, Matthew C; Morrissey, Dylan; Knight, Philippa R; McAuliffe, Thomas B; King, John B

    2005-11-01

    Open kinetic chain (OKC) knee extensor resistance training has lost favour in rehabilitation of patients with knee ACLD due to concerns that this exercise is harmful to the remaining portion of the ACL and its secondary stabilizers, and will be less effective in improving function. In this randomized, single-blind clinical trial, closed and OKC knee extensor training were compared for their effects on knee laxity and function in patients with ACLD knees. Sixty-four patients with a diagnosis of knee ACLD (49 M, 15 F; mean age=30 years) were measured for knee laxity, using a ligament arthrometer, and function with the Hughston Clinic knee self-assessment questionnaire and maximal effort single leg jump testing. Between the above tests and identical tests carried out 6 weeks later, subjects trained using either open or closed kinetic chain resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week for 6 weeks. The groups exhibited no statistically significant differences (pACL deficiency, and shows no superiority to CKC training.

  19. VARIATION IN THE FEMORAL ATTACHMENT AND ANATOMY OF ANTERIOR CRUCIATE LIGAMENT OF KNEE : A CASE REPORT

    OpenAIRE

    Sesi

    2015-01-01

    Anterior cruciate ligament is the main restraint of anterior tibial movement over femoral condyles in the knee joint. It is functionally a double bundle structure with a twisted single bundle anatomy . A natomical variation in the anatomy of acl are rare and usually confer with the biomechanical double bundle model. We present an anatomical variation in the femoral attachment and anatomy of anterior cruciate ligament of ...

  20. Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study

    Directory of Open Access Journals (Sweden)

    Tanja Schjødt Jørgensen

    2014-01-01

    Full Text Available Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT were recorded before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus muscles (control site. Results. Significantly increased PPTs were found following intra-articular injection, at both the knee P<0.0001 and the surrounding muscles P<0.042. The treatment effects were sustained for two weeks, and at some points the effect was even greater at two weeks P<0.026. Albeit not statistically significant, a similar trend was observed at the control site. Conclusions. Intra-articular anesthesia, combined with glucocorticosteroid, reduced pain sensitivity in both the knee and surrounding muscles for at least two weeks.

  1. Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis.

    Science.gov (United States)

    Fukutani, Naoto; Iijima, Hirotaka; Fukumoto, Takahiko; Uritani, Daisuke; Kaneda, Eishi; Ota, Kazuo; Aoyama, Tomoki; Tsuboyama, Tadao; Matsuda, Shuichi

    2016-02-01

    Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). The aim of this study was to investigate the association between varus thrust and 2 subcategories-"pain and stiffness" and "activities of daily living (ADL)"-of the Japanese Knee Osteoarthritis Measure (JKOM). This was a cross-sectional study. In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance. © 2016 American Physical Therapy Association.

  2. Comparison of lbuprofen with Acupuncture in Reducing Knee Osteoarthritis Pain

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    MR Emad

    2008-01-01

    Full Text Available ABSTRACT: Introduction & Objective: Osteoarthritis is the most common joint disease of humans. Acupuncture is one of the treatments for osteoarthritis. This study aimed to compare lbuprofen with acupuncture in the pain reduction in knee osteoarthritis. Materials & Methods: This is a clinical trial which was performed in Shiraz Medical School Clinics in 2007. Forty six patients with chronic pain due to the knee osteoarthritis were recruited using strict inclusion and exclusion criteria. All the patients were randomly divided into two groups (A and B who received lbuprofen (1200 mg/day or acupuncture (2 sessions per week for 2 weeks, respectively. Evaluating measuring tools were pain intensity (based on VAS, ROM (based on degree and morning stiffness of the knee joint. Collected data were analyzed by Chi-Square test, using SPSS software. Results: Pain intensity at baseline, after the course of treatment and 3 weeks after the treatment in group A was 7.29 ± 0.61, 4.20±0.93 and 5.20± 1.32 cm, respectively while these figures for group B were 7.35±0.82, 3.43±0.96 and 4.93±1.32 cm, respectively (p<0.005. Also knee ROM degree in group A was 21.54±7.46, 13.08±5.60 and 15.38±3.2 and for group B was 20.36±7.19, 12.40±5.78 and 10.36±5.30, respectively (p=0.003. Knee morning stiffness improved more in group B. Conclusion: Result of this study showed that both modalities significantly reduced the pain in patients with knee osteoarthritis and improved ROM while morning stiffness improved more in group B.

  3. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt

    2014-01-01

    ). It is unknown how these exercise variables influence knee pain after TKA. OBJECTIVE: To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. DESIGN: Cross-sectional study. SETTING: Consecutive sample of patients from the Copenhagen area, Denmark......), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10). RESULTS: Two patients were lost to follow...... up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, Pknee pain 60 seconds after the final repetition (2...

  4. Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study.

    Science.gov (United States)

    Conchie, Henry; Clark, Damian; Metcalfe, Andrew; Eldridge, Jonathan; Whitehouse, Michael

    2016-08-01

    There is a lack of information about the association between patellofemoral osteoarthritis (PFOA) and both adolescent anterior knee pain (AKP) and previous patellar dislocations. This case-control study involved 222 participants from our knee arthroplasty database answering a questionnaire. One hundred and eleven patients suffering from PFOA were 1:1 matched by gender with a unicompartmental tibiofemoral arthritis control group. Multivariate correlation and binary logistic regression analysis were performed, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. An individual is 7.5 times more likely to develop PFOA if they have suffered from adolescent AKP (OR 7.5, 95% CIs 1.51 to 36.94). Additionally, experiencing a patellar dislocation increases the likelihood of development of PFOA, with an adjusted odds ratio of 3.2 (95% CIs 1.25 to 8.18). A 44-year difference in median age of first dislocation was also observed between the groups. This should bring into question the traditional belief that adolescent anterior knee pain is a benign pathology. Patellar dislocation is also a significant risk factor. These patients merit investigation, we encourage clinical acknowledgement of the potential consequences when encountering patients suffering from anterior knee pain or patellar dislocation. Copyright © 2016. Published by Elsevier B.V.

  5. Postoperative pain treatment after total knee arthroplasty

    DEFF Research Database (Denmark)

    Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa

    2017-01-01

    INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-b...... of an optimal procedure-specific analgesic regimen after TKA....

  6. Management of postoperative pain in patients undergoing total knee

    Directory of Open Access Journals (Sweden)

    Sonia Marchán Espinosa

    2011-09-01

    Full Text Available The postoperatory pain after total prothesis of knee is a special type of agony, of great repercussion in the health area, since it affects the surgical patients who suffer it, the family that "suffer" together with the patient, the responsible doctors, the nursing personnel and the involved institutions. Aim: To value the pain degree for the immediate postoperatory of the prothesis of knee surgical patients during his stay at the Post-anesthesic Recovery Unit.Material and method: There was realized a descriptive study at the Valdepeña´s Hospital at the Post-anesthesic Recovery Unit for 7 months. The sample was formed by the prothesis of knee surgical patients during this period. There was designed a multiple answers questionnaire to which the patients answered during his stay in the unit and there was in use as instrument of measure of the pain the visual analogical scale.Results: 50 % of the patients suffered an intense pain after the anesthesic effect disappear. Almost the totality of the patients (90 % needed an analgesic rescue. In spite of it, the satisfaction that the patients expressed with the relief of his pain was very high.Conclusions: The patients experience high pain levels during the immediate postoperatory. The results reveal the need to design analgesic protocols more adapted to the individual patients need.

  7. Systematic Analysis of Painful Total Knee Prosthesis, a Diagnostic Algorithm

    Directory of Open Access Journals (Sweden)

    Oliver Djahani

    2013-12-01

    Full Text Available   Remaining pain after total knee arthroplasty (TKA is a common observation in about 20% of postoperative patients; where in about 60% of these knees require early revision surgery within five years. Obvious causes of this pain could be identified simply with clinical examinations and standard radiographs. However, unexplained painful TKA still remains a challenge for the surgeon. The management should include a multidisciplinary approach to the patient`s pain as well as addressing the underlying etiology. There are a number of extrinsic (tendinopathy, hip, ankle, spine, CRPS and so on and intrinsic (infection, instability, malalignment, wear and so on causes of painful knee replacement. On average, diagnosis takes more than 12 months and patients become very dissatisfied and some of them even acquire psychological problems. Hence, a systematic diagnostic algorithm might be helpful. This review article aims to act as a guide to the evaluation of patients with painful TKA described in 10 different steps. Furthermore, the preliminary results of a series of 100 consecutive cases will be discussed. Revision surgery was performed only in those cases with clear failure mechanism.

  8. Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.

    OpenAIRE

    Carter, N D; Jenkinson, T R; Wilson, D; Jones, D W; Torode, A S

    1997-01-01

    BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability, and strength. METHODS: Fifty patients (46 men and four women, mean age 26.3 years) with unilateral ACL deficient...

  9. Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing.

    Science.gov (United States)

    Ramsey, Dan K; Wretenberg, Per F; Lamontagne, Mario; Németh, Gunnar

    2003-01-01

    Examine the neuromuscular response to functional knee bracing relative to anterior tibial translations in vivo. During randomised brace conditions, electromyographic data with simultaneous skeletal tibiofemoral kinematics were recorded from four anterior cruciate ligament deficient subjects to investigate the effect of the DonJoy Legend functional brace during activity. Knee braces do not increase knee stability but may influence afferent inputs from proprioception and therefore one might expect changes in muscle firing patterns, amplitude and timing. Hoffman bone pins affixed with markers were implanted into the tibia and femur for kinematic measurement. The EMG data from the rectus femoris, semitendinosus, biceps femoris, and lateral head of the gastrocnemius were integrated for each subject in three separate time periods: 250 ms preceding footstrike and two consecutive 125 ms time intervals following footstrike. With brace, semitendinosus activity significantly decreased 17% prior to footstrike whereas bicep femoris significantly decreased 44% during A2, (P<0.05). Rectus femoris activity significantly increased 21% in A2 (P<0.05). No consistent reductions in anterior translations were evident. Our preliminary findings, based on a limited number of subjects, indicate joint stability may result from proprioceptive feedback rather than the mechanical stabilising effect of the brace. Despite a significant increase in rectus femoris activity upon landing, only one subject demonstrated an increase in anterior tibial drawer. Studies have shown functional braces do not mechanically stabilise the anterior cruciate ligament deficient knee. Perhaps bracing alters proprioceptive feedback. It has been shown that bracing the anterior cruciate ligament deficient knee may affect hamstring and quadriceps activity. Our findings stresses the importance of functional knee bracing combined with proprioceptive and muscular coordination training in order to increase joint stability.

  10. Impaired voluntary quadriceps force control following anterior cruciate ligament reconstruction: relationship with knee function.

    Science.gov (United States)

    Perraton, Luke; Clark, Ross; Crossley, Kay; Pua, Yong-Hao; Whitehead, Tim; Morris, Hayden; Telianidis, Stacey; Bryant, Adam

    2017-05-01

    Impairments in quadriceps force control and altered quadriceps and hamstring muscle activation strategies have been observed following anterior cruciate ligament reconstruction; however, the functional implications of these impairments are unclear. This study examined the cross-sectional associations between quadriceps force control, quadriceps activation, hamstring coactivation and clinically assessed knee function following anterior cruciate ligament reconstruction with a hamstring graft. Sixty-six patients (18 ± 3 months following surgery) and 41 uninjured individuals participated. Quadriceps force control was assessed using an isometric knee extension task. Participants cyclically increased and decreased quadriceps force at slow speeds between 5 and 30 % maximum voluntary isometric contraction matching a moving target displayed on a screen. Quadriceps activation and hamstring coactivation were assessed concurrently using surface electromyography. Knee function was assessed with the Cincinnati Knee Rating Scale and three single-leg hop tests. The reconstructed group completed the task with 48 % greater root-mean-square error (RMSE), indicating significantly worse quadriceps force control (p anterior cruciate ligament reconstruction and may contribute to irregular knee joint loading and the onset or progression of knee osteoarthritis. Impairments in quadriceps force control and altered muscle activation strategies may be modifiable through neuromuscular training, and this is an area for future research. Case-control study, Level III.

  11. Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study.

    Science.gov (United States)

    Zobel, Isabelle; Erfani, Tahereh; Bennell, Kim L; Makovey, Joanna; Metcalf, Ben; Chen, Jian Sheng; March, Lyn; Zhang, Yuqing; Eckstein, Felix; Hunter, David J

    2016-06-24

    Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)-a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation "case" period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m(2)). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee buckling was associated with experiencing a

  12. Accelerated aging in adults with knee osteoarthritis pain: consideration for frequency, intensity, time, and total pain sites

    Directory of Open Access Journals (Sweden)

    Kimberly T. Sibille

    2017-06-01

    Conclusion:. Results demonstrate accelerated cellular aging with high knee OA chronic pain severity and provide evidence for the potential utility of the FITT chronic pain severity index in capturing the biological burden of chronic pain.

  13. Clinical characteristics of pain originating from intra-articular structures of the knee joint in patients with medial knee osteoarthritis

    OpenAIRE

    Ikeuchi, Masahiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Tani, Toshikazu

    2013-01-01

    Purpose Although disease progression of osteoarthritis has been well documented, pain pathophysiology is largely unknown. This study was designed with two purposes: 1) to characterize patients with knee pain predominantly originating from intra-articular structures and 2) to describe the location and pattern of their pain. Materials and methods 103 patients with medial knee osteoarthritis underwent an intra-articular injection of local anesthetics (joint block). At least 70% pain relief was d...

  14. Motives for sports participation as predictions of self-reported outcomes after anterior cruciate ligament injury of the knee

    DEFF Research Database (Denmark)

    Roessler, K K; Andersen, Tonny Elmose; Lohmander, S

    2015-01-01

    versus Surgical Treatment (KANON) study, a randomized controlled trial. At baseline, 121 patients recorded in an initial questionnaire that their motives for sports participation fell into four categories: achievement, health, social integration, or fun and well-being. These four categories were used...... predicted by the motives for sports participation. Baseline motives achievement and fun and well-being predicted worse levels of pain and function 2 years after the injury, even after adjusting for age, gender, treatment and baseline scores. Psychological aspects, such as motives for participation in sport......Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical...

  15. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    Science.gov (United States)

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. MRI EVALUATION OF PAINFUL KNEE JOINT- THE CORRELATION OF MULTIPLE COEXISTING PATHOLOGIES, AGE AND SEX

    Directory of Open Access Journals (Sweden)

    Mukheswar Pame

    2017-03-01

    Full Text Available BACKGROUND 1. To evaluate the incidence and coexistence of multiple knee joint pathologies causing painful knee and their correlation to age and sex. 2. To evaluate the Magnetic Resonance Imaging (MRI features in various knee pathologies and to identify the common lesions. MATERIALS AND METHODS A retrospective study was performed using the clinical data of patients presenting with painful knee joint which were evaluated with MRI. Data from 200 patients examined between September 2015 and August 2016 were included into this study. The data was analysed statistically to evaluate the correlation between the MR pathological findings to age and sex of the patients. RESULTS The patient’s age ranged between 8 and 75 years (mean: 36 years. Anterior cruciate ligament (ACL tear was the commonest finding (60% followed by bursitis (55%, meniscal degeneration (54.6% and meniscal tear (52%. Primary signs of ACL tear were hyperintensity, discontinuity and nonvisualisation. Secondary signs like Posterior cruciate ligament (PCL buckling, PCL index of greater than 0.5, uncovered Lateral meniscus (LM and bone contusion assisted in diagnosis in indeterminate cases. Mid substance was the commonest site of ACL tear (64%. PCL tear accounted for only a small percentage (7%. Medial Meniscus (MM tear (35% was commoner than LM tear (17%. The posterior horn of meniscus was the commonest site of injury (86.5%. Age was significantly correlated with meniscal degeneration and tear, Medial collateral ligament (MCL degeneration, parameniscal cyst, and chondromalacia patellae. A significant correlation between male gender and ACL injury was noted. Meniscal injury was significantly correlated with bursitis, as well with MCL injury. Bone bruise was significantly correlated with ACL injury, MCL injury and Lateral collateral ligament (LCL injury. CONCLUSIONS MRI findings of certain pathologies in a painful knee can coexist and significantly correlate with each other, age and sex of

  17. Adductor canal block for postoperative pain treatment after revision knee arthroplasty

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M

    2014-01-01

    BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total...... knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. METHODS: We included patients scheduled for revision knee......01191593. RESULTS: We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1-8 h/7 h...

  18. Doppler ultrasonography of the anterior knee tendons in elite badminton players: colour fraction before and after match

    DEFF Research Database (Denmark)

    Kønig, Merete Juhl; Torp-Pedersen, S; Boesen, Morten Ilum

    2010-01-01

    Anterior knee tendon problems are seldom reported in badminton players although the game is obviously stressful to the lower extremities.......Anterior knee tendon problems are seldom reported in badminton players although the game is obviously stressful to the lower extremities....

  19. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  20. Human hip and knee torque accommodations to anterior cruciate ligament dysfunction.

    Science.gov (United States)

    Osternig, L R; Ferber, R; Mercer, J; Davis, H

    2000-09-01

    It has been postulated that the adaptations of lower extremity function exhibited by anterior cruciate ligament (ACL) deficient and post-ACL surgical patients represent early accommodations to the loss of ACL function after injury so that excessive anterior displacement of the tibia is prevented. Prior studies have suggested that compensation patterns in ACL deficient and post-ACL surgical subjects may affect joint moments of the knee as well as the hip. However, the variance in knee and hip forces between ACL deficient, post-surgical ACL and uninjured groups has not been clearly elucidated. The purpose of this study was to assess hip:knee extensor torque ratios relative to anterior tibia shear in pre-surgical-ACL deficient, post-surgical and uninjured subjects. Measurements of hip and knee joint moments and anterior tibia shear were recorded from 45 injured and uninjured subjects (21 men, 24 women) during lower extremity, variable resistance exercise. Anterior tibia shear was computed by decomposing joint moments and reaction forces according to a model derived from cadaver knee dissections and radiography, in combination, to estimate the tibio-femoral compressive and shear forces generated by the patellar tendon at various angles throughout the knee joint range. Three groups of subjects were studied: recently injured ACL deficient pre-surgical subjects who were scheduled for immediate surgery (PRE; n = 15); postsurgical subjects who had undergone ACL reconstructive surgery at least 1 year prior to testing (POST; n = 15); and uninjured controls (CON; n = 15). All PRE and POST subjects had a normal contralateral limb. Tests were conducted under six conditions: 1 and 1.5 Hz cadence and maximal speed at 33% and 50% one repetition maximum resistance. The results revealed that the hip:knee ratios were significantly greater for the post-ACL surgical group than the PRE and CON groups (PACL surgical subjects appear to accommodate to ACL substitution by using hip extensors

  1. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study

    OpenAIRE

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-01-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint posit...

  2. Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics: a musculoskeletal simulation study.

    Science.gov (United States)

    Marra, Marco A; Strzelczak, Marta; Heesterbeek, Petra J C; van de Groes, Sebastiaan A W; Janssen, Dennis W; Koopman, Bart F J M; Wymenga, Ate B; Verdonschot, Nico J J

    2017-05-12

    In total knee arthroplasty (TKA), the posterior tibial slope is not always reconstructed correctly, and the knee ligaments may become too tight in flexion. To release a tight flexion gap, surgeons can increase the posterior tibial slope using two surgical resection techniques: the anterior tibial cortex (ACR) or the centre of tibial plateau (CPR) referencing. It is not known how this choice affects the knee laxity and function during activities of daily living. The aim of this study was to investigate the effect of tibial slope on knee laxity, kinematics and forces during a squatting activity using computer simulation techniques. We hypothesised that the effects depend on the referencing technique utilised. A validated musculoskeletal model of TKA was used. Knee laxity tests were simulated in flexion and extension. Then, a squat motion was simulated to calculate: movement of the tibiofemoral joint (TFJ) contact points and patello-femoral joint (PFJ) contact force. All analyses were repeated with more anterior (-3°), neutral (0°), and more posterior tibial slope (+3°, +6°, +9°), and with two referencing techniques (ACR, CPR). Knee laxities increased dramatically with more posterior slope with the ACR technique (up to 400%), both in flexion and in extension. The CPR technique, instead, had much smaller effects (up to 42% variations). During squatting, more slope with the ACR technique resulted in larger movements of the TFJ contact point. The PFJ contact force decreased considerably with more slope with the CPR technique (12% body weight reduction every 3° more posterior slope), thanks to the preservation of the patellar height and quadriceps-femur load sharing. ACR technique alters considerably the knee laxity, both in flexion and extensions, and surgeons should be cautious about its use. More slope with CPR technique induces more favourable TFJ kinematics and loading of the knee extensor apparatus and does not substantially alter knee laxity. Preferably, the

  3. Evaluation of the size and position of the insertion of the anterior medial meniscus root in varus osteoarthritic knees.

    Science.gov (United States)

    Sasaki, Akira; Sugita, Takehiko; Aizawa, Toshimi; Miyatake, Naohisa; Kamimura, Masayuki; Fujisawa, Hirokazu; Takahashi, Atsushi

    2017-02-01

    Recent studies have suggested radial displacement of the medial meniscus as a cause of varus knee osteoarthritis (OA). Two anatomical studies reported that such displacement may be associated with anterior insertion of the medial meniscus anterior horn. It was aimed to evaluate the location and area of this insertion in patients with advanced knee OA. Medial meniscus anterior horn insertions were classified into four types, as described in a previously reported classification during 225 total knee arthroplasty (TKA) in 184 patients. The incidence rates of insertion type were compared with previously reported rates in nearly normal or non-arthritic knees. The insertion surface area was also measured during 158 TKAs. Of the 225 knees, 82 (36.4 %), 93 (41.3 %), 35 (15.6 %), and 15 (6.7 %) were classified as I, II, III, and IV, respectively. An anteriorly inserted anterior horn was not more frequent in advanced varus OA knees than in previously reported nearly normal or non-arthritic knees. The insertion surface areas were 57.5 ± 18.9, 56.1 ± 16.0, and 56.4 ± 14.4 mm 2 for types I, II, and III, respectively; these areas did not differ significantly. Since the incidence of an anteriorly inserted medial meniscus anterior horn was not higher in advanced varus OA knees than in normal or non-arthritic knees, an anteriorly inserted anterior horn may have little or no effect on the aetiology of varus OA knees. This study provides some information for clarifying the aetiology of knee OA. IV.

  4. [Knee pain: choosing the right imaging].

    Science.gov (United States)

    Potric, A; Mach, T; Pereira Miozzari, A C

    2013-09-25

    Gonalgia is a frequent reason for consultation of a primary care physician. The road leading to diagnosis is mainly clinical. A detailed medical history and physical examination are capital for establishing diagnostic hypotheses and choosing the most appropriate imaging test. Initially, a simple X-ray of the knee joint is the most common exam, even though it is not always needed, especially after a minor trauma. MRI and CT-scan allow a more detailed examination of the structures; however, they should only be ordered to answer a specific question. Most of the time, echography is reserved to extra-articular pathologies and for guiding an articular tap.

  5. Internet-mediated physiotherapy and pain coping skills training for people with persistent knee pain (IMPACT - knee pain): a randomised controlled trial protocol.

    Science.gov (United States)

    Dobson, Fiona; Hinman, Rana S; French, Simon; Rini, Christine; Keefe, Francis; Nelligan, Rachel; Abbott, J Haxby; Bryant, Christina; Staples, Margaret P; Dalwood, Andrew; Bennell, Kim L

    2014-08-13

    Persistent knee pain in people over 50 years of age is often attributable to knee osteoarthritis (OA), a common joint condition that causes physical and psychological dysfunction. Exercise and pain coping skills training (PCST) can help reduce the impact of persistent knee pain, however, access to health professionals who deliver these services can be challenging. With increasing access to the Internet, remotely delivered Internet-based treatment approaches may provide alternatives for healthcare delivery. This pragmatic randomised controlled trial will investigate whether an Internet-delivered intervention that combines PCST and physiotherapist-guided exercise (PCST + Ex) is more effective than online educational material (educational control) in people with persistent knee pain. We will recruit 148 people over 50 years of age with self-reported persistent knee pain consistent with knee OA from the Australian community. Following completion of baseline questionnaires, participants will be randomly allocated to access a 3-month intervention of either (i) online educational material, or (ii) the same online material plus an 8-module (once per week) Internet-based PCST program and seven Internet-delivered physiotherapy sessions with a home exercise programs to be performed 3 times per week. Outcomes will be measured at baseline, 3 months and 9 months with the primary time point at 3 months. Primary outcomes are average knee pain on walking (11-point numeric rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index subscale). Secondary outcomes include additional measures of knee pain, health-related quality-of-life, perceived global change in symptoms, and potential moderators and mediators of outcomes including self-efficacy for pain management and function, pain coping attempts and pain catastrophising. Other measures of adherence, adverse events, harms, use of health services/co-interventions, and process

  6. [Case-control study on the effect of meniscus shaping on knee function after anterior cruciate ligament reconstruction].

    Science.gov (United States)

    Fu, Li-Feng; Hu, Jin-Tao; Wang, Zheng; Chen, Xin

    2017-08-25

    To observe the effect of the meniscus shaping on the knee function and stability after anterior cruciate ligament reconstruction(ACLR). A total of 64 ACLR patients were included from January 2013 to January 2015. The control group was the ACLR patients with intact meniscus, in which 24 males and 6 females. The mean age was(32.8±5.5) years old(ranged, 22 to 43 years old). The injury side was left on 17 cases and right on 13 cases. The mean follow-up time was(15.2±2.8) months(ranged, 12 to 19 months). The shaping group was the ACLR patients with meniscus shaping, in which 27 males and 7 females. The mean age was (33.1±4.2) years old (ranged, 23 to 42 years old). The injury side was on the left in 22 case and right in 12 cases. The mean follow-up time was (16.0±3.1) months (ranged, 12 to 20 months). The preoperative anterior tibia shift and knee joint function, as well as anterior tibia shift, knee joint function and active proprioception at last follow-up time were observed. The anterior tibia shift was measured by KT-1000. The knee joint function was assessed by Lysholm score and KOOS score. The errors of active proprioception were measured at 30°, 45° and 60° knee flexion. Postoperative anterior tibia shift of the affected side was (1.4±0.2) mm, which was lower than (2.2±0.4) mm in shaping group( P 0.05). In the KOOS score, the postoperative symptoms, pain, daily life, exercise capacity and life quality in control group were 90.7±5.5, 93.2±4.3, 96.8±2.2, 90.9±5.3, 91.8±4.5 respectively, which were higher than 72.7±6.0, 70.6±7.3, 72.5±7.4, 52.8±5.4, 36.2±6.5 preoperatively( P pain, daily life, exercise capacity and life quality in the shaping group were 88.9±5.8, 92.6±3.5, 96.5±2.1, 89.3±7.2, 90.6±4.1 respectively, which were higher than 71.9±5.1, 71.2±7.1, 71.3±6.2, 53.1±6.1, 35.6±4.7 preoperatively( P 0.05). No significant differences were observed in the postoperative active proprioception error of contralateral side between the

  7. MR imaging of the knee extension and flexion. Diagnostic value for reconstructed anterior cruciate ligament

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine] [and others

    1995-09-01

    The purpose of this study is to determine the value of extended and flexed knee positions in MR imaging of the surgically reconstructed anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, knee joint was enabled to extend to a full-extension and bend vertically to a semi-flexion (average 45deg of flexion) within the confines of the magnet bore. Sets of 3-mm-thick oblique sagittal proton-weighted turbo spin echo MR images were obtained at both extended and flexed positions. Twenty-five knees with intact ACL grafts and three knees with arthroscopically proved graft tears were evaluated. Compared to the extended position, MR images of flexed knee provided better delineation of the intact and complicated ACL grafts with statistical significance. The intact graft appeared relaxed at the semi-flexion and taut at the extension. Overall lengths of the intact grafts were readily identified at the flexion. Stretched along the intercondylar roof, the grafts were poorly outlined at the extension. MR images with knee flexion delineated the disrupted site from the impingement more clearly than that with knee extension. (author).

  8. SPECT/CT in patients with painful knee arthroplasty - what is the evidence?

    Energy Technology Data Exchange (ETDEWEB)

    Hirschmann, Michael T. [Kantonsspital Baselland-Bruderholz, Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Henckel, Johann [Imperial College London, London (United Kingdom); Rasch, Helmut [Kantonsspital Baselland-Bruderholz, Institute for Radiology and Nuclear Medicine, Bruderholz (Switzerland)

    2013-09-15

    SPECT/CT is increasingly recognized as a promising imaging modality for the investigation of patients with a painful knee after knee arthroplasty. In this review article, we give an overview of the clinical value and current and future applications of SPECT/CT for patients with knee pain following joint arthroplasty. A detailed evidence-based literature review is performed and presented. (orig.)

  9. Influence of Elastic Bandage and Neoprene Sleeve on Knee Position Sense and Pain in Subjects with Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Basir Majdoleslami

    2003-12-01

    Full Text Available Objective: to investigate whether a neoprene sleeve and elastic bandage around the knee joint of subjects with knee osteoarthritis (OA would , in short term (a reduce pain (b improve knee joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (11 men, 19 women, age between 33-75 with unilateral knee OA. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS of knee pain for study entry.All patients were randomly assigned to either an elastic bandage or a neoprene sleeve. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. Knee pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene sleeve application. Results: the mean of scores for knee variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene sleeve had significant effect on knee JPS (P=0.037. But elastic bandage had no effect (P=0.631. Both of them had significantly reduced knee pain. (P=0.000 Conclusion: In subjects with both neoprene sleeve and elastic bandage reduced knee pain with more effect of neoprene sleeve. Only the neoprene sleeve had effect on knee JPS.

  10. [Benefit of isokinetic evaluations of knee before and after anterior cruciate ligament reconstruction in soccer players].

    Science.gov (United States)

    Olivier, N; Rogez, J; Masquelier, B

    2007-10-01

    The aim of this study was to analyse the evolution of the isokinetic performance of the knee flexor and extensor muscles in soccer players before and after intra-articular anterior cruciate ligament reconstruction (Kennet-Jones). Two isokinetic evaluations were carried out before surgery and after rehabilitation (i.e. 4 months later) in 18 soccer players. The initial evaluation showed that the stabilizing muscles of the knee were affected differently after lesion of the external anterior crossed ligament. At the opposite of the flexor muscles, the performance of the knee extensor muscles of the injured leg was significantly reduced as compared with that of the healthy leg (peak torque at 90 degrees /s, -16%; power at 180 degrees /s, -14%; total work at 240 degrees /s, -11%). Even if 4 months after surgery, this deficit was accentuated (peak torque at 90 degrees /s, -26%; power at 180 degrees /s, -23%; total work at 240 degrees /s, -19%), the preoperative results of the knee extensor muscle do not condition the postoperative performance. After a rupture of the external anterior crossed ligament, a regular program of isokinetic evaluation of the knee seems to be relevant in the follow-up of the wounded athlete. The evaluation before surgery can be used as reference, and from a psychological point of view, this evaluation can create confidence in the athlete during hospitalization. A second evaluation 4 months after surgery can be used to quantify the muscular deficit to direct the exercises of rehabilitation.

  11. Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.

    Science.gov (United States)

    Carter, N D; Jenkinson, T R; Wilson, D; Jones, D W; Torode, A S

    1997-09-01

    Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability, and strength. Fifty patients (46 men and four women, mean age 26.3 years) with unilateral ACL deficient knees were assessed on admission and after rehabilitation (5 hours a day for four weeks). JPS was assessed by reproduction of passive positioning using a visual analogue incorporating a goniometer. Knee stability was analysed by self report questionnaire (score 0-280) and functional activity test (single leg hop and figure of eight run). Isokinetic dynamometry was performed to evaluate quadriceps and hamstring peak torque strength. Controls were either age and sex matched individuals or the contralateral knee. Statistical analysis was by Wilcoxon signed rank test and Spearman rank order correlation coefficient. JPS was impaired in ACL deficient knees. The mean (SD) errors in reproducing angles were 9.4 (3.1) degrees and 7.1 (2.3) degrees for the ACL deficient knee and control knee respectively (P testing (hop: on admission 148.7 (37.3) cm, after rehabilitation 169.8 (31.1) cm, P tests (hop and figure of eight run), the responses to the questionnaire, or strength. There was no correlation between the responses to the questionnaire and functional activity tests or muscle strength. JPS was impaired in ACL deficient knees. Although knee stability improved with exercise therapy, there was no improvement in JPS. The role of JPS in the stability of ACL deficient knees remains unclear.

  12. The posterior condylar offset ratio and femoral anatomy in anterior versus posterior referencing total knee arthroplasty.

    Science.gov (United States)

    Almeida, P H; Vilaça, A

    2015-10-01

    The preservation of joint anatomy is one of the key issues in total knee arthroplasty. The effect of the prosthesis' referencing system, relative to femoral anatomy, remains unknown. It was sought to determine if femoral anatomy, following total knee arthroplasty is better maintained using either anterior referencing or posterior referencing prosthesis. The posterior condylar offset ratio (PCOR) was employed for preoperative and postoperative radiographic comparison of femoral condyles. It was hypothesized that posterior referencing prosthesis would better restore condylar morphology. Sixty-six patients undergoing a total knee arthroplasty with anterior referenced Zimmer(®) NexGen(®) LPS prosthesis and ninety-one with posterior referenced Tornier(®) HLS Noetos(®) were divided into two groups according to the prosthetic model used and retrospectively compared. PCOR was calculated as the quotient of the distance between the posterior condylar border and the tangent to the posterior cortex of the femoral diaphysis, and the distance between the posterior condylar border and the tangent to the anterior cortex of the femoral diaphysis. PCOR was determined preoperatively and postoperatively and compared within each group and between both groups. An increase in the PCOR (Panterior referencing and posterior referencing models. No difference was noted when the postoperative PCOR was compared between both groups (P=0.61). Both anterior and posterior referencing prosthesis lead to a similar increase of the PCOR following total knee arthroplasty. Level IV. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Factors affecting knee laxity following anterior cruciate ligament reconstruction using a hamstring tendon.

    Science.gov (United States)

    Yanagisawa, Shinya; Kimura, Masashi; Hagiwara, Keiichi; Ogoshi, Atsuko; Nakagawa, Tomoyuki; Shiozawa, Hiroyuki; Ohsawa, Takashi

    2017-10-01

    The aim of the present study was to investigate the correlation between the pre-operative and intraoperative factors that predict postoperative knee laxity following anterior cruciate ligament (ACL) reconstruction using a hamstring tendon. The subjects included 108 patients (male, n=49; female, n=59) with ACL-deficient knees who had undergone double-bundle reconstruction. The median time between injury and surgery (TBIS) was 27.5weeks (range one to 504). The patients were divided into two groups according to the side-to-side difference (SSD) in anterior translation on a stress radiograph one year after undergoing the operation (Group A: SSD of ligament, meniscus, and articular cartilage injury. A logistic regression analysis was performed to identify the factors associated with knee laxity. The postoperative SSD values after one year were correlated with the TBIS (r=0.28; P<0.01). Eighty-one and 27 knees were classified into Groups A and B, respectively, based on the SSD at one year after surgery. The TBIS in Group B (60.2weeks) was significantly longer than that in Group A (16.6weeks; P<0.01). A logistic regression analysis showed that there was a significant association between the TBIS and postoperative knee laxity (P<0.01; odds ratio 1.013; 95% CI 1.002-1.023). Increased knee laxity was associated with the time between injury and surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. The anterior intermeniscal ligament of the knee: an anatomic and MR study.

    Science.gov (United States)

    Marcheix, Pierre-Sylvain; Marcheix, Bertrand; Siegler, Julien; Bouillet, Philippe; Chaynes, Patrick; Valleix, Denis; Mabit, Christian

    2009-06-01

    The purposes of this study were to identify the presence of the anterior intermeniscal ligament of the knee (AIL), to study its attachment patterns and relationships to other anatomic structures within the knee and to evaluate the potential association of its rupture with other pathology of the knee. Ten human cadaver knees were dissected excluding knees with surgical scars. Fifty-one MR examinations were performed in symptomatic patients. Arthroscopic observations were carried out on ten patients. AIL was found in nine dissected knees with type I insertion in six cases, type II insertion in three cases. The average length was 31.2 mm (25-45 mm). The average distance between AIL and insertion of the anterior cruciate ligament was 12 mm (11-15 mm). Concerning MR study, AIL was found in 34 cases (82.9%). Four (9.75%) ruptures of the AIL were encountered. Where AIL was intact, 14 patients presented meniscal lesions (46.6%). Where AIL was ruptured, three patients presented meniscal lesions (75%). The present study demonstrates through anatomical and MR studies that AIL is present in more than 80% of the cases with predominant type I insertion. The association of meniscal and AIL lesions was highlighted demonstrating that AIL is not only an anatomical point of interest but also a clinical and surgical reality.

  15. Medio-lateral knee fluency in anterior cruciate ligament-injured athletes during dynamic movement trials.

    Science.gov (United States)

    Panos, Joseph A; Hoffman, Joshua T; Wordeman, Samuel C; Hewett, Timothy E

    2016-03-01

    Correction of neuromuscular impairments after anterior cruciate ligament injury is vital to successful return to sport. Frontal plane knee control during landing is a common measure of lower-extremity neuromuscular control and asymmetries in neuromuscular control of the knee can predispose injured athletes to additional injury and associated morbidities. Therefore, this study investigated the effects of anterior cruciate ligament injury on knee biomechanics during landing. Two-dimensional frontal plane video of single leg drop, cross over drop, and drop vertical jump dynamic movement trials was analyzed for twenty injured and reconstructed athletes. The position of the knee joint center was tracked in ImageJ software for 500 milliseconds after landing to calculate medio-lateral knee motion velocities and determine normal fluency, the number of times per second knee velocity changed direction. The inverse of this calculation, analytical fluency, was used to associate larger numerical values with fluent movement. Analytical fluency was decreased in involved limbs for single leg drop trials (P=0.0018). Importantly, analytical fluency for single leg drop differed compared to cross over drop trials for involved (Pinjury. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Effective chronic low back pain and knee pain treatment with acupuncture in geriatric patients.

    Science.gov (United States)

    Çevik, Cemal; Anil, Afitap; İşeri, Sevgin Özlem

    2015-01-01

    The most common disease of the older age group in Turkey is degenerative articular disease and pain associated with the disease. Analgesics and physical therapy are preferred treatment for geriatric chronic pain but suffering from multiple medical and nutritional problems in old ages can limit treatment options with analgesics due to an increased risk of adverse effects and drug interactions. We aim to show the effect of acupuncture on back-pain and knee-pain treatment of elderly people. The study includes 34 patients, 24 female and 8 male. The mean age was 69.0417 ± 8.95 years for females and 73.12 ± 8.95.24 years for males. Every two days for a total of 10 sessions acupuncture treatment to Yintang, Ht 7 (Shenmen), LI 4 (Hegu), Ki 3 (Taixi) and Ki 6 were found to significantly reduce pain scores of patients. Mean back pain scores (8.8696 ± 1.546) and mean knee pain scores (9.1304 ± 1.4239) of patients were reduced significantly to 2.1739 ± 1.466 and 1.455 ± 0.7; ptreatment. These are important results as they give rationale to use acupuncture treatment widely in chronic low back pain and knee pain in the geriatric group of patients to reduce the side effects of polypharmacy in elderly.

  17. Inadequate pain relief among patients with primary knee osteoarthritis.

    Science.gov (United States)

    Laires, Pedro A; Laíns, Jorge; Miranda, Luís C; Cernadas, Rui; Rajagopalan, Srini; Taylor, Stephanie D; Silva, José C

    Despite the widespread treatments for osteoarthritis (OA), data on treatment patterns, adequacy of pain relief, and quality of life are limited. The prospective multinational Survey of Osteoarthritis Real World Therapies (SORT) was designed to investigate these aspects. To analyze the characteristics and the patient reported outcomes of the Portuguese dataset of SORT at the start of observation. Patients ≥50 years with primary knee OA who were receiving oral or topical analgesics were eligible. Patients were enrolled from seven healthcare centers in Portugal between January and December 2011. Pain and function were evaluated using the Brief Pain Inventory (BPI) and WOMAC. Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). Inadequate pain relief (IPR) was defined as a score >4/10 on item 5 of the BPI. Overall, 197 patients were analyzed. The median age was 67.0 years and 78.2% were female. Mean duration of knee OA was 6.2 years. IPR was reported by 51.3% of patients. Female gender (adjusted odds ratio - OR 2.15 [95%CI 1.1, 4.5]), diabetes (OR 3.1 [95%CI 1.3, 7.7]) and depression (OR 2.24 [95%CI 1.2, 4.3]) were associated with higher risk of IPR. Patients with IPR reported worst outcomes in all dimensions of WOMAC (p<0.001) and in all eight domains and summary components of SF-12 (p<0.001). Our findings indicate that improvements are needed in the management of pain in knee OA in order to achieve better outcomes in terms of pain relief, function and quality of life. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  18. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    Science.gov (United States)

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  19. Knee Osteoarthritis: Condroprotector Action and Symptomatic Effect of Ozone on Pain, Function, Quality of Life, Minimal Joint Space and Knee Arthroplasty Delay

    Directory of Open Access Journals (Sweden)

    Fernandez-Cuadros

    2006-11-01

    Full Text Available Objectives To evaluate the effect of Ozone on pain, function, quality of life, minimal joint space and knee arthroplasty delay in a case series of patients with knee osteoarthritis (OA. Methods Prospective quasi-experimental before-after study on 52 out of 120 patients with knee osteoarthritis (OA Kellgren-Lawrence (K-L grade 2 or more, who attended Santa Cristina's University Hospital, from January 2012 to June 2016. The Ozone protocol consisted of four sessions (1 session/week of an intra-articular infiltration of a medical mixture of oxygen-ozone (95% - 5% at a 20 µg/mL concentration. Pain and quality of life (QoL were measured by visual analogical scale (VAS and western ontario and Mc master universities index for osteoarthritis (WOMAC, and minimal internal/external joint space width were measured by plain posterior-anterior weight-bearing knee radiographies at the beginning / end of treatment. Results Mean age 70.36 years. Women 80.8% (n = 42, men 19.2% (n = 10. The severity of OA according to Kellgren-Lawrence scale was 3° (n = 36; 69.2%. Pain measured by VAS significantly decreased (P < 0.0001 from 8.1 to 2.5. The WOMAC-pain, WOMAC-stiffness and WOMAC-function subscales decreased significantly (P < 0.0001 from 16.5 to 4.9 points, 3.2 to 2 and 48 to 17.6, respectively. With respect to minimal joint space, the internal compartment measured 4.17 mm and increased significantly to 4.44 mm (P = 0.0003; while the external compartment was 6.02 mm and improved significantly to 6.26 mm (P = 0.0032 after the treatment protocol. After a mean of 10 months follow-up to a maximum of 28 months, none of knee OA patients underwent knee arthroplasty replacement. Conclusions Ozone treatment is capable of producing pain relief, recovery of function and radiological improvement on minimal joint space in knee OA patients. Based on the results of our study, it is assumed that Ozone could slow/revert OA progression, due to the increase in the minimal internal

  20. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain

    DEFF Research Database (Denmark)

    Skou, S. T.; Roos, E. M.; Simonsen, O.

    2016-01-01

    (PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication...

  1. Motives for sports participation as predictions of self-reported outcomes after anterior cruciate ligament injury of the knee.

    Science.gov (United States)

    Roessler, K K; Andersen, T E; Lohmander, S; Roos, E M

    2015-06-01

    Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study, a randomized controlled trial. At baseline, 121 patients recorded in an initial questionnaire that their motives for sports participation fell into four categories: achievement, health, social integration, or fun and well-being. These four categories were used as variables in the analyses. All 121 subjects completed the 2-year follow-up. The largest improvement was seen in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale sports and recreation function, with an effect size of 2.43. KOOS sports and recreation function was also the subscale score best predicted by the motives for sports participation. Baseline motives achievement and fun and well-being predicted worse levels of pain and function 2 years after the injury, even after adjusting for age, gender, treatment and baseline scores. Psychological aspects, such as motives for participation in sport, can be factors in predicting of patient-reported outcomes 2 years after injury. Evaluating motives for sports participation may help predict the outcome 2 years after ACL injury. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    Science.gov (United States)

    Simon, David; Saltzman, Bryan M.; Rollins, Meaghan; Bach, Bernard R.; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  3. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    Directory of Open Access Journals (Sweden)

    David Simon

    2015-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

  4. Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures.

    Science.gov (United States)

    De Maeseneer, Michel; Marcelis, Stefaan; Boulet, Cedric; Kichouh, Mimoun; Shahabpour, Maryam; de Mey, Johan; Cattrysse, Erik

    2014-08-01

    To describe the detailed ultrasound anatomy of the anterior, medial, and lateral aspects of the knee and present the ultrasound examination technique used. We present ultrasound using images of patients, volunteer subjects, and cadaveric specimens. We correlate ultrasound images with images of anatomical sections and dissections. The distal quadriceps tendon is made up of different laminas that can be seen with ultrasound. One to five laminas may be observed. The medial retinaculum is made up of three anatomical layers: the fascia, an intermediate layer, and the capsular layer. At the level of the medial patellofemoral ligament (MPFL) one to three layers may be observed with ultrasound. The medial supporting structures are made up of the medial collateral ligament and posterior oblique ligament. At the level of the medial collateral ligament (MCL), the superficial band, as well as the deeper meniscofemoral and meniscotibial bands can be discerned with ultrasound. The posterior part, corresponding to the posterior oblique ligament (POL), also can be visualized. Along the posteromedial aspect of the knee the semimembranosus tendon has several insertions including an anterior arm, direct arm, and oblique popliteal arm. These arms can be differentiated with ultrasound. Along the lateral aspect of the knee the iliotibial band and adjacent joint recesses can be assessed. The fibular collateral ligament is encircled by the anterior arms of the distal biceps tendon. Along the posterolateral corner, the fabellofibular, popliteofibular, and arcuate ligaments can be visualized. The anatomy of the anterior, medial, and lateral supporting structures of the knee is more complex than is usually thought. Ultrasound, with its exquisite resolution, allows an accurate assessment of anatomical detail. Knowledge of detailed anatomy and a systematic technique are prerequisites for a successful ultrasound examination of the knee.

  5. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee.

    Science.gov (United States)

    Jarit, Gregg J; Mohr, Karen J; Waller, Robert; Glousman, Ronald E

    2003-01-01

    We studied the effects of home interferential current therapy (IFC) on postoperative pain, range of motion, and edema in subjects undergoing anterior cruciate ligament (ACL) reconstruction, menisectomy, or knee chondroplasty. Randomized, double-blind, placebo-controlled prospective study. A tertiary care outpatient orthopaedic clinic/ambulatory surgery center. Eighty-seven subjects were separated into three groups based on their type of knee surgery and within each group randomized into a treatment or placebo group. All subjects received home IFC units. Subjects randomized to treatment group received a working IFC unit. Placebo subjects received units that were previously set to deliver no current. Post-operative edema at 24, 48, and 72 hours, and weeks 1-8; range of motion at 1, 3, 6, and 9 weeks; pain immediately after surgery, at 24, 48, and 72 hours, and weeks 1-7; and amount of pain medication taken at days 1-10 were compared between treatment and placebo groups. All IFC subjects reported significantly less pain and had significantly greater range of motion at all post-operative time points. ACL and menisectomy IFC subjects experienced significantly less edema at all time points, while chondroplasty subjects experienced significantly less edema until 4 weeks postoperatively. These findings indicate that home IFC may help reduce pain, pain medication taken, and swelling while increasing range of motion in patients undergoing knee surgery. This could result in quicker return to activities of daily living and athletic activities.

  6. Controversies in knee rehabilitation: anterior cruciate ligament injury.

    Science.gov (United States)

    Failla, Mathew J; Arundale, Amelia J H; Logerstedt, David S; Snyder-Mackler, Lynn

    2015-04-01

    Controversy in management of athletes exists after anterior cruciate ligament (ACL) injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no reinjury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to preinjury sports. Using these criteria, the success rates of current management strategies after ACL injury are reviewed and recommendations are provided for the counseling of athletes after ACL injury. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Knee mechanics during landing in anterior cruciate ligament patients: A longitudinal study from pre- to 12 months post-reconstruction.

    Science.gov (United States)

    Oberländer, Kai Daniel; Brüggemann, Gert-Peter; Höher, Jürgen; Karamanidis, Kiros

    2014-05-01

    Patients with a history of anterior cruciate ligament rupture are at elevated risk of developing knee osteoarthritis. Altered knee kinematics and kinetics during functional activities have been viewed as risk factors for cartilage breakdown and, therefore, one of the primary goals of anterior cruciate ligament reconstruction is to restore knee joint function. Patients' (n=18) knee mechanics while performing a single leg hop for distance were calculated for both legs using a soft-tissue artifact optimized rigid lower-body model at the pre-reconstruction state and six and twelve months after anterior cruciate ligament reconstruction. Independent of the analyzed time point the involved leg showed a lower external flexion and adduction moment at the knee, and an increased anterior translation and external rotational offset of the shank with respect to the thigh compared to the uninvolved leg. There were no differences for any of the analyzed knee kinematic and kinetic parameters within the control subject group. The identified kinematic changes can cause a shift in the normal load-bearing regions of the knee and may support the view that the risk of developing knee osteoarthritis in an anterior cruciate ligament ruptured joint while performing activities involving frequent landing and stopping actions is less likely to be associated with the knee adduction moment and is rather due to kinematic changes. Anterior cruciate ligament reconstruction surgery failed to restore normal knee kinematics during landing, potentially explaining the persistent risk for the development of knee osteoarthritis in patients who have returned to sports following reconstruction surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Differences between the sexes in the anatomy of the anterior condyle of the knee.

    Science.gov (United States)

    Fehring, Thomas K; Odum, Susan M; Hughes, Josh; Springer, Bryan D; Beaver, Walter B

    2009-10-01

    Claims that there are dramatic differences in anterior condylar anatomy between the sexes have led to the design of total knee implants with thinner anterior condyles specifically for use in women. We had observed, in our patients, differences in anterior condylar anatomy that appeared to be highly variable and dependent on the size, height, and ethnicity of the patient as well as his or her sex. Because of this observed variability, we sought to determine if differences in anterior condylar anatomy between the sexes actually exist. Two hundred and twelve randomly selected magnetic resonance images (112 of men and 100 of women) were evaluated. The anterior condyle was defined as the area of bone anterior to the anterior femoral cortex, 10 mm above the joint line. The medial and lateral heights of the anterior condyles were measured in millimeters directly from magnetic resonance imaging data obtained in two planes. The so-called aspect ratio was calculated to determine whether patient size had an effect on the size of the anterior condyles. On the basis of the numbers available, there was no significant difference (p = 0.16) between the sexes with regard to lateral condylar height. The average difference was only 0.5 mm. There was a significant difference (p = 0.001) between men and women with regard to medial condylar height. However, the average difference was only 1.1 mm. While the difference between the sexes with regard to anterior condylar height was nominal, the measurements were highly variable regardless of sex. On the basis of the numbers available, there were no significant differences between men and women with regard to the condylar aspect ratios. The difference in anterior condylar anatomy is mentioned as one of three reasons for the need for a so-called gender-specific knee implant. The aspect ratio reported here, which is a surrogate for patient size, seems to negate any difference in anterior condylar anatomy based on sex. We have shown that

  9. Pain and Sensitisation after Total Knee Replacement or Non-Surgical Treatment in Patients with Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Simonsen, Ole; Laursen, Mogens Berg

    2018-01-01

    BACKGROUND: This study is a secondary analysis of 12-month follow-ups from two parallel, randomised controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by non-surgical treatment compared with non-surgical treatment. RCT2: Non-surgical treat...

  10. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life

    DEFF Research Database (Denmark)

    Kiadaliri, A. A.; Lamm, C.J.; Gerhardsson de Verdier, Maria

    2016-01-01

    examination. A total of 1527 individuals with a mean (SD) age 69.4 (7.2) participated and responded to both generic (EQ-5D-3L) and disease-specific (the Knee injury and Osteoarthritis Outcome Score) questionnaires. Knee pain was defined as pain during the last month during most of the days. Knee OA......Background: While the impact of knee pain and knee osteoarthritis (OA) on health-related quality of life (HRQoL) has been investigated in the literature, there is a lack of knowledge on the impact of different definitions of OA on HRQoL. The main aim of this study was to measure and compare...... the impact of knee OA and its different definitions on HRQoL in the general population. Methods: A random sample of 1300 participants from Malmö, Sweden with pain in one or both knees in the past 12 months with duration ≥4 weeks and 650 participants without were invited to clinical and radiographic knee...

  11. The Knee Clinical Assessment Study – CAS(K. A prospective study of knee pain and knee osteoarthritis in the general population

    Directory of Open Access Journals (Sweden)

    Hay Elaine

    2004-02-01

    Full Text Available Abstract Background Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities but the clinical usefulness of these two approaches to classifying knee pain in older adults has not been established. We plan to conduct a prospective, population-based, observational cohort study to investigate the relative merits of disease-based and regional pain syndrome-based approaches to classification and prognosis of knee pain in older adults. Methods All patients aged 50 years and over registered with three general practices in North Staffordshire will be invited to take part in a two-stage postal survey. Respondents to this survey phase who indicate that they have experienced knee pain within the previous 12 months will be invited to attend a research clinic for a detailed assessment. This will consist of clinical interview, physical examination, digital photography, plain x-rays, anthropometric measurement and a brief self-complete questionnaire. All consenting clinic attenders will be followed up by (i general practice medical record review, (ii repeat postal questionnaire at 18-months.

  12. Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Wing P. [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); Taipei Medical University-Wan Fang Hospital, Department of Radiology, Taipei (China); Huang, Guo-Shu [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Hsu, Shu-Mei [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); National Taiwan University, Department of Public Health, Taipei (China); Chang, Yue-Cune [Tamkang University, Department of Mathematics, Taipei County (China); Ho, Wei-Pin [Taipei Medical University-Wan Fang Hospital, Department of Orthopedic Surgery, Taipei (China)

    2008-10-15

    The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis. A total of 140 patients who had knee osteoarthritis and underwent primary total knee replacement (TKR) surgery, with unicompartmental medial tibiofemoral JSN (grade 1 or greater) and normal lateral compartments, were recruited. Polytomous logistic regression was used to assess the relationship between JSN and risk factors. All patients with JSN were categorized as grade 1 (n=14, 10.0%), grade 2 (n=64, 45.7%), or grade 3 (n=62, 44.3%). Women presented with indications for a TKR at a younger age than men (mean age, 69 vs 73 years, P<0.05). There were 123 (87.9%) meniscal tears and 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures; 115 of 134 (85.8%) patients had moderate to severe cartilage erosion. A higher grade of JSN was correlated with a higher frequency of meniscal tears [odds ratio (OR) 6.00, 95% CI 1.29-27.96 for grade 2 vs grade 1 JSN] and duration of knee pain (OR 1.25, 95% CI 1.01-1.53 for grade 3 vs grade 1 JSN). A higher grade of JSN was not correlated with a higher frequency of ACL rupture or articular cartilage erosion. A higher grade of JSN is associated with a higher frequency of meniscal tears and long duration of knee pain in patients with knee osteoarthritis. (orig.)

  13. Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain

    International Nuclear Information System (INIS)

    Chan, Wing P.; Huang, Guo-Shu; Hsu, Shu-Mei; Chang, Yue-Cune; Ho, Wei-Pin

    2008-01-01

    The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis. A total of 140 patients who had knee osteoarthritis and underwent primary total knee replacement (TKR) surgery, with unicompartmental medial tibiofemoral JSN (grade 1 or greater) and normal lateral compartments, were recruited. Polytomous logistic regression was used to assess the relationship between JSN and risk factors. All patients with JSN were categorized as grade 1 (n=14, 10.0%), grade 2 (n=64, 45.7%), or grade 3 (n=62, 44.3%). Women presented with indications for a TKR at a younger age than men (mean age, 69 vs 73 years, P<0.05). There were 123 (87.9%) meniscal tears and 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures; 115 of 134 (85.8%) patients had moderate to severe cartilage erosion. A higher grade of JSN was correlated with a higher frequency of meniscal tears [odds ratio (OR) 6.00, 95% CI 1.29-27.96 for grade 2 vs grade 1 JSN] and duration of knee pain (OR 1.25, 95% CI 1.01-1.53 for grade 3 vs grade 1 JSN). A higher grade of JSN was not correlated with a higher frequency of ACL rupture or articular cartilage erosion. A higher grade of JSN is associated with a higher frequency of meniscal tears and long duration of knee pain in patients with knee osteoarthritis. (orig.)

  14. Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

    DEFF Research Database (Denmark)

    Sørensen, T J; Langberg, H; Hodges, P W

    2012-01-01

    Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function...... and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals....

  15. Knee pain and swelling: An atypical presentation of metastatic colon cancer to the patella

    Directory of Open Access Journals (Sweden)

    Bethany Gasagranda, DO

    2014-01-01

    Full Text Available Knee pain is a common reason for a patient to seek medical evaluation. Of the many causes of knee pain, malignancy is one of the least common. When malignancy is the etiology of the pain, it is usually due to a primary tumor of the osseous structures or soft tissues of the knee joint. Metastatic disease involving the knee joint is uncommon, with few cases reported in the literature. Of these reported cases, metastatic colon cancer is exceedingly rare. However, in a patient with new onset knee pain and the proper clinical history, metastatic disease should be considered as a potential explanation of symptoms. We report a case of knee pain and swelling due to metastatic colon cancer to the patella.

  16. Knee Pain and Driving Duration: A Secondary Analysis of the Taxi Drivers’ Health Study

    Science.gov (United States)

    Chen, Jiu-Chiaun; Dennerlein, Jack T.; Shih, Tung-Sheng; Chen, Chiou-Jong; Cheng, Yawen; Chang, Wushou P.; Ryan, Louise M.; Christiani, David C.

    2004-01-01

    Objectives. We explored a postulated association between daily driving time and knee pain. Methods. We used data from the Taxi Drivers’ Health Study to estimate 1-year prevalence of knee pain as assessed by the Nordic musculoskeletal questionnaire. Results. Among 1242 drivers, the prevalence of knee pain, stratified by duration of daily driving (≤ 6, > 6 through 8, > 8 through 10, and > 10 hours), was 11%, 17%, 19%, and 22%, respectively. Compared with driving 6 or fewer hours per day, the odds ratio of knee pain prevalence for driving more than 6 hours per day was 2.52 (95% confidence interval = 1.36, 4.65) after we adjusted for socioeconomic, work-related, and personal factors in the multiple logistic regression. Conclusions. The dose-related association between driving duration and knee pain raises concerns about work-related knee joint disorders among professional drivers. PMID:15054008

  17. Increased joint loads during walking--a consequence of pain relief in knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Simonsen, Erik B; Alkjaer, T

    2006-01-01

    Joint pain is a primary symptom in knee osteoarthritis (OA), but the effect of pain and pain relief on the knee joint mechanics of walking is not clear. In this study, the effects of local knee joint analgesia on knee joint loads during walking were studied in a group of knee osteoarthritis....... Although the patients walked with less compressive knee joint forces compared to the reference group, the effects of pain relief may accelerate the degenerative changes....... patients. A group of healthy subjects was included as a reference group. The joint loads were calculated from standard gait analysis data obtained with standardised walking speed (4 km/h). The gait analyses were performed before and after pain relief by intra-articular injections of 10 mL lidocaine (1...

  18. Snapping popliteal tendon as a source of lateral knee pain.

    Science.gov (United States)

    Crites, B M; Lohnes, J; Garrett, W E

    1998-08-01

    A 25-year-old female patient underwent surgery for a history of pain and popping on the lateral aspect of her right knee. It was initially thought that the patient had iliotibial (IT) band syndrome which was refractory to conservative treatment. However, upon release of the IT band, the snapping which was audible and palpable pre-operatively was still present. Further exploration of the posterior-lateral aspect of the knee revealed that the popliteal tendon was snapping over the incisura poplitea extensoria on the lateral femoral condyle. Excision of the prominent portion of the articular ridge below the sulcus popliteus eliminated the snapping sensation. The patient has remained asymptomatic since surgery for the past 22 months.

  19. Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty.

    Science.gov (United States)

    Kim, Joong Il; Jang, Jak; Lee, Ki Woong; Han, Hyuk Soo; Lee, Sahnghoon; Lee, Myung Chul

    2017-06-12

    Rotational alignment of the tibial component is important for long-term success of total knee arthroplasty (TKA). This study aimed to compare five axes in normal and osteoarthritic (OA) knees to determine a reliable landmark for tibial rotational alignment in TKA. One hundred twenty patients with OA knees and 40 with normal knees were included. The angle between a line perpendicular to the surgical transepicondylar axis and each of five axes were measured on preoperative computed tomography. The five axes were as follows: a line from the center of the posterior cruciate ligament (PCL) to the medial border of the patellar tendon (PCL-PT), medial border of the tibial tuberosity (PCL-TT1), medial one-third of the tibial tuberosity (PCL-TT2), and apex of the tibial tuberosity (PCL-TT3), as well as the anteroposterior axis of the tibial prosthesis along the anterior tibial curved cortex (ATCC). For all five axes tested, the mean angles were smaller in OA knees than in normal knees. In normal knees, the angle of the ATCC axis had the smallest mean value and narrowest range (1.6° ± 2.8°; range, -1.7°-7.7°). In OA knees, the mean angle of the ATCC axis (0.8° ± 2.7°; range, -7.9°-9.2°) was larger than that of the PCL-TT1 axis (0.3° ± 5.5°; range, -19.7°-10.6°) (P = 0.461), while the angle of the ATCC axis had the smallest SD and narrowest range. The ATCC was found to be the most reliable and useful anatomical landmark for tibial rotational alignment in TKA.

  20. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

    Directory of Open Access Journals (Sweden)

    Papalia R

    2015-02-01

    sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise. Conclusion: Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function. Keywords: bone bruise, anterior cruciate ligament, magnetic resonance imaging, knee

  1. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    Science.gov (United States)

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  2. An unusual case of partial Anterior Cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint.

    Science.gov (United States)

    S M, Shishir; K, Abhay Harsh; R, Kanagasabai; Gnanadoss, James J

    2016-01-01

    Various types of foreign bodies have been removed from the knee joint. We report an unusual case of partial anterior cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint. A 13-year-old boy presented with pain, swelling and deformity of the left knee since 4 days. X-Ray revealed a foreign body in the left knee joint. The glass foreign body remained in the subcutaneous tissue for few days and later migrated into the knee joint. Arthroscopy revealed partial tear in the ACL at the femoral attachment with about 10-20 % of fibres being involved. The glass piece was removed arthroscopically and the ACL fibres were trimmed. Arthroscopic removal of foreign bodies from the knee is a very simple procedure and has the advantages of avoiding large incision, shorter stay in the hospital, faster recovery and reduced infection rates. Glass foreign bodies were previously implicated in cartilage damage and meniscal injuries but a foreign body resulting in ACL tear has not been reported in literature.

  3. Knee arthroscopy - series (image)

    Science.gov (United States)

    ... between the femur and the tibia in the knee joint. The anterior cruciate ligament, the posterior cruciate ligament, and the ... Several small punctures are made into the knee joint while the patient ... and pain-free (regional anesthesia or spinal anesthesia).

  4. Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty

    DEFF Research Database (Denmark)

    Lunn, Troels H; Gaarn-Larsen, Lissi; Kehlet, Henrik

    2013-01-01

    postoperative pain after total knee arthroplasty (TKA). Patients scheduled for elective, unilateral, primary TKA under spinal anesthesia were consecutively included in this prospective, observational study. Perioperative analgesia was standardized for all patients. Outcomes were postoperative pain during walk......It has been estimated that up to 54% of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli, with suprathreshold heat pain as the most consistent test modality. We aimed to explore if 2 heat test paradigms could predict......: From 6-24hrs (primary), from postoperative day (POD) 1-7 (secondary), and from POD14-30 (tertiary). Two preoperative tonic heat stimuli with 47°C were used; short (5sec) and long (7min) stimulation upon which patients rated their pain response on an electronic VAS. Multivariate stepwise linear...

  5. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmatt, H.H.; Janssen, D.; Verkerke, Gijsbertus Jacob; Diercks, R.L.; Verdonschot, Nicolaas Jacobus Joseph

    2015-01-01

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  6. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmat, H.H.; Janssen, D.W.; Verkerke, G.J.; Diercks, R.L.; Verdonschot, N.J.J.

    2016-01-01

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  7. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmat, Hendi; Janssen, D.; Verkerke, Gijsbertus; Diercks, Ronald; Verdonschot, N.

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  8. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty

    Science.gov (United States)

    Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

    2013-01-01

    Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

  9. The relationship between pain and dynamic knee joint loading in knee osteoarthritis varies with radiographic disease severity. A cross sectional study

    DEFF Research Database (Denmark)

    Henriksen, Marius; Aaboe, Jens; Bliddal, Henning

    2012-01-01

    between pain intensity and dynamic knee joint loading indicate a natural reaction to pain, which will limit the stress on the joint. In contrast, either absent or positive relationships between pain and dynamic loading in severe OA may lead to overuse and accelerated disease progression. These findings......OBJECTIVE: In a cross sectional study, we investigated the relationships between knee pain and mechanical loading across the knee, as indicated by the external knee adduction moment (KAM) during walking in patients with symptomatic knee OA who were distinguished by different radiographic disease...... severities. METHODS: Data from 137 symptomatic medial knee OA patients were used. Based on Kellgren/Lawrence (K/L) grading, the patients were divided into radiographically less severe (K/L=2, n=68) or severe (K/L>2, n=69) medial knee OA. Overall knee pain was rated on a 10cm visual analog scale, and peak KAM...

  10. Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis.

    Science.gov (United States)

    Lluch Girbés, Enrique; Dueñas, Lirios; Barbero, Marco; Falla, Deborah; Baert, Isabel A C; Meeus, Mira; Sánchez-Frutos, José; Aguilella, Luis; Nijs, Jo

    2016-08-01

    Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. The aim of this study was to examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. This was a cross-sectional study. Fifty-three people with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, completed self-administration questionnaires, and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs=.325, PCentral Sensitization Inventory (rs=.456, P<.01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is needed. Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed. © 2016 American Physical Therapy Association.

  11. Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Asaeda, Makoto; Deie, Masataka; Fujita, Naoto; Kono, Yoshifumi; Terai, Chiaki; Kuwahara, Wataru; Watanabe, Hodaka; Kimura, Hiroaki; Adachi, Nobuo; Sunagawa, Toru; Ochi, Mitsuo

    2017-03-01

    The aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL). Gait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods. Females exhibited more tibial external rotation, in both the Control and ACL groups (P<0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P<0.05). These abnormal sagittal plane mechanics were recovered at 12months, but not six months post-reconstruction. We identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: a population-based cohort study in southern Sweden.

    Science.gov (United States)

    Kiadaliri, Aliasghar A; Lamm, Carl Johan; de Verdier, Maria Gerhardsson; Engström, Gunnar; Turkiewicz, Aleksandra; Lohmander, L Stefan; Englund, Martin

    2016-08-26

    While the impact of knee pain and knee osteoarthritis (OA) on health-related quality of life (HRQoL) has been investigated in the literature, there is a lack of knowledge on the impact of different definitions of OA on HRQoL. The main aim of this study was to measure and compare the impact of knee OA and its different definitions on HRQoL in the general population. A random sample of 1300 participants from Malmö, Sweden with pain in one or both knees in the past 12 months with duration ≥4 weeks and 650 participants without were invited to clinical and radiographic knee examination. A total of 1527 individuals with a mean (SD) age 69.4 (7.2) participated and responded to both generic (EQ-5D-3L) and disease-specific (the Knee injury and Osteoarthritis Outcome Score) questionnaires. Knee pain was defined as pain during the last month during most of the days. Knee OA was defined radiographically (equivalent to Kellgren and Lawrence grade ≥2) and clinically according to the American College of Rheumatology (ACR) criteria. Of participants with either knee pain or knee OA or both, 7 % reported no problem for the EQ-5D-3L attributes. The corresponding proportion among references (neither knee pain nor OA) was 42 %. The participants with knee pain and OA had all HRQoL measures lower compared to those with knee pain but no OA. The ACR clinical definition of knee OA was associated with lower HRQoL than the definition based on radiographic knee OA (adjusted difference -0.08 in UK EQ-5D-3L index score). Applying different definitions of knee OA result in different levels of HRQoL and this is mainly explained by the knee pain experience. These differences may lead to discrepant conclusions from cost-utility analyses.

  13. Patient-reported knee function, quality of life, and activity level after bilateral anterior cruciate ligament injuries.

    Science.gov (United States)

    Fältström, Anne; Hägglund, Martin; Kvist, Joanna

    2013-12-01

    About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. Cohort study; Level of evidence, 3. A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 ± 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 ± 0.22, and the mean EQ-5D visual analog scale score was 75.5 ± 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. Patients with bilateral ACL injuries reported

  14. Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes

    Science.gov (United States)

    Smith, Matthew V.; Nepple, Jeffrey J.; Wright, Rick W.; Matava, Matthew J.; Brophy, Robert H.

    2016-01-01

    Background: Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. Hypothesis: In elite football players undergoing knee magnetic resonance imaging at the National Football League’s Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. Study Design: Retrospective cohort. Level of Evidence: Level 4. Methods: A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery—including ACL reconstruction, meniscal procedures, and articular cartilage surgery—and position were recorded for each athlete. BMI was calculated based on height and weight. Results: There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P 30 kg/m2 was also associated with a higher risk of OA (P = 0.007) but player position was not associated with knee OA. Conclusions: Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes. Clinical Relevance: Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible. PMID:27940573

  15. Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes.

    Science.gov (United States)

    Smith, Matthew V; Nepple, Jeffrey J; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. In elite football players undergoing knee magnetic resonance imaging at the National Football League's Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. Retrospective cohort. Level 4. A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery-including ACL reconstruction, meniscal procedures, and articular cartilage surgery-and position were recorded for each athlete. BMI was calculated based on height and weight. There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P 30 kg/m 2 was also associated with a higher risk of OA ( P = 0.007) but player position was not associated with knee OA. Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes. Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible.

  16. Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study.

    Science.gov (United States)

    Iijima, Hirotaka; Ohi, Hiroshi; Isho, Takuya; Aoyama, Tomoki; Fukutani, Naoto; Kaneda, Eishi; Ohi, Kazuko; Abe, Kaoru; Kuroki, Hiroshi; Matsuda, Shuichi

    2017-11-01

    This cross-sectional study examined the relationship of flat feet with knee pain, disability, and physical performance in patients with knee osteoarthritis (OA). Orthopedic clinic participants (n = 95; age 61-91 years; 68.4% women) with Kellgren-Lawrence (K/L) grade ≥1 in the medial compartment underwent evaluation of navicular height and foot length for flat feet. Knee pain intensity, disability, and physical performance were evaluated using the Japanese Knee Osteoarthritis Measure, 10-m walk, timed up and go, and five-repetition chair stand tests. Of the 95 enrolled patients, 24 (25.3%) had bilateral flat feet, and significantly higher knee pain compared to patients with no flat feet (11.3 ± 8.23 points vs. 6.58 ± 6.37 points; p = 0.043). A ordinal logistic regression analysis showed that bilateral flat feet were significantly associated with increased knee pain (proportional odds ratio: 5.48, 95% confidence interval: 1.96, 15.3; p = 0.001) compared with no flat feet, adjusted for age, sex, body mass index, and tibiofemoral joint K/L grade, which is consistent across various different cutoffs of the definition of flat feet. Physical performance was similar between patients with and without bilateral flat feet. The presence of unilateral flat feet was not significantly associated with any outcome measures. These findings indicate that bilateral, but not unilateral, flat feet are associated with worse knee pain. A prospective study investigating a causal relationship between bilateral flat feet posture and knee pain as well as disability would be of particular interest to verify the potential adverse effect of altered foot posture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2490-2498, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  17. Ultrasound imaging for the rheumatologist XXX. Sonographic assessment of the painful knee.

    Science.gov (United States)

    Meenagh, G; Filippucci, E; Delle Sedie, A; Iagnocco, A; Scirè, C A; Riente, L; Montecucco, C; Valesini, G; Bombardieri, S; Grassi, W

    2010-01-01

    The knee joint is a frequent focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound findings in patients presenting with a variety of rheumatic disorders and knee pain. US imaging provides for a sensitive and detailed identification of different intra- and peri-articular pathology responsible for knee pain.

  18. Sex-Based Differences in Knee Kinetics With Anterior Cruciate Ligament Strain on Cadaveric Impact Simulations.

    Science.gov (United States)

    Schilaty, Nathan D; Bates, Nathaniel A; Nagelli, Christopher; Krych, Aaron J; Hewett, Timothy E

    2018-03-01

    Females are at an increased risk of sustaining noncontact knee ligament injuries as compared with their male counterparts. The kinetics that load the anterior cruciate ligament (ACL) are still under dispute in the literature. The purpose of this study was to determine whether there are differences in knee kinetics between the sexes that lead to greater ACL strain in females when similar external loads are applied during a simulated drop vertical jump landing task. It was hypothesized that female limbs would demonstrate significant differences in knee abduction moment that predispose females to ACL injury when compared with males. Controlled laboratory study. Motion analysis data of 67 athletes who performed a drop vertical jump were collected. The kinematic and kinetic data were used to categorize tertiles of relative risk, and these values were input into a cadaveric impact simulator to assess ligamentous loads during the simulated landing task. Uni- and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect kinetic data and maximum ACL strain for analysis. Conditions of external loads applied to the cadaveric limbs were systematically varied and randomized. Data were analyzed with 2-way repeated-measures analysis of variance and the Fisher exact test. Five kinetic parameters were evaluated. Of the 5 kinetic variables, only knee abduction moment (KAM) demonstrated significant differences in females as compared with males ( F 1,136 = 4.398, P = .038). When normalized to height and weight, this difference between males and females increased in significance ( F 1,136 = 7.155, P = .008). Compared with males, females exhibited a 10.3-N·m increased knee abduction torque at 66 milliseconds postimpact and a 22.3-N·m increased abduction torque at 100 milliseconds postimpact. For loading condition, the condition of "maximum ACL strain" demonstrated a maximum difference of 54.3-N·m increased abduction torque and 74

  19. Kinematic characteristics of anterior cruciate ligament deficient knees with concomitant meniscus deficiency during ascending stairs.

    Science.gov (United States)

    Zhang, Yu; Huang, Wenhan; Ma, Limin; Lin, Zefeng; Huang, Huayang; Xia, Hong

    2017-02-01

    It is commonly believed that a torn ACL or a damaged meniscus may be associated with altered knee joint movements. The purpose of this study was to measure the tibiofemoral kinematics of ACL deficiency with concomitant meniscus deficiency. Unilateral knees of 28 ACL deficient participants were studied while ascending stairs. Among these patients, 6 had isolated ACL injuries (group I), 8 had combined ACL and medial meniscus injuries (group II), 8 had combined ACL and lateral meniscus injuries (group III) and 6 had combined ACL and medial-lateral meniscus injuries (group IV). Both knees were then scanned during a stair climb activity using single fluoroscopic image system. Knee kinematics were measured at 0°, 5°, 10°, 15°, 30° and 60° of flexion during ascending stairs. At 0°, 15° and 30° flexion of the knee, the tibia rotated externally by 13.9 ± 6.1°,13.8 ± 9.5° and 15.9 ± 9.8° in Group I. Group II and III exhibited decreased external rotation from 60° to full extension. Statistical differences were found in 0°, 15°and 30° of flexion for the 2 groups compared with Group I. In general, the tibia showed anterior translation with respect to the femur during ascending stairs. It was further determined that Group III had larger anterior translation compared with Group IV at 0° and 5° of flexion (-6.9 ± 1.7 mm vs. 6.2 ± 11.3 mm, P = 0.041; -9.0 ± 1.8 mm vs. 8.1 ± 13.4 mm, P = 0.044). During ascending stairs the ACL deficient knee with different deficiencies in the meniscus will show significantly different kinematics compared with that of uninjured contralateral knee. Considering the varying effect of meniscus injuries on knee joint kinematics, future studies should concentrate on specific treatment of patients with combined ACL and meniscus injuries to protect the joint from abnormal kinematics and subsequent postoperative degeneration.

  20. Effect of Matching or Overconstraining Knee Laxity During Anterior Cruciate Ligament Reconstruction on Knee Osteoarthritis and Clinical Outcomes: A Randomized Controlled Trial With 84-Month Follow-up.

    Science.gov (United States)

    Akelman, Matthew R; Fadale, Paul D; Hulstyn, Michael J; Shalvoy, Robert M; Garcia, Arlene; Chin, Kaitlyn E; Duryea, Jeffrey; Badger, Gary J; Tung, Glenn A; Fleming, Braden C

    2016-07-01

    The "initial graft tension" applied at the time of graft fixation during anterior cruciate ligament (ACL) reconstruction surgery modulates joint contact mechanics, which in turn may promote posttraumatic osteoarthritis (OA). The study objectives were to compare clinical, functional, patient-reported, and OA imaging outcomes between 2 different initial laxity-based graft tension cohorts and a matched uninjured control group as well as to evaluate the effects of laxity-based graft tension on OA development at 84-month follow-up. The 2 laxity-based tension protocols were (1) to restore normal anteroposterior (AP) laxity at the time of surgery relative to the contralateral uninjured knee (low-tension group) or (2) to overconstrain AP laxity by 2 mm relative to the contralateral uninjured knee (high-tension group). The hypotheses were that (1) the high-tension group would have improved outcomes and decreased OA compared with the low-tension group after 84 months, and (2) the outcomes for the high-tension group would be equivalent to those for an age-, sex-, race-, and activity-matched group of control participants with uninjured knees. Randomized controlled trial; Level of evidence, 1. Patients had their ACLs reconstructed with either a bone-patellar tendon-bone or 4-stranded hamstring autograft, and outcomes were compared with a matched control group. Outcomes were evaluated preoperatively and at 60 and 84 months postoperatively and included clinical (KT-1000 arthrometer AP laxity measurement and International Knee Documentation Committee [IKDC] examination score), functional (1-legged hop for distance and knee extensor torque), patient-reported (Knee injury and Osteoarthritis Outcome Score [KOOS], Short Form-36 [SF-36], and patient satisfaction survey), and OA imaging (measurement of joint space width [JSW], Osteoarthritis Research Society International [OARSI] radiographic score, and Whole-Organ Magnetic Resonance Imaging Score [WORMS]) components. Repeated

  1. Cold Pain Threshold Identifies a Subgroup of Individuals With Knee Osteoarthritis That Present With Multimodality Hyperalgesia and Elevated Pain Levels.

    Science.gov (United States)

    Wright, Anthony; Benson, Heather A E; Will, Rob; Moss, Penny

    2017-09-01

    Cold hyperalgesia has been established as an important marker of pain severity in a number of conditions. This study aimed to establish the extent to which patients with knee osteoarthritis (OA) demonstrate widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function. A total of 80 participants with knee OA and 40 matched healthy, pain-free controls participated. OA participants completed a washout of their usual medication. Quantitative sensory testing was completed at 3 sites using standard methods. Cold pain threshold (CPT) and heat pain thresholds (HPT) were tested using a Peltier thermode and pressure pain thresholds (PPT) using a digital algometer. All participants completed the short-form health survey questionnaire and OA participants completed the PainDETECT, Western Ontario and McMaster Universities Osteoarthritis Index of the Knee (WOMAC), and pain quality assessment scale questionnaires. OA participants demonstrated widespread cold hyperalgesia (Ppain, decreased function, and more features of neuropathic pain. This study identified a specific subgroup of patients with knee OA who exhibited widespread, multimodality hyperalgesia, more pain, more features of neuropathic pain, and greater functional impairment. Identification of patients with this pain phenotype may permit more targeted and effective pain management.

  2. Auricular Acupressure for Managing Postoperative Pain and Knee Motion in Patients with Total Knee Replacement: A Randomized Sham Control Study

    Directory of Open Access Journals (Sweden)

    Ling-hua Chang

    2012-01-01

    Full Text Available Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR. Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a day for 3 days. A visual analog scale (VAS and the Short-Form McGill Pain Questionnaire were used to assess pain intensity. Pain medication consumption was recorded, and the knee motion was measured using a goniometer. Results. The patients experienced a moderately severe level of pain postoperatively (VAS 58.66 ± 20.35 while being on the routine PCA. No differences were found in pain scores between the groups at all points. However, analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group (<0.05, controlling for BMI, age, and pain score. On the 3rd day after surgery, the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients (<0.05, controlling for BMI. Conclusion. The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR.

  3. Prepatellar Friction Syndrome: a common cause of knee pain in the elite cyclist.

    Science.gov (United States)

    Claes, Tom; Claes, Steven; De Roeck, Jeoffrey; Claes, Toon

    2015-12-01

    Although anterior knee pain is extremely common in high-level road cyclists, the exact etiology still remains unclear. A group of 28 professional male elite cyclists diagnosed with Prepatellar Friction Syndrome (PPFS) were retrospectively reviewed with specific attention for the typical history, clinical findings and treatment modalities. A traumatic onset of the complaints was reported by 10 athletes, while the complaints were caused by chronic overuse in the remaining 18 subjects. Conservative treatment delivered poor results and all cases were eventually treated surgically. Surgery confirmed macroscopic damage to at least one prepatellar fascial layer in all patients, after which partial fasciectomy was performed through a mini incision. PPFS is a new clinical entity of the triple-layered prepatellar fascial structures. Correct diagnosis is critical and based on the typical history and clinical findings. Partial prepatellar fasciectomy is the treatment of choice in order to regain the pre-injury performance level.

  4. Clinical, radiological and ultrasonographic findings related to knee pain in osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Keith K W Chan

    Full Text Available Pain is the predominant symptom of knee osteoarthritis (OA and the main reason of disability. Ultrasound is now one of the new imaging modality in Musculoskeletal medicine and its role in assessing the pain severity in the knee osteoarthritis is evaluated in this study.(1 To study the correlation between ultrasonographic (US findings and pain score and (2 whether ultrasonographic findings show a better association of pain level than conventional X-rays in patients suffering from primary knee osteoarthritis.In this multi-center study, 193 patients with primary knee OA were asked to score their average knee pain using the Western Ontario and McMaster Universities Arthritis (WOMAC questionnaire;patients would then go for a radiological and an US evaluation of their painful knee. Findings from both imaging modalities will be studied with the associated pain score.Ultrasound showed that knee effusion has positive correlation with pain score upon walking (r = 0.217 and stair climbing (r = 0.194. Presence of suprapatellar synovitis had higher pain score on sitting (Spearman's Rank correlation  = 0.355. The medial(r = 0.170 and lateral meniscus protrusion (r = 0.201 were associated with pain score upon stair climbing.Our study found that both imaging modalities shown some significant association with the aspect of pain; neither one is clearly better but rather complementary to each other. A trend is found in both modalities: walking pain is related to pathologies of the either the lateral or medial tibiofemoral joint(TFJwhile stair climbing pain is related to both tibiofemoral joint pathologies and also to the patellofemoral joint (PFJ pathology. This suggested that biomechanical derangement is an important aspect in OA knee pain.

  5. Prevalence of knee pain and knee OA in southern Sweden and the proportion that seeks medical care

    DEFF Research Database (Denmark)

    Turkiewicz, Aleksandra; Gerhardsson de Verdier, Maria; Engström, Gunnar

    2015-01-01

    OBJECTIVE: The aim of this study was to estimate the prevalence of frequent knee pain in radiographic, symptomatic and clinically defined knee OA in middle-aged and elderly patients and the proportion that seeks medical care. METHODS: In 2007 a random sample of 10 000 56- to 84-year-old residents....... RESULTS: The 10 000 subjects had a mean age of 70 years (s.d. 7.6), a mean BMI of 27.1 kg/m(2) and 62% were women. The prevalence of frequent knee pain was 25.1% (95% CI 24.1, 26.1), higher in women and similar across age groups. The prevalence of radiographic knee OA was 25.4% while 15.4% had either...... symptomatic or clinically defined knee OA. Of these, 68.9% consulted a physician for knee OA or pain during 2004-11. CONCLUSION: Fifteen per cent of middle-aged or elderly individuals have knee OA and symptoms. About one in three of those do not consult a physician. Inefficient care of OA and self-coping may...

  6. Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes.

    Science.gov (United States)

    Magnussen, Robert A; Reinke, Emily K; Huston, Laura J; Hewett, Timothy E; Spindler, Kurt P

    2016-12-01

    Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Increased preoperative knee laxity would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Cohort study; Level of evidence, 2. From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscus status. Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients

  7. Quadriceps Strength and Anterior Knee Pain following Tibia ...

    African Journals Online (AJOL)

    2017-07-17

    Jul 17, 2017 ... fixation with interlocking intramedullary nailing done and were followed up for at least 1 year were recruited into the study. The tension .... at the foot of the couch. The patient was made to sit at the edge of the ... screws leading to proximal migration of the nail with irritation of the patellar tendon. The nail was ...

  8. Quadriceps Strength and Anterior Knee Pain following Tibia ...

    African Journals Online (AJOL)

    2017-07-17

    Jul 17, 2017 ... necrosis and irritation, meniscal and cartilage damage, gait changes, tendonitis, and inadequate neuromuscular rehabilitation have been suggested as possible causes.[5]. Thigh muscle strength deficits have also been reported after intramedullary nailing of tibial shaft fractures,[6,7] and this has been ...

  9. THE EFFECT OF ADDING SPECIFIC HIP STRENGTHENING EXERCISES TO CONVENTIONAL KNEE EXERCISES IN PATIENTS WITH PATELLO FEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Raghav Monika

    2016-02-01

    Full Text Available Background: Patello femoral pain Syndrome is an over use injury and one of the commonest problems seen in adolescents who are physically active. Till date no study has been done comparing the effect of adding specific hip strengthening exercises (gluteus medius, gluteus maximus & lateral rotators to conventional exercises in patients with Patello femoral Pain Syndrome (PFPS while minimizing the effect of minimizing the activation of tensor fascia lata (TFL. Methods: 30 subjects were randomly allocated using convenience random sampling into 2 Groups Group A and Group B with 15 subjects in each group. Readings were taken for Numeric Pain Rating Scale (NPRS, Manual Muscle Testing (MMT for hip abductors, extensors and external rotators muscles quadriceps and hamstrings, and Anterior Knee Pain Scale (AKPS on baseline and at the end of 4th week. Results: Analysis of the data collected for NPRS, AKPS and MMT of Quadriceps, Hamstrings, Hip Abductors and Hip External Rotators of 30 subjects was done by statistical analysis tests using STATA and software version 11.2. Although improvement was seen in both the groups but group B improved better compared to group A. Conclusion: Group B treatment protocol i.e. Hip specific strengthening (gluteus medius and gluteus maximus in addition to conventional treatment in patients with patello-femoral pain syndrome, was found to be effective in reducing pain, improving functional status and increasing muscle strength than Group A treatment protocol i.e. Knee strengthening and stretching.

  10. Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Kim, Sung-Jae; Moon, Hong-Kyo; Chun, Yong-Min; Chang, Woo-Hyuk; Kim, Sul-Gee

    2011-05-01

    Valgus high tibial osteotomy (HTO) has been recommended for ligament stability and enhanced function after anterior cruciate ligament (ACL) reconstruction in varus-angulated knees. However, it is not clear whether HTO should be performed in patients undergoing ACL reconstruction who have primary varus knees without medial compartment arthrosis. We therefore asked whether stability and function differed in patients having ACL reconstruction with differing degrees of preoperative alignment. We retrospectively reviewed 201 patients who had primary, single-bundle ACL reconstructions with primary varus knees based on the preoperative mechanical axis deviation (MAD) on preoperative standing hip-knee-ankle radiographs. Patients were categorized into four groups according to the MAD: Group 1: 0 mm to 4 mm, Group 2: 5 mm to 9 mm, Group 3: 10 mm to 14 mm, and Group 4: greater than 15 mm. A total of 201 patients, 67 in Group 1, 53 in Group 2, 38 in Group 3, and 43 in Group 4, were assessed. Ligament stability was determined with the Lachman test, pivot shift test, and KT 2000™ arthrometer. Functional scores were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score. The minimum followup was 24 months (mean, 45 months; range, 24-96 months). We observed no differences in the side-to-side KT 2000™ measurements, Lysholm score, or IKDC functional scores based on the preoperative MAD. The stability and functional scores after ACL reconstruction were not adversely altered by primary varus alignment. Thus, if there is no medial compartment arthritis or varus thrust, we do not believe a correctional tibial osteotomy is crucial in primary varus knees undergoing ACL reconstruction.

  11. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Laurel A Donnell-Fink

    Full Text Available Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs.We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs weighted by their precision (1/variance using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis.Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0-5 scale. The summary incidence rate ratio was estimated at 0.731 (95% CI: 0.614, 0.871 for knee injury and 0.493 (95% CI: 0.285, 0.854 for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy.The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs.

  12. Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location.

    Science.gov (United States)

    Kim, Sophia Y; Spritzer, Charles E; Utturkar, Gangadhar M; Toth, Alison P; Garrett, William E; DeFrate, Louis E

    2015-10-01

    The motions causing noncontact anterior cruciate ligament (ACL) injury remain unclear. Tibiofemoral bone bruises are believed to be the result of joint impact near the time of ACL rupture. The locations and frequencies of these bone bruises have been reported, but there are limited data quantifying knee position and orientation near the time of injury based on these contusions. Knee position and orientation near the time of noncontact ACL injury include extension and anterior tibial translation. Descriptive laboratory study. Magnetic resonance images of 8 subjects with noncontact ACL injuries were acquired within 1 month of injury and were subsequently analyzed. All subjects exhibited bruises on both the femur and tibia in both medial and lateral compartments. The outer margins of bone and the bone bruise surfaces were outlined on each image to create a 3-dimensional model of each subject's knee in its position during magnetic resonance imaging (MRI position). Numerical optimization was used to maximize overlap of the bone bruises on the femur and tibia and to predict the position of injury. Flexion angle, valgus orientation, internal tibial rotation, and anterior tibial translation were measured in both the MRI position and the predicted position of injury. Differences in kinematics between the MRI position, which served as an unloaded reference, and the predicted position of injury were compared by use of paired t tests. Flexion angle was near full extension in both the MRI position and the predicted position of injury (8° vs 12°; P = .2). Statistically significant increases in valgus orientation (5°; P = .003), internal tibial rotation (15°; P = .003), and anterior tibial translation (22 mm; P injury relative to the MRI position. These results suggest that for the bone bruise pattern studied, landing on an extended knee is a high risk for ACL injury. Extension was accompanied by increased anterior tibial translation (22 mm), internal tibial rotation (15

  13. Capturing patient-reported area of knee pain: a concurrent validity study using digital technology in patients with patellofemoral pain.

    Science.gov (United States)

    Matthews, Mark; Rathleff, Michael S; Vicenzino, Bill; Boudreau, Shellie A

    2018-01-01

    Patellofemoral pain (PFP) is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient's description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets. To assess the validity of using computer tablets to acquire a patient's knee pain drawings as compared to paper-based records in patients with PFP. Patients ( N = 35) completed knee pain drawings on identical images (size and colour) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland-Altman plots, intraclass correlation coefficient (ICC), Pearson's correlation coefficients and one-sample tests were used in data analysis. No significant difference in pain area was found between the paper and digital records of mapping pain area ( p = 0.98), with the mean difference = 0.002% (95% CI [-0.159-0.157%]). A very high agreement in pain area between paper and digital pain drawings (ICC = 0.966 (95% CI [0.93-0.98], F = 28.834, df = 31, p digital drawings. Pain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as quantification and reporting of pain area, could be realized in both research and clinical settings.

  14. Effects of Mild and Severe Knee Joint Pain on Various Activities of Daily Living in the Female Elderly

    Directory of Open Access Journals (Sweden)

    Hiroki Sugiura

    2013-01-01

    Full Text Available This study aimed to examine the differences in the ability to perform various activities of daily living (ADLs among groups with various knee problems. The participants consisted of 328 elderly females (age 60–94; mean age 76.1 years; standard deviation 6.2. The subjects were classified into three groups: those without knee pain, those with mild knee pain, and those with severe knee pain. ADLs with markedly higher (>97% and lower (<38% achievement rates in the group without knee pain were not significantly different among the three groups. Achievement rates of 40%–97% for ADLs were significantly lower in the group with severe knee pain than in the group without knee pain. In addition, the groups with mild and severe knee pain demonstrated significantly lower achievement rates of ascending and descending stairs and sitting up than the group without knee pain. In conclusion, regardless of the presence of absence of mild or severe knee pain, some ADLs are difficult to achieve, while others are easy. The elderly with severe knee pain find it difficult to achieve many ADLs. In addition, it is difficult for the elderly with mild and severe knee pain to ascend and descend stairs and to sit up.

  15. Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction.

    Directory of Open Access Journals (Sweden)

    Adam Czaplicki

    Full Text Available The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ≤ 0.05 in peak knee extension and flexion torques, hamstring/quadriceps (H/Q strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age.

  16. Knee chondrolysis by infusion of bupivacaine with epinephrine through an intra-articular pain pump catheter after arthroscopic ACL reconstruction.

    Science.gov (United States)

    Buchko, Jordan Z; Gurney-Dunlop, Tanner; Shin, Jason J

    2015-02-01

    Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication. To determine the association between postoperative intra-articular infusion of bupivacaine with epinephrine and the development of knee chondrolysis in patients who have undergone arthroscopic anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the development of knee chondrolysis after ACLR is associated with postoperative high-dose intra-articular bupivacaine with epinephrine infusion. Cohort study; Level of evidence, 3. In this retrospective cohort study, the charts of all patients treated with arthroscopic ACLR by a single surgeon between January 1, 2004, and December 31, 2006, were reviewed. Patients with severe articular cartilage damage at the time of the index procedure, with known knee joint infection, inflammatory arthritis, multiligament knee injury, bilateral knee injury, or any previous knee surgery, were excluded. Patients were grouped into 2 cohorts: the exposure group (those who had postoperative infusion of bupivacaine with epinephrine via an intra-articular pain pump [IAPP]) and the nonexposure group (those without postoperative infusion). A total of 105 patients met the inclusion and exclusion criteria. There were 57 male and 48 female patients with a mean age at surgery of 25.5 ± 8.6 years (range, 13-52 years). The exposure group consisted of 46 patients and the control group of 59 patients. Thirteen of 46 patients (28.3%) who received an IAPP developed chondrolysis. There were no cases of chondrolysis in the control group. Of those in the exposure group, 32 patients were exposed to 0.5% bupivacaine with epinephrine and 12 developed chondrolysis (37.5%), while 14 patients were exposed to 0.25% bupivacaine with epinephrine and 1 developed chondrolysis (7.1%). Patients exposed to 0.5% bupivacaine with epinephrine had a significantly higher incidence of chondrolysis

  17. How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard.

    Science.gov (United States)

    Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

    2017-01-01

    Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury - a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms.

  18. Acute Concomitant Anterior Cruciate Ligament and Patellar Tendon Tears in a Non-dislocated Knee

    Directory of Open Access Journals (Sweden)

    Robert D Wissman

    2012-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are common and may occur in isolation or with other internal derangements of the joint. Tears of the patellar tendon (PT occur less frequently and are rarely associated with intra-articular pathology. Acute combined tears of both the ACL and PT are known complications of high-energy traumatic knee dislocations. We present a case of an acute concomitant ACL and PT tears in a low-energy non-dislocated knee. To our knowledge, this injury has only been described in a limited number of case reports in the orthopedic literature. We present the imaging findings of this combined injury and discuss the importance of magnetic resonance (MR in diagnosis.

  19. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Huang, Ambrose J.; Chang, Connie Y.; Smith, Maximilian; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Gill, Thomas J. [Boston Sports Medicine and Research Institute, Boston, MA (United States)

    2014-12-20

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome. (orig.)

  20. Patellar SPECT and planar imaging in orthopedic patients with knee pain

    International Nuclear Information System (INIS)

    Dehdashti, F.; Collier, B.D.; Johnson, R.P.; Isitman, A.T.; Hellman, R.S.; Carrera, G.F.; Krasnow, A.Z.

    1987-01-01

    Eighty-five painful knees in 56 patients were independently evaluated clinically, radiographically, and scintigraphically. All patients had an established final diagnosis of osteoarthritis or other predisposing conditions. Results of patellar bone scintigraphy were abnormal in 66 of 85 knees; there were ten isolated findings and 12 cases of medial, nine of lateral, and 35 of triple compartment involvement. Four-quadrant patellar analysis identified nine instances of isolated lateal patellar facet syndrome. Single-photon emission CT was of significant value in localizing patellar abnormalities. Radiographic evaluation disclosed osteoarthritis in 27 of 66 scintigraphically abnormal knees. Patellar bone scintigraphy is more valuable than radiography for evaluating adult orthopedic patients with knee pain

  1. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

    International Nuclear Information System (INIS)

    Dyck, Pieter van; Gielen, Jan L.; Parizel, Paul M.; Vanhoenacker, Filip M.; Wouters, Kristien; Dossche, Lieven

    2012-01-01

    To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee. MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears. MR images were interpreted by two blinded reviewers and scored with respect to previously reported primary and secondary MR signs of ACL injury. Based on a comprehensive assessment of all the MR findings, ACLs were categorized as being stable or unstable. MR accuracy was calculated considering only primary MR signs and considering both primary and secondary MR signs of ACL injury, separately. Accuracy of each individual primary and secondary MR sign was calculated. Considering only primary MR signs, sensitivity, specificity, and accuracy of MR were 77, 92, and 82%, respectively. Considering both primary and secondary MR signs, sensitivity, specificity, and accuracy of MR were 59, 81, and 67%, respectively. Of all MR signs, discontinuity and abnormal orientation had highest test accuracy (79 and 87%, respectively). Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL were only seen in unstable ACLs (specificity 100%), but these secondary findings had low sensitivity (23%). Bone contusion around the lateral knee compartment was seen in both unstable and stable ACLs (accuracy 64%). Previously reported MR imaging signs do not allow accurate distinction between clinically stable and unstable ACL injuries. Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL, if present, are helpful signs in the diagnosis of an unstable tear. The presence of bone marrow edema around the lateral knee compartment is not predictive of ACL insufficiency. (orig.)

  2. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Gielen, Jan L.; Parizel, Paul M. [University Hospital Antwerp and University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip M. [University Hospital Antwerp and University of Antwerp, Department of Radiology, Edegem (Belgium); AZ St-Maarten Duffel/Mechelen, Department of Radiology, Duffel (Belgium); Wouters, Kristien [University Hospital Antwerp and University of Antwerp, Department of Scientific Coordination and Biostatistics, Edegem (Belgium); Dossche, Lieven [University Hospital Antwerp and University of Antwerp, Department of Orthopedics, Edegem (Belgium)

    2012-03-15

    To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee. MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears. MR images were interpreted by two blinded reviewers and scored with respect to previously reported primary and secondary MR signs of ACL injury. Based on a comprehensive assessment of all the MR findings, ACLs were categorized as being stable or unstable. MR accuracy was calculated considering only primary MR signs and considering both primary and secondary MR signs of ACL injury, separately. Accuracy of each individual primary and secondary MR sign was calculated. Considering only primary MR signs, sensitivity, specificity, and accuracy of MR were 77, 92, and 82%, respectively. Considering both primary and secondary MR signs, sensitivity, specificity, and accuracy of MR were 59, 81, and 67%, respectively. Of all MR signs, discontinuity and abnormal orientation had highest test accuracy (79 and 87%, respectively). Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL were only seen in unstable ACLs (specificity 100%), but these secondary findings had low sensitivity (23%). Bone contusion around the lateral knee compartment was seen in both unstable and stable ACLs (accuracy 64%). Previously reported MR imaging signs do not allow accurate distinction between clinically stable and unstable ACL injuries. Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL, if present, are helpful signs in the diagnosis of an unstable tear. The presence of bone marrow edema around the lateral knee compartment is not predictive of ACL insufficiency. (orig.)

  3. Krill Oil Improves Mild Knee Joint Pain: A Randomized Control Trial.

    Directory of Open Access Journals (Sweden)

    Yoshio Suzuki

    Full Text Available Krill oil is an edible oil extracted from krill, a small red-colored crustacean found in the Antarctic Ocean. The administration of krill oil is reported to mitigate inflammation in patients with cardiac disease, rheumatoid arthritis, or osteoarthritis. However, the effect of krill oil on mild knee pain has not yet been determined.To assess the effect of krill oil on mild knee pain.A randomized, double-blind, parallel-group, placebo-controlled trial of fifty adults (38-85 years old with mild knee pain attending the Fukushima Orthopedic Clinic (Tochigi, Japan between September 2014 and March 2015.Participants were randomized to receive 2 g per day of either krill oil or an identical placebo for 30 days.The primary outcome was improvement in subjective symptoms of knee pain as assessed by the Japanese Knee Osteoarthritis Measure (JKOM and Japanese Orthopaedic Association score (JOA. Secondary outcomes included blood and urine biochemical parameters.Both the placebo and krill oil groups showed significant improvements in the questions in the JKOM and JOA questionnaires after administration. After the intervention, krill oil group showed more improvements than placebo group in two questions regarding the pain and stiffness in knees in JKOM. Controlling for age, sex, weight, and smoking and drinking habits, krill oil significantly mitigated knee pain in sleeping (P < 0.001, standing (P < 0.001 and the range of motion of both right and left knees (both P = 0.011 compared to placebo. Krill oil administration raised plasma EPA (P = 0.048 and EPA/AA ratio (P = 0.003.This study indicates that krill oil administration (2 g/day, 30 days improved the subjective symptoms of knee pain in adults with mild knee pain.UMIN-CTR; ID UMIN000014413.

  4. A systematic review to evaluate exercise for anterior cruciate ligament injuries: does this approach reduce the incidence of knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Duncan KJ

    2016-01-01

    Full Text Available Koji J Duncan, Jaclyn N Chopp-Hurley, Monica R Maly School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada Purpose: Among a variety of conservative and surgical options to treat anterior cruciate ligament (ACL injuries, we do not understand which options could potentially prevent knee osteoarthritis (OA. The aim of this systematic review was to examine the evidence pertaining to exercise treatment of ACL injuries in the context of knee OA. Methods: Medline, Embase, CINAHL, PubMed, and PEDro (Physiotherapy Evidence Database databases were systematically searched using keywords encompassed within four primary key terms: knee, osteoarthritis, anterior cruciate ligament, and exercise. Clinical studies evaluating the effect of an exercise treatment for ACL injuries on the development of knee OA in adult humans were included. The PEDro scale was used to critically assess the studies included in the review. Results: Eighteen studies were included in this review, with a median PEDro score of 6/11 (range, 2/11–9/11. Three studies provided statistical evidence that exercise following ACL injury lowered the risk for knee OA development. Nine studies demonstrated no benefit of exercise in preventing knee OA incidence relative to either operative treatment or the contralateral, unaffected knee. However, exercise resulted in higher knee instability. Nonetheless, there were no significant differences in subjective or objective knee outcomes for early versus late ACL reconstruction. Limitations: This review was not registered through PROSPERO. Conclusion: The relationship between a rehabilitative exercise for ACL injuries and long-term knee OA prevalence is inconclusive. However, research suggests initial conservative treatment with optional late ACL reconstruction because this treatment strategy may reduce the risk of knee OA. More research, ideally randomized controlled trials or comparable designs, is required prior to establishing

  5. Combination of lateral and PA view radiographs to study development of knee OA and associated pain

    Science.gov (United States)

    Minciullo, Luca; Thomson, Jessie; Cootes, Timothy F.

    2017-03-01

    Knee Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people around the world. The effects of the disease have been studied using the shape and texture features of bones in PosteriorAnterior (PA) and Lateral radiographs separately. In this work we compare the utility of features from each view, and evaluate whether combining features from both is advantageous. We built a fully automated system to independently locate landmark points in both radiographic images using Random Forest Constrained Local Models. We extracted discriminative features from the two bony outlines using Appearance Models. The features were used to train Random Forest classifiers to solve three specific tasks: (i) OA classification, distinguishing patients with structural signs of OA from the others; (ii) predicting future onset of the disease and (iii) predicting which patients with no current pain will have a positive pain score later in a follow-up visit. Using a subset of the MOST dataset we show that the PA view has more discriminative features to classify and predict OA, while the lateral view contains features that achieve better performance in predicting pain, and that combining the features from both views gives a small improvement in accuracy of the classification compared to the individual views.

  6. Secondary Stabilizers of Tibial Rotation in the Intact and Anterior Cruciate Ligament Deficient Knee.

    Science.gov (United States)

    Kaplan, Daniel James; Jazrawi, Laith M

    2018-01-01

    The controversy regarding the existence and function of the anterolateral ligament or anterolateral complex has reinvigorated interest in rotational stability of the knee joint. This is particularly true of anterolateral rotary instability, as many patients, despite anatomic reconstruction of their anterior cruciate ligament, continue to experience instability. Many experts point toward compromised anterolateral restraints as the underlying culprit, namely, the anterolateral complex, which includes the iliotibial band, anterolateral capsule, lateral meniscus, and lateral collateral ligament. This article provides a breakdown of these structures, their function, biomechanical properties, and clinical importance, based on a thorough review of available literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Anterolateral subluxation of the tibia associated with combined anterior cruciate and medial collateral ligament tears: MR imaging of the knee

    International Nuclear Information System (INIS)

    Park, Jin Gyoon; Kang, Heoung Keun; Lee, Joong K.; Phelps, Carlton T.

    1995-01-01

    To evaluate the passive subluxation of the tibia on MR imaging in patient with both anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears and to demonstrate the usefulness of its measurement. The authors performed a retrospective study of 123 knees with tears of both ACL (complete, n = 70, partial, n = 53) and MCL (complete, n = 10, partial, n 113). ACL tears were documented at arthroscopy and MCL tears were interpreted by abnormal MR findings. One hundred normal knees were also studied for comparison. Using new internal landmarks, anterior subluxation was measured on an intercondylar sagittal image and lateral subluxation was measured on a mid-coronal image. Anterior subluxation of 3 mm or more was seen in 45/123(37%) abnormal knees, lateral subluxation of 3 mm or more in 20/123(16%), and anterolateral subluxation in 15/123(12%). Anterior subluxation of 5 mm or more was seen in 25/70(36%) complete ACL tears, and no knees with partial ACL tears showed anterior subluxation of 5 mm or more. Static anterolateral subluxation of the tibia occurs in knees with combined ACL and MCL tears, as measured on routine MR imaging. These measurements may help confirm the presence of ligament injuries and differentiate complete from partial ACL tear

  8. Anterolateral subluxation of the tibia associated with combined anterior cruciate and medial collateral ligament tears: MR imaging of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Gyoon; Kang, Heoung Keun [Chonnam University Medical School, Kwangju (Korea, Republic of); Lee, Joong K.; Phelps, Carlton T. [Albany Medical College and Albany Medical Center Hospital, Newyork (United States)

    1995-09-15

    To evaluate the passive subluxation of the tibia on MR imaging in patient with both anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears and to demonstrate the usefulness of its measurement. The authors performed a retrospective study of 123 knees with tears of both ACL (complete, n = 70, partial, n = 53) and MCL (complete, n = 10, partial, n 113). ACL tears were documented at arthroscopy and MCL tears were interpreted by abnormal MR findings. One hundred normal knees were also studied for comparison. Using new internal landmarks, anterior subluxation was measured on an intercondylar sagittal image and lateral subluxation was measured on a mid-coronal image. Anterior subluxation of 3 mm or more was seen in 45/123(37%) abnormal knees, lateral subluxation of 3 mm or more in 20/123(16%), and anterolateral subluxation in 15/123(12%). Anterior subluxation of 5 mm or more was seen in 25/70(36%) complete ACL tears, and no knees with partial ACL tears showed anterior subluxation of 5 mm or more. Static anterolateral subluxation of the tibia occurs in knees with combined ACL and MCL tears, as measured on routine MR imaging. These measurements may help confirm the presence of ligament injuries and differentiate complete from partial ACL tear.

  9. Obesity in early adulthood predicts knee pain and walking difficulties among men: A life course study.

    Science.gov (United States)

    Frilander, H; Viikari-Juntura, E; Heliövaara, M; Mutanen, P; Mattila, V M; Solovieva, S

    2016-09-01

    Few studies have addressed the role of obesity in young adulthood in knee problems later in life. We assessed the associations of overweight/obesity with knee pain and functional limitations of the knee across the life course. Military health records from 1967 to 2000 (baseline) were searched for 18- to 50-year-old Finnish men (n = 1913) who participated in the Health 2000 Study (follow-up). Visits to health care were followed during service. Height and weight were measured at baseline and follow-up and waist circumference at follow-up. Weight was inquired at follow-up for ages of 20, 30, 40 and 50 years, if applicable. Life course body mass index (BMI) was calculated. One-month knee pain and functional limitations (walking difficulties and limping) due to knee problems were enquired with interview at follow-up. Cox regression model, logistic regression and trajectory analysis were applied. Body mass index at the age of 20 increased the risk of unilateral knee pain by 38% and functional limitations by 27% for one standard deviation increment of BMI, respectively. One-unit increment of Z-score of life course BMI increased knee pain by 32%. Development of severe obesity during the follow-up increased the risk of knee pain by 80% and functional limitations by 93%. The effect of obesity on functional limitations was partly mediated by traumatic knee problems during military service. Reducing overweight already in adolescence and avoiding further weight gain during life course may prevent knee pain and associated disability. WHAT DOES THIS STUDY ADD?: BMI at the age of 20 increases the likelihood of knee pain and functional limitations of the knee later in life. Development of severe obesity in adulthood increases the risk of knee pain by 80% and functional limitations by more than 90%. Both general and abdominal obesity are associated with knee pain, associations being stronger for general obesity. © 2016 European Pain Federation - EFIC®

  10. The effects of kinesiology taping therapy on degenerative knee arthritis patients' pain, function, and joint range of motion.

    Science.gov (United States)

    Lee, Kwansub; Yi, Chae-Woo; Lee, Sangyong

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of kinesiology taping therapy on degenerative knee arthritis patients' pain, function, and joint range of motion. [Subjects] To conduct the experiment in the present study, 30 patients with degenerative knee arthritis were divided into a control group (the conservative treatment group) of 15 patients, who received conservative physical therapy, and an experimental group (the kinesiology taping group) of 15 patients, who received kinesiology taping therapy. [Methods] All patients received treatment three times per week for four weeks. The kinesiology taping group had elastic tapes applied to the hamstring muscles, anterior tibialis, quadriceps femoris, and gastrocnemius. The range of motion was measured using joint goniometers, pain was measured using visual analog scales, and functional evaluation was conducted using the Korean Western Ontario and McMaster Universities Osteoarthritis Index. [Results] In intragroup comparisons of the kinesiology taping group and the conservative treatment group, the visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores significantly decreased, and the range of motion increased more than significantly. In intergroup comparisons, the kinesiology taping group showed significantly lower visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores and significantly larger ranges of motion than the conservative treatment group. [Conclusion] Kinesiology taping therapy is considered to be an effective nonsurgical intervention method for pain relief, daily living activities, and range of motion of degenerative knee arthritis patients.

  11. Association of bone scintigraphic abnormalities with knee malalignment and pain.

    Science.gov (United States)

    Kraus, V B; McDaniel, G; Worrell, T W; Feng, S; Vail, T P; Varju, G; Coleman, R E

    2009-11-01

    The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms. A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase (99m)Technetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data. The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001). To the authors' knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

  12. The effectiveness of hyaluronic acid intra-articular injections in managing osteoarthritic knee pain

    Science.gov (United States)

    Anand, A

    2013-01-01

    Introduction Knee osteoarthritis (OA) is a common and progressive joint disease. Treatment options for knee OA vary from simple analgesia in mild cases to knee replacement for advanced disease. Knee pain due to moderate OA can be targeted with intra-articular injections. Steroid injections have been used widely in managing acute flare-ups of the disease. In recent years, viscosupplementation has been used as a therapeutic modality for the management of knee OA. The principle of viscosupplementation is based on the physiological properties of the hyaluronic acid (HA) in the synovial joint. Despite a sound principle and promising in vitro studies, clinical studies have been less conclusive on the effectiveness of HA in managing osteoarthritic knee pain. The aim of this systematic review was to assess the effectiveness of HA intra-articular injections in the management of osteoarthritic knee pain. Methods A systematic review of the literature was performed using MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature). The databases were searched for randomised controlled trials available on the effectiveness of HA intra-articular injections in managing osteoarthritic knee pain. Results The search yielded 188 studies. Of these, 14 met the eligibility criteria and were reviewed in chronological order. Conclusions HA intra-articular injections have a modest effect on early to moderate knee OA. The effect peaks at around 6–8 weeks following administration, with a doubtful effect at 6 months. PMID:24165334

  13. Association of Exercise Therapy and Reduction of Pain Sensitivity in Patients With Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Klokker, Louise; Graven-Nielsen, Thomas

    2014-01-01

    OBJECTIVE: Exercise has beneficial effects on pain in knee osteoarthritis (OA), yet the underlying mechanisms are unclear. The purpose of this study was to investigate the effects of exercise on pressure-pain sensitivity in patients with knee OA. METHODS: In a randomized controlled trial...... visual analog scale pain scores during constant pressure for 6 minutes at 125% of the PPT as a measure of temporal summation (TS) of pressure-pain. Secondary outcomes included self-reported pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Analyses were based on the "per......, participants were assigned to 12 weeks of supervised exercise therapy (ET; 36 sessions) or a no attention control group (CG). Pressure-pain sensitivity was assessed by cuff pressure algometry on the calf of the most symptomatic leg. The coprimary outcomes were pressure-pain thresholds (PPTs) and cumulated...

  14. Is Pain in One Knee Associated with Isometric Muscle Strength in the Contralateral Limb?: Data From the Osteoarthritis Initiative.

    Science.gov (United States)

    Steidle-Kloc, Eva; Wirth, Wolfgang; Glass, Natalie A; Ruhdorfer, Anja; Cotofana, Sebastian; Eckstein, Felix; Segal, Neil A

    2015-10-01

    Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Of 4796 Osteoarthritis Initiative participants, 224 (mean ± SD age, 63.9 ± 8.9 yrs) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale, ≥ 4/10; ≥infrequent pain) and one pain-free knee (numerical rating scale, 0-1; ≤infrequent pain; Western Ontario and McMaster Universities Arthritis Index, ≤ 1). Controls were defined as having bilaterally pain-free knees (numerical rating scale, 0-1; ≤infrequent pain; Western Ontario and McMaster Universities Arthritis Index, ≤ 1). Maximal isometric muscle strength (N) was compared between limbs in participants with unilateral pain (cases) as well as between pain-free limbs of cases and controls. Knee extensor/flexor strength in pain-free limbs of the cases was lower than that in bilaterally pain-free controls (-5.5%/-8.4%; P = 0.043/P = 0.022). Within the cases, maximum extensor/flexor strength was significantly lower in the painful limb than in the pain-free limb (-6.3%/4.1%; P strength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength caused by contralateral knee pain might be centrally mediated.

  15. IS PAIN IN ONE KNEE ASSOCIATED WITH ISOMETRIC MUSCLE STRENGTH IN THE CONTRALATERAL LIMB? - DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

    Science.gov (United States)

    Steidle, E.; Wirth, W.; Glass, N.; Ruhdorfer, A.; Cotofana, S.; Eckstein, F.; Segal, N. A.

    2014-01-01

    Objective Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Design Of 4796 Osteoarthritis Initiative participants, 224 (mean±SD age 63.9±8.9 years) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale (NRS)≥4/10; ≥infrequent pain) and one pain-free knee (NRS 0–1; ≤infrequent pain; WOMAC≤1). Controls were defined as having bilaterally pain-free knees (NRS 0–1; ≤infrequent pain; WOMAC≤1). Maximal isometric muscle strength [N] was compared between limbs in participants with unilateral pain (cases), and between pain-free limbs of cases and controls. Results Knee extensor/flexor strength in pain-free limbs of cases was lower than in bilaterally pain-free controls (−5.5%/–8.4%; p=0.043/p=0.022). Within cases, maximum extensor/flexor strength was significantly lower in the painful than in the pain-free limb (−6.4%/4.1%; pstrength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength due to contralateral knee pain might be centrally mediated. PMID:25768069

  16. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review.

    Science.gov (United States)

    Hamilton, Clayon B; Wong, Ming-Kin; Gignac, Monique A M; Davis, Aileen M; Chesworth, Bert M

    2017-01-01

    To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis. © 2016 World Institute of Pain.

  17. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty: A Cross-Sectional Study

    Science.gov (United States)

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt; Kehlet, Henrik; Jakobsen, Thomas Linding

    2014-01-01

    Background Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. Objective To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Design Cross-sectional study. Setting Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Participants Seventeen patients, no more than 3 weeks after their TKA. Main outcome measures: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0–10). Results Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, Pknee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Conclusion Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. Trial Registration Clinical

  18. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study

    Science.gov (United States)

    Murase, Kimihiko; Tabara, Yasuharu; Ito, Hiromu; Kobayashi, Masahiko; Takahashi, Yoshimitsu; Setoh, Kazuya; Kawaguchi, Takahisa; Muro, Shigeo; Kadotani, Hiroshi; Kosugi, Shinji; Sekine, Akihiro; Yamada, Ryo; Nakayama, Takeo; Mishima, Michiaki; Matsuda, Shuichi; Matsuda, Fumihiko; Chin, Kazuo

    2015-01-01

    Introduction Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population. Methods Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old) by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS) score and a Roland-Morris disability questionnaire (RDQ) score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality. Results Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR) = 1.19, plow back pain: OR = 1.13, p = 0.01) and poor sleep quality (knee pain: OR = 1.22, plow back pain; OR = 1.57, plow back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, plow back pain: OR = 1.61, plow back pain: OR = 2.17, plow back pains were independently associated with short sleep duration and poor sleep quality. Further, they additively increased the correlation with these sleep problems in the general population. PMID:26444713

  19. Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: a randomized controlled trial.

    Science.gov (United States)

    Sørensen, T J; Langberg, H; Hodges, P W; Bliddal, H; Henriksen, M

    2012-01-01

    Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals. Twenty-seven healthy untrained volunteers participated in a randomized controlled trial of quadriceps strengthening (3 times per week for 8 weeks). Participants were randomized to perform resistance training either during pain induced by injections of painful hypertonic saline (pain group, n = 13) or during a nonpainful control condition with injection of isotonic saline (control group, n = 14) into the infrapatellar fat pad. The primary outcome measure was change in maximal isokinetic muscle strength in knee extension/flexion (60, 120, and 180 degrees/second). The group who exercised with pain had a significantly larger improvement in isokinetic muscle strength at all angular velocities of knee extension compared to the control group. In knee flexion there were improvements in isokinetic muscle strength in both groups with no between-group differences. Experimental knee joint pain improved the training-induced gain in muscle strength following 8 weeks of quadriceps training. It remains to be studied whether knee joint pain has a positive effect on strength gain in patients with knee pathology. Copyright © 2012 by the American College of Rheumatology.

  20. Weighted cumulative exposure models helped identify an association between early knee-pain consultations and future knee OA diagnosis.

    Science.gov (United States)

    Yu, Dahai; Peat, George; Bedson, John; Edwards, John J; Turkiewicz, Aleksandra; Jordan, Kelvin P

    2016-08-01

    To establish the association between prior knee-pain consultations and early diagnosis of knee osteoarthritis (OA) by weighted cumulative exposure (WCE) models. Data were from an electronic health care record (EHR) database (Consultations in Primary Care Archive). WCE functions for modeling the cumulative effect of time-varying knee-pain consultations weighted by recency were derived as a predictive tool in a population-based case-control sample and validated in a prospective cohort sample. Two WCE functions ([i] weighting of the importance of past consultations determined a priori; [ii] flexible spline-based estimation) were comprehensively compared with two simpler models ([iii] time since most recent consultation; total number of past consultations) on model goodness of fit, discrimination, and calibration both in derivation and validation phases. People with the most recent and most frequent knee-pain consultations were more likely to have high WCE scores that were associated with increased risk of knee OA diagnosis both in derivation and validation phases. Better model goodness of fit, discrimination, and calibration were observed for flexible spline-based WCE models. WCE functions can be used to model prediagnostic symptoms within routine EHR data and provide novel low-cost predictive tools contributing to early diagnosis. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial.

    Science.gov (United States)

    Cho, Hwi-young; Kim, Eun-Hye; Kim, Junesun; Yoon, Young Wook

    2015-03-01

    This study investigated the short-term effects of Kinesio taping (KT) on various types of pain, active range of motion (AROM), and proprioception in patients with knee osteoarthritis. Forty-six older participants (mean [SD], 57.9 [4.4] yrs) with osteoarthritis were randomly allocated to two groups: the KT group or the placebo-KT group. Taping with tension (KT application) or without tension (placebo-KT application) was applied to the quadriceps of the participants in both groups. Before and after intervention, pain intensity was measured using a visual analog scale at rest and during walking, and pressure pain thresholds (PPTs) were assessed using an algometer in the quadriceps and the tibialis anterior. In addition, pain-free AROM and proprioception were measured. The KT group showed attenuation of pain during walking (effect size [ES], 1.97), PPT in the quadriceps (ES, 2.58), and PPT in the tibialis anterior (ES, 2.45). This group also showed significantly improved AROM (ES, 2.01) and proprioception (ES, 1.73-1.89; P proprioception. There were significant differences between the two groups in pain during walking and PPT. In addition, pain during walking showed a significant correlation with AROM and proprioception, and a significant correlation was found between PPT and AROM. These results demonstrated that KT application with proper tension to the quadriceps effectively attenuates various types of pain and improves AROM and proprioception in osteoarthritis patients. Thus, KT may be a suitable intervention to improve pain, AROM, and proprioception in patients with osteoarthritis in clinics.

  2. Painful knees and hearing-loss: A rare presentation of meningococcal disease

    NARCIS (Netherlands)

    Kahlmann, V. (Vivienne); C. Alves (Celina); Coleman, J. (Johannes); L.-A. Korswagen (Lindy-Anne)

    2016-01-01

    textabstractA 49-year-old woman with a medical history of rheumatoid arthritis presented to the emergency room, with high fever and painful knees. In addition, she had had a mild headache for several days and some hearing loss over several months. We saw an ill patient with arthritis of both knees,

  3. Risk prediction model for knee pain in the Nottingham community: a Bayesian modelling approach.

    Science.gov (United States)

    Fernandes, G S; Bhattacharya, A; McWilliams, D F; Ingham, S L; Doherty, M; Zhang, W

    2017-03-20

    Twenty-five percent of the British population over the age of 50 years experiences knee pain. Knee pain can limit physical ability and cause distress and bears significant socioeconomic costs. The objectives of this study were to develop and validate the first risk prediction model for incident knee pain in the Nottingham community and validate this internally within the Nottingham cohort and externally within the Osteoarthritis Initiative (OAI) cohort. A total of 1822 participants from the Nottingham community who were at risk for knee pain were followed for 12 years. Of this cohort, two-thirds (n = 1203) were used to develop the risk prediction model, and one-third (n = 619) were used to validate the model. Incident knee pain was defined as pain on most days for at least 1 month in the past 12 months. Predictors were age, sex, body mass index, pain elsewhere, prior knee injury and knee alignment. A Bayesian logistic regression model was used to determine the probability of an OR >1. The Hosmer-Lemeshow χ 2 statistic (HLS) was used for calibration, and ROC curve analysis was used for discrimination. The OAI cohort from the United States was also used to examine the performance of the model. A risk prediction model for knee pain incidence was developed using a Bayesian approach. The model had good calibration, with an HLS of 7.17 (p = 0.52) and moderate discriminative ability (ROC 0.70) in the community. Individual scenarios are given using the model. However, the model had poor calibration (HLS 5866.28, p prediction model for knee pain, regardless of underlying structural changes of knee osteoarthritis, in the community using a Bayesian modelling approach. The model appears to work well in a community-based population but not in individuals with a higher risk for knee osteoarthritis, and it may provide a convenient tool for use in primary care to predict the risk of knee pain in the general population.

  4. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    knee loading activities were the most painful, while sitting with knee bend for prolonged time caused surprisingly little pain. Pain was most commonly perceived in the peripatellar area (25 patients (83%)). The most common site of pain on clinical examination was the peripatellar area (25 patients (83......Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical...

  5. [Medial anterior flange overhang related to the prosthesis selection determined by femoral sizer in total knee arthroplasty].

    Science.gov (United States)

    Sun, Z H; Li, N; Xin, J Y; Liu, J; Ren, Z S; Sun, H J

    2016-12-20

    Objective: To evaluate the medial anterior flange overhang related to the femoral prosthesis size determined by femoral sizer in total knee arthroplasty. Methods: Sixty one cases of varus knee osteoarthritis (61 knees) were analyzed from January 2014 to January 2015, 14 males and 47 females, aged (66.8±6.8) year old. 3D models of distal femur were established by Mimics, total knee arthroplasty surgeries were simulated and the medial and lateral femoral condylar anteroposterior diameter were measured. According to the AP diameter of lateral femoral condyle (lateral condyle group) and femoral sizer (sizer group), different size of the PFC Sigma femoral prosthesis models were imported to mimics, and the coverage of medial anterior femoral flange were compared. Results: The AP diameter of lateral femoral condyle[(55.76±3.64) mm]was significantly less than the sizer group[(57.02±3.59) mm], P 0.05). Femoral prosthesis sizes, the uncoverage diameter of the anterior chamfer line, midpoint of the flange in the sizer group were significantly larger than the lateral condyle group ( P prosthesis, and the risks of medial femoral anterior flange overhang increased. Medial anterior flange overhang in male was significantly less than female, but the difference had no correlation to the distal femur asepect ratio.

  6. Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

    OpenAIRE

    Moss, Penny; Benson, Heather A.E.; Will, Rob; Wright, Anthony

    2017-01-01

    Objectives: PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher “positive neuropathic” score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores. Materials and Methods: In total, ...

  7. No exacerbation of knee joint pain and effusion following preoperative progressive resistance training in patients scheduled for total knee arthroplasty

    DEFF Research Database (Denmark)

    Skoffer, Birgit; Dalgas, Ulrik; Maribo, Thomas

    2017-01-01

    BACKGROUND: Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion. OBJECTIVE: To examine if preoperative PRT initiated 5 weeks prior to TKA would 1...... were scheduled for TKA due to osteoarthritis and assigned for the intervention group. METHODS: Patients underwent unilateral PRT (3 sessions/week). Exercise loading was 12 repetition maximum (RM) with progression towards 8RM. The training program consisted of 6 exercises performed unilaterally. MAIN......) exacerbate pain and knee effusion, 2) allow a progressively increased training load throughout the training period that would subsequently increase muscle strength. DESIGN: Secondary analyses from a randomized controlled trial. SETTING: University Hospital and a Regional Hospital. PATIENTS: Thirty patients...

  8. Effects on proprioception by Kinesio taping of the knee after anterior cruciate ligament rupture.

    Science.gov (United States)

    Bischoff, Lars; Babisch, Christian; Babisch, Jürgen; Layher, Frank; Sander, Klaus; Matziolis, Georg; Pietsch, Stefan; Röhner, Eric

    2018-03-10

    The use of Kinesio tape (KT) to improve proprioception is a matter of considerable debate. In comparison, the rupture of the anterior cruciate ligament is a sufficiently well-investigated injury with a proven compromise of proprioception. The objective of the present study was to assess a supportive effect on proprioception after KT application, taking the anterior cruciate ligament (ACL) rupture as an example. Forty-eight patients who had suffered an ACL rupture, confirmed clinically and by magnetic resonance imaging, and who were treated conservatively or were awaiting surgery were included in this study. In all patients, a gait analysis was performed on the affected leg before and after KT application. In addition, the IKDC score, the Lysholm score, stability using the Rolimeter, and the angle reproduction test were determined. Thirty-nine men and nine women who had had an ACL rupture for at least 3 weeks were included in the study. Significant improvements were achieved on the affected knee joint for the gait analysis parameters touchdown and unrolling, cadence, stability and stance phase as well as an extension of the hip joint. The Lysholm score improved from 79.3 to 85.8 (p < 0.001) and the IKDC score from 60.2 to 71.3 points (p < 0.001). Significant improvements were achieved in the Rolimeter and angle reproduction test. The use of KT has a positive effect on proprioception in patients with an anterior cruciate ligament rupture. Therefore, the application may improve gait pattern as well as the subjective function of the affected knee joint.

  9. Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho Analgesia controlada por el paciente reduce consumo de bupivacaína en bloqueo femoral para manejo de dolor postoperatorio en reconstrucción de ligamento cruzado anterior de rodilla Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Victor A. Contreras-Domínguez

    2007-08-01

    a cada 30 min; Grupo 3 (n = 30: 5 mL.h-1 de B + C en PCA cada 30 min. Los pacientes fueron intervenidos bajo anestesia espinal. Se registró dolor posquirúrgico a las 2, 4, 6, 24 y 48 horas mediante Escala Visual Análoga (EVA, consumo de morfina y bupivacaína. RESULTADOS: No se registraron diferencias en las variables demográficas entre ambos grupos. El EVA postoperatorio entre las 2 y 48 horas no mostró diferencias. El consumo de morfina entre las 4 y 48 horas fue similar en los 3 grupos (p = 0,07. En el grupo en que sólo se utilizó modo PCA, el consumo de bupivacaína fue significativamente menor (p BACKGROUND AND OBJECTIVES: Continuous femoral nerve block (CFNB is used in postoperative analgesia of hip and knee replacement surgeries with good results. The objective of this study was to evaluate the usefulness of CFNB, comparing 3 administration schedules of bupivacaine in the arthroscopic anterior cruciate ligament (ACL repair of the knee. METHODS: A prospective, controlled study with 90 stable patients, physical status ASA I and II was undertaken. Patients were divided in three groups: Group 1 (n = 30: continuous infusion (CI at a rate of 10 mL.h-1 of 0.125% bupivacaine + clonidine 1 µg.ml-1 (B+C; Group 2 (n = 30: CI at a rate of 5 mL.h-1 + PCA with 2.5 ml of B+C every 30 minutes; Group 3 (n = 30: PCA with 5 mL.h-1 of B+C every 30 minutes. Patients underwent spinal anesthesia. Postoperative pain at 2, 4, 6, 24, and 48 hours, using the Visual Analogue Scale (VAS, and consumption of morphine and bupivacaine were recorded. RESULTS: There were no statistically significant differences regarding the demographic data in both groups. The postoperative VAS between 2 and 48 hours did not show any differences. Morphine consumption between 4 and 48 hours was similar in all 3 groups (p = 0.07. The consumption of bupivacaine was significantly lower in the group that used only PCA (p < 0.001. CONCLUSIONS: Continuous femoral nerve block is a useful technique to manage

  10. Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique.

    Science.gov (United States)

    Schliemann, Benedikt; Lenschow, Simon; Domnick, Christoph; Herbort, Mirco; Häberli, Janosch; Schulze, Martin; Wähnert, Dirk; Raschke, Michael J; Kösters, Clemens

    2017-04-01

    Dynamic intraligamentary stabilization (DIS) has been introduced for the repair of acute anterior cruciate ligament (ACL) tears as an alternative to delayed reconstruction. The aim of the present study was to compare knee joint kinematics after DIS to those of the ACL-intact and ACL-deficient knee under simulated Lachman/KT-1000 and pivot-shift tests. We hypothesized that DIS provides knee joint kinematics equivalent to an intact ACL. With the use of a robotic knee simulator, knee kinematics were determined in simulated Lachman/KT-1000 and pivot-shift tests at 0°, 15°, 30°, 60°, and 90° of flexion in eight cadaveric knees under the following conditions: (1) intact ACL, (2) ACL deficiency, (3) DIS with a preload of 60 N, and (4) DIS with a preload of 80 N. Statistical analyses were performed using two-factor repeated-measures analysis of variance. The significance level was set at a p value of knee (p knee joint kinematics to that of an intact knee in all degrees of flexion. DIS with a preload of 80 N restores knee joint kinematics comparable to that of an ACL-intact knee and is therefore capable of providing knee joint stability during ACL healing. DIS therefore provides a new technique for primary ACL repair with superior biomechanical properties in comparison with other techniques that have been described previously, although further clinical studies are required to determine its usefulness in clinical settings.

  11. Prognostic Factors in Adults With Knee Pain in General Practice

    NARCIS (Netherlands)

    Belo, J. N.; Berger, M. Y.; Koes, B. W.; Bierma-Zeinstra, S. M. A.

    2009-01-01

    Objective. To predict the 1-year outcome of incident nontraumatic knee symptoms in adults presenting in general practice. Methods. Adults age >35 years with nontraumatic knee symptoms (n = 480) were followed for 1 year. At baseline, data on knee symptoms and demographics were collected and a

  12. Validity of summing painful joint sites to assess joint-pain comorbidity in hip or knee osteoarthritis

    NARCIS (Netherlands)

    Tjin-Kam-Jet-Siemons, Liseth; ten Klooster, Peter M.; van de Laar, Mart A F J; van den Ende, Cornelia H.M.; Hoogeboom, Thomas J.

    2013-01-01

    BACKGROUND: Previous studies in patients with hip and knee osteoarthritis (OA) have advocated the relevance of assessing the number of painful joint sites, other than the primary affected joint, in both research and clinical practice. However, it is unclear whether joint-pain comorbidities can

  13. MRI findings in renal transplant recipients with hip and knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Fuldem Yildirim [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: fuldemyildirim@yahoo.com; Basaran, Ceyla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: ceylab@baskent-ank.edu.tr; Ulu, Esra Meltem Kayahan [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: emkayahanulu@yahoo.com; Uyusur, Arzu [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: arzuuyusur@yahoo.com; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: caglat@baskent-ank.edu.tr; Muhtesem Agildere, A. [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: amuhtesem@superonline.com

    2009-09-15

    Purpose: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. Materials and methods: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. Results: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. Conclusion: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be Second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

  14. MRI findings in renal transplant recipients with hip and knee pain

    International Nuclear Information System (INIS)

    Donmez, Fuldem Yildirim; Basaran, Ceyla; Ulu, Esra Meltem Kayahan; Uyusur, Arzu; Tarhan, Nefise Cagla; Muhtesem Agildere, A.

    2009-01-01

    Purpose: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. Materials and methods: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. Results: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. Conclusion: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be Second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

  15. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization.

    Science.gov (United States)

    Bartley, Emily J; King, Christopher D; Sibille, Kimberly T; Cruz-Almeida, Yenisel; Riley, Joseph L; Glover, Toni L; Goodin, Burel R; Sotolongo, Adriana S; Herbert, Matthew S; Bulls, Hailey W; Staud, Roland; Fessler, Barri J; Redden, David T; Bradley, Laurence A; Fillingim, Roger B

    2016-04-01

    Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle age versus older age). Participants (n = 288) between the ages of 45 and 85 years completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional performance. When compared to men, women exhibited greater sensitivity to multiple pain modalities (i.e., lower heat, cold, pressure thresholds/tolerances, greater TS of pain); however, there were no sex differences in clinical pain, with the exception of greater widespread pain observed in women. Although there were select age-related differences in pain sensitivity, sex differences in pain varied minimally across the age cohort. Overall, these findings provide evidence for greater overall sensitivity to experimental pain in women with symptomatic knee OA compared to men, suggesting that enhanced central sensitivity may be an important contributor to pain in this group. © 2016, American College of Rheumatology.

  16. Radionuclide scanning after total knee replacement: correlation with pain and radiolucent lines. A prospective study

    DEFF Research Database (Denmark)

    Duus, B R; Boeckstyns, M; Kjaer, L

    1987-01-01

    patients. Twenty-seven patients had no pain 12 months after surgery and eight patients had moderate or severe pain. Prosthetic loosening was seen in one patient. Thirty-three patients exhibited a radiolucent line under the tibial part of the prosthesis. Isotope uptake was the same in the painful......The authors examined the relationships among Tc-99m radionuclide bone scan findings, pain, and radiolucent lines in 35 postsurgical knees. Our prospective study included bone scans, as well as radiographic and clinical examination three, seven, and 12 months after knee replacement surgery in 35...

  17. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort

    NARCIS (Netherlands)

    Holla, J.F.M.; van der Leeden, M.; Knol, D.L.; Roorda, L.D.; van der Esch, M.; Voorneman, R.E.; Lems, W.F.; Dekker, J.

    2013-01-01

    Background: Body-mass index (BMI) and depressed mood are both positively associated with pain and activity limitations in knee osteoarthritis (OA), and are interrelated. The aims of the present study were: 1) to assess whether BMI and depressed mood are independently associated with knee pain and

  18. Burden of reduced work productivity among people with chronic knee pain: a systematic review.

    Science.gov (United States)

    Agaliotis, Maria; Mackey, Martin G; Jan, Stephen; Fransen, Marlene

    2014-09-01

    The aims of this systematic review were to determine the prevalence of reduced work productivity among people with chronic knee pain as well as specifically categorise determinants of work productivity losses into individual, disease and work-related factors, conduct an evaluation of study methodological quality and present a best-evidence synthesis. We searched the literature using combinations of key words such as knee pain, knee osteoarthritis, absenteeism (days taken off work) and presenteeism (reduced productivity while at work) for observational studies published in English. Methodological quality appraisal and a best-evidence synthesis were used to pool the study findings. The studies were conducted exclusively in high income countries of North America, Western Europe and Hong Kong. 17 studies were included in the review, 10 measuring absenteeism and six measuring presenteeism. Of the 10 studies reporting absenteeism, seven found a 12-month absenteeism prevalence ranging from 5% to 22%. Only two studies evaluated presenteeism prevalence and reported a range from 66% to 71%. Using best-evidence synthesis: three high quality cohort studies and three cross-sectional studies provided strong evidence that knee pain or knee osteoarthritis was associated with absenteeism; two high quality cross-sectional studies and one cohort study provided limited evidence for an association with presenteeism; one cross-sectional study provided limited evidence for an association among age, high job demands and low coworker support and absenteeism among nurses with knee pain. No studies examined individual or work-related factors associated with presenteeism. A number of high quality studies consistently demonstrated that chronic knee pain or knee osteoarthritis is associated with absenteeism. However, data are lacking regarding presenteeism and individual or work-related risk factors for reduced work productivity among older workers with chronic knee pain. PROSPERO registry

  19. In Vivo Kinematics of the Anterior Cruciate Ligament Deficient Knee During Wide-Based Squat Using a 2D/3D Registration Technique

    OpenAIRE

    Miyaji, Takeshi; Gamada, Kazuyoshi; Kidera, Kenichi; Ikuta, Futoshi; Yoneta, Kei; Shindo, Hiroyuki; Osaki, Makoto; Yonekura, Akihiko

    2012-01-01

    Anterior cruciate ligament (ACL) deficiency increases the risk of early osteoarthritis (OA). Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD) knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients w...

  20. The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty.

    Science.gov (United States)

    Dave, A J; Selzer, F; Losina, E; Usiskin, I; Collins, J E; Lee, Y C; Band, P; Dalury, D F; Iorio, R; Kindsfater, K; Katz, J N

    2017-05-01

    Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA. This prospective analysis included 241 patients with knee osteoarthritis (OA) undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID). Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18-1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16-1.86).). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73-7.31). Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  1. Knee Pain Predicts Subsequent Shoulder Pain and the Association Is Mediated by Leg Weakness: Longitudinal Observational Data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Laslett, Laura L; Otahal, Petr; Hensor, Elizabeth M A; Kingsbury, Sarah R; Conaghan, Philip G

    2016-11-01

    To assess whether the "spread" of joint pain is related to pain-associated muscle loss in 1 joint leading to increased loading and subsequent pain in other joints. Associations between persistent knee pain (pain in 1 or 2 knees over 0-3 years vs no persistent pain) and incident shoulder pain at Year 4 were examined in participants from the longitudinal National Institutes of Health Osteoarthritis Initiative. Associations were assessed using log multinomial modeling, adjusted for age, sex, body mass index, depression score, other lower limb pain, and baseline leg weakness (difficulty standing from a sitting position). In older adults with clinically significant knee osteoarthritis (OA) or at risk of knee OA (n = 3486), the number of painful joints increased yearly, from 2.1 joints (95% CI 2.0-2.2) at baseline increasing by 5.2% (95% CI 2.2-8.3) at Year 4. Shoulders were the next most commonly affected joints after knees (28.5%). Persistent pain in 1 or 2 knees increased risk of bilateral shoulder pain at Year 4 [1 knee: relative risk (RR) 1.59, 95% CI 0.97-2.61; 2 knees: RR 2.02, 95% CI 1.17-3.49] after adjustment for confounders. Further adjustment for leg weakness attenuated effect sizes (1 knee: RR 1.13, 95% CI 0.60-2.11; 2 knees: RR 1.44, 95% CI 0.75-2.77), indicating mediation by functional leg weakness. Spread of joint pain is not random. Persistently painful knees predict new bilateral shoulder pain, which is likely mediated by leg weakness, suggesting that biomechanical factors influence the spread of pain.

  2. The value of FDG-PET in patients with painful total knee arthroplasty

    International Nuclear Information System (INIS)

    Stumpe, Katrin D.M.; Schulthess, Gustav K. von; Strobel, Klaus; Romero, Jose; Ziegler, Oliver; Kamel, Ehab M.; Hodler, Juerg

    2006-01-01

    The purpose of this study was to evaluate 18 F-fluorodeoxyglucose (FDG) uptake in patients with painful total knee arthroplasty and to relate FDG uptake to the location of soft tissue pain. Twenty-eight patients with painful total knee arthroplasty had a clinical examination, standard radiographs, CT measurement of rotation of the femoral component and FDG-PET (18 PET/CT, 10 PET). The diagnosis of infection was based on microbiological examinations of surgical specimens (n=12) or clinical follow-up for at least 6 months (n=16), 99m Tc-labelled monoclonal antibody scintigraphy and joint aspiration. Twenty-seven of 28 patients presented with diffuse synovial FDG uptake. Additional focal extrasynovial FDG uptake was observed in 19 knees. Twenty-four of the 28 patients had a diagnosis of internal femoral malrotation. The remaining four patients showed no rotation (0 ) and 3 , 4 and 7 of external rotation, respectively. Three patients presented with the additional diagnosis of an infected total knee replacement. Pain was described as diffuse (n=10) or focal (n=18). In two knees a relationship between pain location and FDG uptake was observed. Of ten patients with a severe internal femoral component rotation (>6 ), seven had focal uptake, four in the femoral periosteum and three in the tibial periosteum. The difference between knees with severe malrotation and the remaining knees was not significant (p=1.000, Fisher's Exact Test). Diffuse synovial and focal extrasynovial FDG-PET uptake is commonly found in patients with malrotation of the femoral component and is not related to pain location. The information provided by FDG-PET does not contribute to the diagnosis and management of individual patients with persistent pain after total knee replacement. (orig.)

  3. Medial abrasion syndrome: a neglected cause of knee pain in middle and old age.

    Science.gov (United States)

    Lyu, Shaw-Ruey; Lee, Ching-Chih; Hsu, Chia-Chen

    2015-04-01

    Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated.A total of 232 knees of 169 patients >40 years of age (41-82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation for the diagnosis of MAS were evaluated after confirmation by arthroscopy. For patients with MAS, the roentgenographic and arthroscopic manifestations were investigated, and arthroscopic medial release (AMR) was performed. The outcomes were evaluated by the changes in the pain domain of the Knee Society scoring system and by patient satisfaction. The prevalence of medial plica was 95%, and osteoarthritis (OA) was the most common clinical diagnosis. Symptoms of pain and crepitus in motion and local tenderness during physical examination were the most sensitive parameters for the diagnosis. A history of a single knee injury combined with local tenderness and a palpable band found during physical examination were the most specific parameters for the diagnosis. The majority of patients suffering from this syndrome were successfully treated using AMR, yielding a satisfaction rate of 85.5% after a minimum of 3 years.MAS is a common cause of knee pain in middle and old age and can be effectively treated by AMR. Its concomitance with OA warrants further investigation.

  4. A case of synovial lipomatosis with chronic synovitis presenting as acute knee pain

    Directory of Open Access Journals (Sweden)

    Sushma HM, Anoosha K, Vijay Shankar S, Amita K

    2014-07-01

    Full Text Available Background: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion characterized by villous proliferation of the synovium, most commonly affecting the knee joint. The usual presentation is long standing progressive swelling of the affected joint, with or without pain and restriction of movements. Histopathology is confirmatory. Case Report: We present the case of a 35- year old male patient with long standing history of swelling, short history of pain in the left knee joint. X-Ray and magnetic resonance imaging scans of the left knee showed the characteristic features of synovial lipomatosis with chronic synovitis. The patient underwent diagnostic arthroscopy with lavage of left knee joint. Histopathological study confirmed synovial lipomatosis with chronic synovitis. Conclusion: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion. Although rare, clinically it should be considered as an important differential in evaluating neoplastic and non- neoplastic conditions of the knee joint.

  5. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical....../ultrasound. Conclusions: Acute anterior knee pain should be regarded as a subgroup of PFPS as both symptoms and clinical examination suggests this. The clinical examination with disseminated pain in all synovial covered structures is consistent with ideas of the importance of synovium in the genesis of pain...

  6. Cold Pain Threshold Identifies a Subgroup of Individuals With Knee Osteoarthritis That Present With Multimodality Hyperalgesia and Elevated Pain Levels

    OpenAIRE

    Wright, Anthony; Benson, Heather A.E.; Will, Rob; Moss, Penny

    2017-01-01

    Objectives: Cold hyperalgesia has been established as an important marker of pain severity in a number of conditions. This study aimed to establish the extent to which patients with knee osteoarthritis (OA) demonstrate widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function. Methods: A...

  7. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care

    NARCIS (Netherlands)

    Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.

    2010-01-01

    Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To

  8. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee.

    Science.gov (United States)

    Bevilaqua-Grossi, Debora; Zanin, Marilia; Benedetti, Camila; Florencio, Lidiane; Oliveira, Anamaria

    2018-02-26

    The aim was to assess sensitization using quantitative sensory testing in mechanical and thermal modes in individuals with and without osteoarthritis (OA) of the knee. Pain thresholds were correlated with functionality, symptoms of depression and intensity of pain. Thirty control volunteers and 30 patients with OA of the knee were assessed. Punctate pain thresholds using Von Frey filaments and thermal pain thresholds using a Thermal Sensory Analyzer were evaluated in the periarticular region of the knee and forearm. Using a digital pressure algometer, pressure pain thresholds were assessed in the periarticular region of the knee and on the root exit zone on the lumbar and sacral spine. Punctate, pressure, and thermal pain thresholds differed significantly between participants with and without OA (p pain sensitization. Pressure pain thresholds also showed moderate and negative correlations with data on functionality, symptoms of depression and intensity of pain (-0.36  -0.56), contributing up to 30% of their variability. Allodynia and hyperalgesia were demonstrated in the OA group, suggesting central sensitization in patients with mild to moderate severity of joint damage. Correlation between mechanical hypersensitivity and psychosocial factors seems to be small, despite of its significance.

  9. Muscle Power Is an Independent Determinant of Pain and Quality of Life in Knee Osteoarthritis.

    Science.gov (United States)

    Reid, Kieran F; Price, Lori Lyn; Harvey, William F; Driban, Jeffrey B; Hau, Cynthia; Fielding, Roger A; Wang, Chenchen

    2015-12-01

    This study examined the relationships between leg muscle strength, power, and perceived disease severity in subjects with knee osteoarthritis (OA) in order to determine whether dynamic leg extensor muscle power would be associated with pain and quality of life in knee OA. Baseline data on 190 subjects with knee OA (mean ± SD age 60.2 ± 10.4 years, body mass index 32.7 ± 7.2 kg/m(2) ) were obtained from a randomized controlled trial. Knee pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, and health-related quality of life was assessed using the Short Form 36 (SF-36). One-repetition maximum (1RM) strength was assessed using the bilateral leg press, and peak muscle power was measured during 5 maximum voluntary velocity repetitions at 40% and 70% of 1RM. In univariate analysis, greater muscle power was significantly associated with pain (r = -0.17, P determinant of pain or quality of life (P ≥ 0.06). Muscle power is an independent determinant of pain and quality of life in knee OA. Compared to strength, muscle power may be a more clinically important measure of muscle function within this population. New trials to systematically examine the impact of muscle power training interventions on disease severity in knee OA are particularly warranted. © 2015, American College of Rheumatology.

  10. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Directory of Open Access Journals (Sweden)

    Diego García-Germán

    2013-01-01

    Full Text Available We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

  11. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Science.gov (United States)

    García-Germán, Diego; Menéndez, Pablo; de la Cuadra, Pablo; Rodríguez-Arozena, Ricardo

    2013-01-01

    We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure. PMID:24369517

  12. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    International Nuclear Information System (INIS)

    Bedoya, Maria A.; Jaramillo, Diego; McGraw, Michael H.; Wells, Lawrence

    2014-01-01

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  13. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  14. [The effects of hand acupuncture therapy on pain, ROM, ADL and depression among elders with low back pain and knee joint pain].

    Science.gov (United States)

    Yang, Jin-Hyang

    2009-02-01

    The purpose of this study was to identify the effects of hand acupuncture therapy on pain, ROM, ADL, and depression among older people with low back pain and knee joint pain. The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 40 patients, 18 in the experimental group and 22 in the control group. A pretest and 2 posttest were conducted to measure the main variables. For the experimental group, hand acupuncture therapy, consisting of hand acupuncture and press-pellets based on corresponding points, was given. There were statistically significant differences in pain, ROM in knee joint, and ADL in the experimental group but not in depression compared to the control group over two different times. The hand acupuncture therapy was effective for low back pain, knee joint pain, ROM in knee joint and ADL among the elders in this study. Therefore, the hand acupuncture therapy can be utilized in the field of geriatric nursing as a nursing intervention for older people with low back pain and knee joint pain.

  15. Knee functions and a return to sports activity in competitive athletes following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Nakayama, Y; Shirai, Y; Narita, T; Mori, A; Kobayashi, K

    2000-06-01

    We investigated knee functions and a return to sports in 50 competitive athlete patients treated with arthroscopic anterior cruciate ligament reconstruction using double-looped STG augmented by woven polyester at a 1-year follow-up. There were 25 males and 25 females with a mean age of 24.3 years (range: 19-39 years). The majority of preinjury sports were basketball, volleyball and soccer. Athletic rehabilitation including agility training and sports-specific training was started at 12 weeks. Fourty patients (80%) was rated as normal or nearly normal on the assessment of International Knee Documentation Commitee postoperatively. Fourty-eight patients (96%) obtained full range of motion, and the mean quadriceps muscle strength of the injured side was 91.3%of that of the uninjured side. As for a return to sports, 46 patients (92%) were able to do fully competitive sports at a mean of 8.1 postoperative months. These results suggest that arthroscopic reconstruction using augmented double-looped STG allows early athletic rehabilitation, and lead satisfactory outcome as well as a reliable and early return to preinjury level of sport activity for the majority of the competitive athlete patients.

  16. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  17. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear. Contribution of ultrasonography and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Faruch Bilfeld, Marie; Constans, Olivia; Lapegue, Franck; Chiavassa Gandois, Helene; Sans, Nicolas [CHU Toulouse-Purpan, Service de Radiologie, Toulouse (France); Cavaignac, Etienne; Wytrykowski, Karine [CHU Toulouse-Purpan, Service d' Orthopedie, Toulouse (France); Larbi, Ahmed [Hopital Universitaire Caremeau, Service de Radiologie, Nimes (France)

    2018-01-15

    To describe the pathological appearance of the anterolateral ligament (ALL) on US and MRI in knees with an anterior cruciate ligament (ACL) tear. This prospective study included 30 patients who had a suspected acute ACL tear. Their injured and contralateral knees were evaluated with radiography, US and MRI. Two radiologists evaluated the ALL on the MRI and US examinations. Agreement between these examiners' findings was evaluated with Cohen's kappa. On US examination, the ALL was found to be injured in 63% of cases (19/30; k = 0.93). The enthesis was found to be torn in 50% of cases (15/30; k = 1), with the tear located at the tibial attachment in all instances. On the MRI exam, the ALL was found to be injured in 53% of cases (16/30; k = 0.93). The enthesis was found to be torn in 13% of cases (4/30; k = 0.76), with the tear located at the tibial attachment in all instances (k = 0.93). ALL injuries that occur with ACL tears are located at the tibial enthesis. They are often associated with bone avulsion at the enthesis and are better viewed on US. (orig.)

  18. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study.

    Directory of Open Access Journals (Sweden)

    Kimihiko Murase

    Full Text Available Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS score and a Roland-Morris disability questionnaire (RDQ score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01 and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01. The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01 Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01 and poor sleep quality (either of knee or low back pain: OR

  19. The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Salehi

    2016-09-01

    Full Text Available Background The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1 standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2 standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD of body sway along the anteroposterior (AP and mediolateral (ML axis, mean velocity of center of pressure (COP along AP/ ML axis and the area ellipse (measured in 2 mm were calculated. Results Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations (P < 0.05. But in high challengeable conditions this effect was not significant. Conclusions Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

  20. Characterizing Pain Flares From the Perspective of Individuals With Symptomatic Knee Osteoarthritis.

    Science.gov (United States)

    Murphy, Susan L; Lyden, Angela K; Kratz, Anna L; Fritz, Heather; Williams, David A; Clauw, Daniel J; Gammaitoni, Arnold R; Phillips, Kristine

    2015-08-01

    Although pain in knee osteoarthritis (OA) commonly affects activity engagement, the daily pain experience has not been fully characterized. Specifically, the nature and impact of pain flares is not well understood. This study characterized pain flares as defined by participants with knee OA. Pain flare occurrence and experience were measured over 7 days. This was a multiple methods study; qualitative methods were dominant. Data were collected during the baseline portion of a randomized controlled trial. Participants met criteria for knee OA and had moderate to severe pain. They completed questionnaires and a 7-day home monitoring period that captured momentary symptom reports simultaneously with physical activity via accelerometry (n = 45). Participants also provided individual definitions of pain flare that were used throughout the home monitoring period to indicate whether a pain flare occurred. Pain flares were described most often by quality (often sharp), followed by timing (seconds, minutes) and by antecedents and consequences. When asked if their definition of a flare agreed with a supplied definition, 49% of the sample reported only "somewhat," "a little," or "not at all." Using individual definitions, 78% experienced at least 1 daily pain flare over the home monitoring period; 24% had a flare on more than 50% of the monitored days. Pain flares were common, fleeting, and often experienced in the context of activity engagement. Participants' views on what constitutes a pain flare differ from commonly accepted definitions. Pain flares are an understudied aspect of the knee OA pain experience and require further characterization. © 2015, American College of Rheumatology.

  1. IN VIVO KINEMATICS OF THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE DURING WIDE-BASED SQUAT USING A 2D/3D REGISTRATION TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Takeshi Miyaji

    2012-12-01

    Full Text Available Anterior cruciate ligament (ACL deficiency increases the risk of early osteoarthritis (OA. Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100° flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5° flexion in both phases (p < 0.05. Tibiofemoral medial contact points of the ACLD knees were more posterior than that of the contralateral knees at 5, 10 and 15° of knee flexion in the extension phase of the squat activity (p < 0.05. Tibiofemoral lateral contact points of the ACLD knees were more posterior than that of the contralateral knees at 0° flexion in the both phases (p < 0.05. The kinematics of the ACLD and contralateral intact knees were similar during the wide-based squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension

  2. Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain

    DEFF Research Database (Denmark)

    Sandal, L F; Roos, E M; Bøgesvang, S J

    2016-01-01

    with acute exercise-induced pain flares in persons with knee or hip pain. DESIGN: Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint......OBJECTIVE: Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together...... stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. RESULTS: Joint pain was reduced from baseline (NRS 3.6; 95...

  3. Preoperative pain mechanisms assessed by cuff algometry are associated with chronic postoperative pain relief after total knee replacement.

    Science.gov (United States)

    Petersen, Kristian Kjær; Graven-Nielsen, Thomas; Simonsen, Ole; Laursen, Mogens Berg; Arendt-Nielsen, Lars

    2016-07-01

    Chronic postoperative pain after total knee replacement (TKR) in knee osteoarthritis (KOA) implies clinical challenges. Widespread hyperalgesia, facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM) have been found in painful KOA. This exploratory study investigated postoperative pain relief 12 months after TKR in 4 subgroups of patients preoperatively profiled by mechanistic quantitative sensory testing. In 103 patients with KOA, pressure pain detection threshold (PDT) and tolerance thresholds (PTT) were assessed at the lower leg using cuff algometry. Temporal summation of pain was measured as an increase in pain intensity scores during 10 repeated (2 seconds intervals) painful cuff stimuli. Conditioned pain modulation was calculated as the relative increase in PDT during painful conditioning stimulation. The grand averages of TSP and CPM were calculated and values below or above were used for subgrouping: facilitated TSP/impaired CPM (group A, N = 16), facilitated TSP/normal CPM (group B, N = 15), normal TSP/impaired CPM (group C, N = 44), and normal TSP/normal CPM (group D, N = 28). Clinical VAS pain intensity scores were collected before and 12 months after TKR surgery and the pain relief calculated. Less pain relief was found in group A (52.0% ± 14.0% pain relief) than in group B (81.1% ± 3.5%, P = 0.023) and group C (79.6% ± 4.4%, P = 0.007), but not group D (69.4% ± 7.9%, P = 0.087). Low preoperative PDT was associated with a less postoperative pain relief (R = -0.222, P = 0.034), whereas TSP or CPM alone showed no associations with postoperative pain relief. This explorative study indicated that patients with osteoarthritis with facilitated TSP together with impaired CPM are more vulnerable to experience less pain relief after TKR.

  4. Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery

    DEFF Research Database (Denmark)

    Espelund, M; Grevstad, U; Jaeger, P

    2014-01-01

    BACKGROUND: The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery. METHODS: Fifty...... subjects with moderate to severe pain after arthroscopic knee surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB...... with the opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the knee at 45 min after the first block, assessed on a 0-100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the knee, worst pain experienced...

  5. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

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    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  6. Quality of life in elderly subjects with pain in the hip or knee

    NARCIS (Netherlands)

    Hopman-Rock, M.; Kraaimaat, F. W.; Bijlsma, J. W.

    1997-01-01

    This study examines the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic pain in the hip or knee and of a reference group without pain (total n = 306). Firstly, it was hypothesized that the experienced QOL is lower in people with more chronic

  7. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Lorentzen, Jan S; Larsen, Allan S

    2002-01-01

    We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups...... the procedure. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use...

  8. Multiple half-second acquisition method of the moving knee joint. Kinematic MR imaging of the anterior cruciate ligament

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    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Echigo, Junko; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1996-10-01

    The objective of this study was to delineate the moving anterior cruciate ligament (ACL) with multiple rapid magnetic resonance (MR) imaging. Rapid gradient echo MR images with an one-shot acquisition time of a half-second were accomplished by short repetition time and phase encoding reduction. Using a mobile knee brace and a flexible surface coil, half-second acquisitions were sequentially acquired during active, constant knee movement. Sixteen knees with intact ACLs and 27 knees with arthroscopically proven ACL tears were examined. Normal ACLs were identified as moving linear low-intensities. The ligaments were readily identified as straight or minimally curved structures when the knee was in semi-flexion compared to the knee extension. Torn ACLs were demonstrated as moving fragments or an amorphous configuration. Intermittent appearances of joint fluid interrupted the ligamentous continuities. Compared to the static images, no significant superiority of the kinematic imaging was found in diagnosis of ACL tears. However, this instant kinematic imaging is feasible with a standard MR system and can provide morphological information for functional analysis of the knee. (author)

  9. Multiple half-second acquisition method of the moving knee joint. Kinematic MR imaging of the anterior cruciate ligament

    International Nuclear Information System (INIS)

    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Echigo, Junko; Itai, Yuji

    1996-01-01

    The objective of this study was to delineate the moving anterior cruciate ligament (ACL) with multiple rapid magnetic resonance (MR) imaging. Rapid gradient echo MR images with an one-shot acquisition time of a half-second were accomplished by short repetition time and phase encoding reduction. Using a mobile knee brace and a flexible surface coil, half-second acquisitions were sequentially acquired during active, constant knee movement. Sixteen knees with intact ACLs and 27 knees with arthroscopically proven ACL tears were examined. Normal ACLs were identified as moving linear low-intensities. The ligaments were readily identified as straight or minimally curved structures when the knee was in semi-flexion compared to the knee extension. Torn ACLs were demonstrated as moving fragments or an amorphous configuration. Intermittent appearances of joint fluid interrupted the ligamentous continuities. Compared to the static images, no significant superiority of the kinematic imaging was found in diagnosis of ACL tears. However, this instant kinematic imaging is feasible with a standard MR system and can provide morphological information for functional analysis of the knee. (author)

  10. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    Science.gov (United States)

    Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

    2015-01-01

    Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient

  11. Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho Bloqueo 3 en 1 prolongado versus analgesia sistemica en el tratamiento del dolor postoperatorio después de la reconstrucción del ligamento cruzado anterior de la rodilla Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Víctor A. Contreras-Domínguez

    2007-06-01

    = 30: bloqueo femoral continuo con infusión de bupivacaína y clonidina; y Grupo 2 (n =3 0: infusión intravenosa de cetoprofeno. La intervención quirúrgica se hizo bajo raquianestesia y sedación. El tratamiento del dolor postoperatorio se hizo con analgesia controlada por el paciente (PCA usando morfina. El dolor postoperatorio fue registrada 2, 4, 6, 24 y 36 horas después de la intervención quirúrgica usando la Escala Visual Analógica (VAS. El consumo de morfina, la satisfacción de los pacientes y las complicaciones también fueron registrados. RESULTADOS: En el Grupo 1, el VAS postoperatorio entre 4 y 48 horas trás de la intervención quirúrgica fue de 21 mm ± 2 y en el Grupo 2 fue de 45 mm ± 4 (p BACKGROUND AND OBJECTIVES: Continuous femoral block (three-in-one is used for postoperative analgesia in hip and knee replacements with good results, with advantages over other locoregional analgesic or intravenous techniques having low incidence of complications. The aim of this study was to clinically evaluate the utility of continuous femoral block compared with intravenous analgesia in reconstruction of anterior cruciate ligament. METHODS: Controlled prospective study of 60 patients ASA I. Patients were divided into two groups: Group 1 (n = 30: continuous femoral block with an infusion of bupivacaine and clonidine; and Group 2 (n = 30: intravenous ketoprofen infusion. Surgery was performed under spinal anesthesia and sedation. Postoperative pain management with morphine patient controlled analgesia (PCA. Postoperative pain recorded at 2, 4, 6, 24 and 36 hours after surgery using Visual Analog Scale (VAS. Morphine consumption, satisfaction's score and complications are registered. RESULTS: In Group 1 postoperative VAS between 4 and 48 hours was 21 mm ± 2 and in Group 2 was 45 mm ± 4 (p < 0.001. Morphine consumption between 4 and 48 hours in Group 1 was 4.5 mg ± 1.5 and in Group 2 was 25.5 mg ± 3 (p < 0.001. In Group 1, 6.7% of patients presented

  12. Half of 12-15-year-olds with knee pain still have pain after one year

    DEFF Research Database (Denmark)

    Rathleff, Camilla Rams; Olesen, Jens Lykkegaard; Roos, Ewa M.

    2013-01-01

    Introduction: Adolescent knee pain is considered benign and presumed to disappear without treatment. However, this has never been investigated. The purpose of this study was to 1) compare leisure time sports participation, health-related quality of life (HRQoL) and body mass index between...... knee pain after one year. Funding: Danish Rheumatism Association, The Association of Danish Physiotherapists Research Fund and The Obel Family Foundation. None of the funders have any role in the study other than to provide funding. Trial registration: Ethical approval was obtained from the local...

  13. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement

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    Tonelli Shalome M

    2011-11-01

    Full Text Available Abstract Background Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown. Methods This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women and men with knee osteoarthritis (N = 208 immediately prior to total knee arthroplasty. We assessed: (1 pain using self-report measures and a numerical rating scale at rest and during functional tasks, (2 pain sensitivity using quantitative sensory measures, (3 function with self-report measures and specific function tasks (timed walk, maximal active flexion and extension, (4 psychosocial measures (depression, anxiety, catastrophizing, and social support, and (5 physical activity using accelerometry. The ability of these mixed variables to explain physical activity, function and pain was assessed using regression analysis. Results Our findings showed significant differences on pain intensity, pain sensitivity, and function tasks, but not on psychosocial measures or physical activity. Women had significantly worse pain and more impaired function than men. Their levels of depression, anxiety, pain catastrophizing, social support, and physical activity, however, did not differ significantly. Factors explaining differences in (1 pain during movement (during gait speed test were pain at rest, knee extension, state anxiety, and pressure pain threshold; (2 function (gait speed test were sex, age, knee extension, knee flexion opioid medications, pain

  14. Comparison of the effects of knee and hip and single knee muscles strengthening/ stretching exercises on pain intensity and function in athletes with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Vahid Mazloum

    2016-08-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS is a common musculoskeletal condition among athletes. The evidence emphasizes on the importance of hip musculature strengthening exercises for such patients. Objective: To investigate the effects of strengthening-stretching knee muscles exercises and hip posterolateral musculature exercises in athletes with PFPS. Methods: In this clinical trial, 28 athletes with age average of 22.7±2.4 years with PFPS were allocated into conventional knee muscles exercises (CKME (n=14 and posterolateral hip muscles exercises (PHME (n=14. The subjects of both groups performed the supervised exercise protocols in 12 sessions. The Visual Analogue Scale and 6-minute walking tests were administrated respectively to evaluate pain intensity and function. The data were analyzed using Shapiro-wilk test, Independent-sample t test, and Repeated Measure ANOVA test. Findings: Demographic, pain intensity, and physical function data were similar between groups at baseline. Both groups significantly improved in pain intensity and function following a 4-week exercise program. Additionally, the athletes in PHME group had higher level of decreased pain intensity and improved function in follow-up assessment than the subjects in CKME group. Conclusion: Using hip posterolateral musculature exercises in addition to the knee conventional exercises is more effective for athletes with PFPS.

  15. In Vivo Kinematics of the Anterior Cruciate Ligament Deficient Knee During Wide-Based Squat Using a 2D/3D Registration Technique.

    Science.gov (United States)

    Miyaji, Takeshi; Gamada, Kazuyoshi; Kidera, Kenichi; Ikuta, Futoshi; Yoneta, Kei; Shindo, Hiroyuki; Osaki, Makoto; Yonekura, Akihiko

    2012-01-01

    Anterior cruciate ligament (ACL) deficiency increases the risk of early osteoarthritis (OA). Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD) knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100° flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5° flexion in both phases (p squat activity (p squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension.

  16. Coping with pain in the hip or knee in relation to physical disability in community-living elderly people

    NARCIS (Netherlands)

    Hopman-Rock, M.; Kraaimaat, F. W.; Odding, E.; Bijlsma, J. W.

    1998-01-01

    To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. A group of 157 people with pain "in the last month" was identified.

  17. The Effect of the Mulligan Knee Taping Technique on Patellofemoral Pain and Lower Limb Biomechanics.

    Science.gov (United States)

    Hickey, Anne; Hopper, Diana; Hall, Toby; Wild, Catherine Y

    2016-05-01

    Patellofemoral pain (PFP) affects 25% of the general population, occurring 2 times more often in females compared with males. Taping is a valuable component of the management plan for altering lower limb biomechanics and providing pain relief; however, the effects of alternative taping techniques, such as Mulligan knee taping, appear yet to be researched. To determine whether the Mulligan knee taping technique altered levels of perceived knee pain and lower limb biomechanics during a single-legged squat (SLSq) in adult females with PFP. Controlled laboratory study. A total of 20 female patients with PFP, aged 18 to 35 years, participated in this study. Participants performed 3 to 5 SLSq on their most symptomatic limb during a taped (Mulligan knee taping technique) and nontaped (control) condition. During the eccentric phase of the SLSq, the 3-dimensional kinematics (250 Hz) of the knee and hip and the ground-reaction forces (1000 Hz) and muscle activation patterns (1000 Hz) of the gluteus medius, vastus lateralis, and vastus medialis oblique were measured. Participants' perceived maximum knee pain was also recorded after the completion of each squat. Between-condition differences were found for hip kinematics and gluteus medius activation but not for kinetics or vastus medialis oblique and vastus lateralis muscle activity (timing and activation). Compared with the nontaped condition, the Mulligan knee taping technique significantly (P = .001) reduced perceived pain during the SLSq (mean ± SD: 2.29 ± 1.79 and 1.29 ± 1.28, respectively). In the taped condition compared with the control, the onset timing of the gluteus medius occurred significantly earlier (120.6 ± 113.0 and 156.6 ± 91.6 ms, respectively; P = .023) and peak hip internal rotation was significantly reduced (6.38° ± 7.31° and 8.34° ± 7.92°, respectively; P = .002). The Mulligan knee taping technique successfully reduced knee pain in participants with PFP. This is the first study to establish a

  18. Impact of persistent hip or knee pain on overall health status in elderly people: a longitudinal population study.

    Science.gov (United States)

    Dawson, Jill; Linsell, Louise; Zondervan, Krina; Rose, Peter; Carr, Andrew; Randall, Tony; Fitzpatrick, Ray

    2005-06-15

    To investigate hip or knee symptoms in older persons from a longitudinal, population perspective, and to determine the impact of persistent hip or knee pain on general health status over time. A postal questionnaire was sent to a random sample of 5,500 individuals ages > or = 65 years containing the Short Form 36 (SF-36) general health survey, Lequesne hip and knee indices, and a hip/knee pain severity item. Respondents reporting hip or knee symptoms at baseline received an identical questionnaire 12 months later. Respondents were classified into a persistent pain group with either hip or knee pain at both baseline and followup, and a non-persistent pain group who reported hip or knee pain at baseline but no pain at followup. At baseline, 1,305 (40.7%) of 3,210 eligible respondents reported hip or knee pain. At 1 year, 1,072 (82.1%) of 1,305 individuals responded, of whom 820 (76.5%) remained symptomatic (the persistent group). In multivariate analysis, baseline factors identified as strongly related to having persistent pain were maximum Lequesne score (odds ratio [OR] 1.09, P hip/knee pain score (OR 1.61, P hip and knee joints at baseline (OR 1.48, P = 0.004). Following adjustment for age, sex, and baseline score, differences in mean SF-36 change scores of the 2 groups were significant for all dimensions except for mental health. In older persons, a symptomatic hip or knee frequently progresses in terms of worsening symptoms and accrual of other symptomatic hip or knee joints. The impact of persistent symptoms on general health is substantial.

  19. SHORT TERM EFFECT OF MULLIGANS MOBILIZATION VERSUS KINESIO TAPING ON KNEE PAIN AND DISABILITY FOR OSTEOARTHRITIS OF KNEE

    Directory of Open Access Journals (Sweden)

    Priyesh P. Malgaonkar

    2014-10-01

    Full Text Available Background: Mulligan’s mobilization and Kinesio taping treatment techniques found to be effective on improving pain and functional disability for osteoarthritis of knee. Hence the purpose is to compare the effect of Mulligan’s mobilization and kinesio taping on improvement of pain and functional disability in subjects with osteoarthritis of knee. Method: An experimental study design, 40 subjects with osteoarthritis of knee joint randomized 20 subjects each into Mobilization Group and Taping Group. Mobilization Group was treated with Mulligan’s Mobilization and Taping Group was treated with Therapeutic Kinesio Taping thrice a week for 2 weeks. Outcome measurements such as Visual analog scale (VAS for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC for functional disability was measured before and after 2 weeks post intervention. Results: Analysis using Paired ‘t’ test and Wilcoxon signed rank test found that there is a statistically significant improvement in VAS and WOMAC within the group. Comparative analysis using Independent‘t’ test and Mann Whitney U test found there is a statistically significant difference in post-intervention means between the groups. Conclusion: The study concluded that both Mulligan’s Mobilization and Kinesio Taping techniques significantly shown short term effect on improvement of pain and functional disability for subjects with osteoarthritis of knee. However, there is no statistically significant difference in short term improvements between Mulligan’s Mobilization and Kinesio Taping. Among both, Mulligan’s Mobilization technique found clinically more effective with greater percentage of improvement than Kinesio Taping technique.

  20. The Association Between Knee Confidence and Muscle Power, Hop Performance, and Postural Orientation in People With Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Ageberg, Eva; Roos, Ewa M

    2016-06-01

    Study Design Cross-sectional. Background The association between muscle function and lack of knee confidence in people with anterior cruciate ligament (ACL) injury has not been well investigated. Such knowledge would help in the design of training programs for this population. Objective To investigate associations between self-reported knee confidence and muscle function in patients with ACL injury. Methods Cross-sectional data from 54 patients (mean age, 30 years; range, 20-39 years; 28% women) with ACL injury, treated with training and reconstructive surgery (n = 36) or training only (n = 18), were assessed 3 ± 1 years after injury. Univariate and multivariable ordinal regression analyses were conducted to test the association between the patient's knee confidence (question 3 from the Knee injury and Osteoarthritis Outcome Score as the dependent variable) and performance on tests of muscle power, hop performance, and postural orientation (test for substitution patterns score) as independent variables (absolute value on the injured leg, and limb symmetry index [LSI; injured leg/uninjured leg × 100] or absolute difference between the injured and uninjured legs). Results Sixteen patients reported no trouble with lack of knee confidence, 24 mild trouble, 10 moderate trouble, and 4 severe or extreme trouble. Univariate analyses revealed significant associations between worse knee confidence and lower (worse) LSIs for knee extension power, vertical jump, and side hop, and worse test for substitution patterns scores. In the multivariable analysis, worse vertical jump LSI (P = .043) and worse side hop LSI (P = .012) significantly accounted for 25% of the variation in perceived knee confidence. Conclusion Between-leg differences during demanding tasks are associated with knee confidence in individuals with ACL injury. J Orthop Sports Phys Ther 2016;46(6):477-482. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6374.

  1. Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

    2014-01-01

    before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus...

  2. Does Kinesio Taping of the Knee Improve Pain and Functionality in Patients with Knee Osteoarthritis?: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Kaya Mutlu, Ebru; Mustafaoglu, Rustem; Birinci, Tansu; Razak Ozdincler, Arzu

    2017-01-01

    This study investigated the effect of Kinesio taping on the functionality, pain, range of motion (ROM), and muscle strength in patients with knee osteoarthritis compared with a placebo Kinesio tape (KT) application. Forty-two consecutive patients were randomized to a KT group and a placebo taping group. The assessments were performed at baseline, after the initial KT application, the third KT application, and 1 month later. The functional status of patients was evaluated using the Aggregated Locomotor Function score and the Western Ontario and McMaster Universities Osteoarthritis scale. Pain level, muscle strength, and active ROM were measured using the Visual Analog Scale (VAS), a handheld dynamometer, and digital goniometer, respectively. Patients receiving the KT application demonstrated large decrease in VAS activity and walking task scores compared with the placebo taping group from the initial taping application to after the third taping application (P = 0.009 and P Kinesio taping resulted in superior short-term effects on walking task, pain, and knee-flexion ROM compared with placebo taping in patients with knee osteoarthritis.

  3. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis.

    Science.gov (United States)

    Lin, Xianfeng; Huang, Kangmao; Zhu, Guiqi; Huang, Zhaobo; Qin, An; Fan, Shunwu

    2016-09-21

    Acupuncture reportedly relieves chronic knee pain and improves physical function in patients diagnosed with osteoarthritis, but the duration of these effects is controversial. The aim of this study was to evaluate the temporal effects of acupuncture on chronic knee pain due to knee osteoarthritis by means of a meta-analysis. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published through March 2015. Ten randomized controlled trials of acupuncture compared with sham acupuncture, usual care, or no intervention for chronic knee pain in patients with clinically diagnosed or radiographically confirmed knee osteoarthritis were included. All of the studies were available in English. Weighted mean differences (WMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. The acupuncture groups showed superior pain improvement (p 50%) and physical function (p 50%) in the short term (up to 13 weeks). The acupuncture groups showed superior physical function (p = 0.016; WMD = 2.73 [95% CI, 0.51 to 4.94]; I(2) > 50%) but not superior pain improvement (p = 0.199; WMD = -0.55 [95% CI, -1.39 to 0.29]; I(2) > 50%) in the long term (up to 26 weeks). Subgroup analysis revealed that the acupuncture groups tended to have better outcomes compared with the controls. Significant publication bias was not detected (p > 0.05), but the heterogeneity of the studies was substantial. This meta-analysis demonstrates that acupuncture can improve short and long-term physical function, but it appears to provide only short-term pain relief in patients with chronic knee pain due to osteoarthritis. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  4. Impairment-targeted exercises for older adults with knee pain: a proof-of-principle study (TargET-Knee-Pain).

    Science.gov (United States)

    Wood, Laurence R J; Blagojevic-Bucknall, Milica; Stynes, Siobhán; D'Cruz, Deborah; Mullis, Ricky; Whittle, Rebecca; Peat, George; Foster, Nadine E

    2016-01-29

    Therapeutic exercise is an effective intervention for knee pain and osteoarthritis (OA) and should be individualised. In a preliminary, proof-of-principle study we sought to develop a home exercise programme targeted at specific physical impairments of weak quadriceps, reduced knee flexion range of motion (ROM) and poor balance, and evaluate whether receipt of this was associated with improvements in those impairments and in patient-reported outcomes among older adults with knee pain. This community-based study used a single group, before-after study design with 12-week follow-up. Participants were 58 adults aged over 56 years with knee pain and evidence of quadriceps weakness, loss of flexion ROM, or poor balance, recruited from an existing population-based, observational cohort. Participants received a 12-week home exercise programme, tailored to their physical impairments. The programme was led, monitored and progressed by a physiotherapist over six home visits, alternating with six telephone calls. Primary outcome measures were maximal isometric quadriceps strength, knee flexion ROM and timed single-leg standing balance, measured at baseline, 6 and 12 weeks by a research nurse blinded to the nature and content of participants' exercise programmes. Secondary outcome measures included the WOMAC. At 12 weeks, participants receiving strengthening exercises demonstrated a statistically significant change in quadriceps isometric strength compared to participants not receiving strengthening exercises: 3.9 KgF (95 % CI 0.1, 7.8). Changes in knee flexion ROM (2.1° (-2.3, 6.5)) and single-leg balance time (-2.4 s (-4.5, 6.7)) after stretching and balance retraining exercises respectively, were not found to be statistically significant. There were significant improvements in mean WOMAC Pain and Physical Function scores: -2.2 (-3.1, -1.2) and -5.1 (-7.8, -2.5). A 12-week impairment-targeted, home-based exercise programme for symptomatic knee OA appeared to be associated

  5. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial.

    Science.gov (United States)

    Dias, João Marcos; Cisneros, Lígia; Dias, Rosângela; Fritsch, Carolina; Gomes, Wellington; Pereira, Leani; Santos, Mary Luci; Ferreira, Paulo Henrique

    Currently, there is poor evidence of the effect of hydrotherapy alone on patients with hip or knee osteoarthritis. The study aimed to assess the impact of hydrotherapy on pain, function, and muscle function in older women with knee osteoarthritis. A randomized controlled trial was conducted to evaluate the efficacy of hydrotherapy in women with knee osteoarthritis. Seventy-three women aged 65 and older were randomized to hydrotherapy (n=36) or a control group (n=37). The hydrotherapy group received the intervention program in a heated pool (twice per week for six weeks) and an educational protocol while the control group received an educational protocol only. Primary outcomes (before and post-treatment) were pain intensity (0-100) and function (0-100), assessed with the WOMAC questionnaire. Secondary outcomes (before and post-treatment) were knee extensor and knee flexor muscle performance (strength, power, and endurance), assessed by an isokinetic dynamometer. The magnitude of change between the groups for the outcomes was calculated using linear regression models adjusted by baseline outcome values. The hydrotherapy group had better outcomes for pain (adjusted mean difference=11 points, 95% CI: 3-18) and function (adjusted mean difference=12 points, 95% CI: 5-18). Patients receiving hydrotherapy had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance. Older women with knee osteoarthritis are likely to have benefits from a course of hydrotherapy exercises. Registry of clinical trials (Trial number RBR-8F57KR) - http://www.ensaiosclinicos.gov.br/rg/RBR-8f57kr/. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Patellofemoral Pain : Where does the pain come from?

    NARCIS (Netherlands)

    R.A. van der Heijden (Rianne)

    2016-01-01

    markdownabstractMy thesis is about patellofemoral pain (PFP), a common knee complaint among physically active young individuals. It is also known as ’anterior knee pain’, ’retropatellar chondropathy’ or more recently suggested ‘theatre or moviegoers knee’. PFP is characterized by retropatellar pain

  7. The Relationship between Fuctional Tests and Knee Muscles Isokinetic Parameters in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Shahin Goharpey

    2007-04-01

    Full Text Available Objective: Patellofemoral pain syndrome is the most prevalent problem involving25 percent of all knee disorders. Such problems might be lead to functional disabilities. The goal of this study was to evaluate the relationship between functional tests and Isokinetic parameters of knee muscles and subjective assessment of knee function in patellofemoral pain syndrome and to compare between patient and control group. Materials & Methods: In this analytical and case – control research fifteen normal subjects and 15 patients with patellofemoral pain syndrome were selected with purposive sampling method in performing two main levels of this study: 1- Functional tests (bilateral squat and step down test which performed randomly with considering of repetitions per 30 seconds, within 3 minutes rest between them applied and followed by subjective assessment of knee function with Kujala questionnaire. 2- Isokinetic tests performed with Biodex dynamometer device, during 10 to 90 degree of knee flexion with two distinct speeds, 60 and 120 degree per second. Results: No relationship was found between functional tests and Isokinetic parameters in patient group, but we observed a low significant relationship between functional tests and subjective assessment in this group (r=0/47 for Squat test and 0/37 for Step down test. Moderate significant relationship was found between subjective assessment of knee function and functional Hamstring: Quadriceps ratio for knee flexion at 60 degree per second (r = - 0/58. All of the Isokinetic parameters of quadriceps muscle in patient group were lower than control group. Conclusion: As there were low correlation between Isokinetic strength measurement and functional tests and subjective assessment of knee function, it is not recommended using these methods of assessment interchangeable in patients with patellofemoral pain syndrome.

  8. Ultrasound-Guided Genicular Nerve Thermal Radiofrequency Ablation for Chronic Knee Pain

    OpenAIRE

    Wong, Joshua; Bremer, Nicholas; Weyker, Paul D.; Webb, Christopher A. J.

    2016-01-01

    Osteoarthritis (OA) of the knee is one of the most common joint diseases affecting adults in the United States. For elderly patients with multiple medical comorbidities who do not wish to undergo total knee arthroplasty (TKA), lifestyle modification, pharmacologic management, and injections are the mainstay of therapy. Previously, pain management interventions were limited to intra-articular joint injections and viscosupplementation with hyaluronic acid. Fluoroscopic-guided techniques for rad...

  9. Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis

    OpenAIRE

    Mutlu, Ebru Kaya; Ozdincler, Arzu Razak

    2015-01-01

    [Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 cl...

  10. [Fear and preoperative anxiety behaviour and pain intensity perceived after knee arthroscopy].

    Science.gov (United States)

    Anguita-Palacios, M Carmen; Talayero-San-Miguel, Marta; Herrero-Cereceda, Salomé; Martín-Cadenas, Mar; Pardo-Cuevas, Pilar; Gil-Martínez, Alfonso

    2016-01-01

    The aim of this study was to investigate the short-term (24hours) association between postoperative pain and preoperative psychological variables (anxiety, pain catastrophizing and kinesiophobia) in a sample of knee arthroscopy ambulatory surgery. Observational cross-sectional study, conducted with 40 adult subjects who underwent knee arthroscopy in the surgical area of Cantoblanco Hospital (Hospital Universitario La Paz) in Madrid. The fear-avoidance beliefs and anxiety were assessed using validated questionnaires of pain catastrophizing, kinesiophobia and anxiety. Pre and post-surgical pain and perceived disability were evaluated by the Verbal Numeric Scale. Mean age of the sample (22 men and 18 women) was 52.85±14.21 without significant differences between gender. No statistically significant data for the association between variables of kinesiofobia, anxiety and pain catastrophizing and the intensity of perceived pain by the postoperative knee arthroscopy patient were found. Length of surgery in our study has a correlation with the immediate post-surgical pain (r=0.468; P=.002) and there is a relationship between age and pain intensity at 24hours (r=-0.329; P=.038), and between age and perceived disability (r=-0.314; P=.049). An association between catastrophizing and kinesiophobia scales (r=0.337; P=.033) is obtained likewise. In conclusion, preoperative fear-avoidance beliefs like pain anxiety or pain catastrophizing and kinesiophobia were not associated with acute postoperative pain in our study. Analyses of secondary pain related outcomes, however, indicated that reduced time of surgery may contribute to enhance clinical postoperative pain. If confirmed and replicated in larger samples, this may potentially enable clinicians to improve postoperative pain management in future patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  11. Prevalence of Baker’s cyst in patients with knee pain: an ultrasonographic study

    Directory of Open Access Journals (Sweden)

    V. Picerno

    2014-03-01

    Full Text Available The objectives of this study are to investigate the prevalence of Baker’s cyst (BC in patients with knee pain, and to assess the correlation between BC and severity of osteophytes and joint effusion. A retrospective study was conducted on a group of patients with knee pain referred to our outpatient clinic for ultrasonography of the knee between January 2010 and February 2011. Patients underwent an ultrasonographic exam of the knees to assess the presence of marginal femorotibial osteophytosis, joint effusion and BC. A dichotomous score was assigned to each item (1 present, 0 absent and severity of US signs of osteoarthritis and joint effusion were also graded semiquantitatively. Collected data were processed using logistic regression analysis to evaluate the correlation between degree of osteophytosis and joint effusion and BC. Patients affected by inflammatory joint conditions or with history of joint surgery or recent trauma were excluded. A total of 399 patients with knee pain were studied (299 women, in the age range 18-89 years (mean 56.2, SD 16.3 years. 293 patients (73.4% showed sonographic features of osteoarthritis and 251 (62.9% joint effusion. BC was found in 102 patients (25.8% together with a positive association with sonographic features of osteoarthritis and joint effusion. Our data show a prevalence of BC of 25.8% in a population of patients with knee pain, and suggest that BC is positively related to osteoarthritis and joint effusion. Ultrasonographic examination of knee is worthwhile in patients with painful osteoarthritis or evidence of effusion.

  12. Knee extensor strength is associated with pressure pain thresholds in adults with fibromyalgia.

    Directory of Open Access Journals (Sweden)

    W Michael Hooten

    Full Text Available Individuals with fibromyalgia (FM have lower muscle strength and lower pressure pain thresholds (PPT. The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (VO2 on the associations between muscle strength and PPT.Knee extensor and flexor strength (N = 69 was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak VO2 uptake was quantified using an electronically braked cycle ergometer.Univariable linear regression analysis demonstrated a significant association between PPT (dependent variable and isometric knee extensor (P<.001, isokinetic (60°/s knee extensor (P = .002, and isokinetic (60°/s knee flexor strength (P = .043. In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak VO2 uptake, a significant association was found between PPT and isometric knee extensor strength (P = .008. In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P = .044.Greater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models.ClinicalTrials.gov NCT01253395.

  13. Association of Joint Inflammation With Pain Sensitization in Knee Osteoarthritis: The Multicenter Osteoarthritis Study.

    Science.gov (United States)

    Neogi, Tuhina; Guermazi, Ali; Roemer, Frank; Nevitt, Michael C; Scholz, Joachim; Arendt-Nielsen, Lars; Woolf, Clifford; Niu, Jingbo; Bradley, Laurence A; Quinn, Emily; Law, Laura Frey

    2016-03-01

    Pain sensitization is associated with pain severity in knee osteoarthritis (OA), but its cause in humans is not well understood. We examined whether inflammation, assessed as synovitis and effusion on magnetic resonance imaging (MRI), or mechanical load, assessed as bone marrow lesions (BMLs), was associated with sensitization in knee OA. Subjects in the Multicenter Osteoarthritis Study, a National Institutes of Health-funded cohort of persons with or at risk of knee OA, underwent radiography and MRI of the knee, and standardized quantitative sensory testing (temporal summation and pressure pain threshold [PPT]) of the wrist and patellae at baseline and 2 years later. We examined the relation of synovitis, effusion, and BMLs to temporal summation and PPT cross-sectionally and longitudinally. There were 1,111 subjects in the study sample (mean age 67 years, mean body mass index 30 kg/m(2) , 62% female). Synovitis was associated with a significant decrease in PPT at the patella (i.e., more sensitized) over 2 years (adjusted β -0.30 [95% confidence interval (95% CI) -0.52, -0.08]). Effusion was similarly associated with a decrease in PPT at the wrist (adjusted β -0.24 [95% CI -0.41, -0.08]) and with risk of incident temporal summation at the patella (adjusted OR 1.54 [95% CI 1.01, 2.36]). BMLs were not associated with either quantitative sensory testing measure. Inflammation, as evidenced by synovitis or effusion, is associated with pain sensitization in knee OA. In contrast, BMLs do not appear to contribute to sensitization in knee OA. Early targeting of inflammation is a reasonable strategy to test for prevention of sensitization and through this, reduction of pain severity, in knee OA. © 2016, American College of Rheumatology.

  14. Validation of varus stress radiographs for anterior cruciate ligament and posterolateral corner knee injuries: A biomechanical study.

    Science.gov (United States)

    McDonald, Lucas S; Waltz, Robert A; Carney, Joseph R; Dewing, Christopher B; Lynch, Joseph R; Asher, Dean B; Schuett, Dustin J; LeClere, Lance E

    2016-12-01

    The purpose of this study was to determine the effect of isolated anterior cruciate ligament (ACL) insufficiency on the radiographic varus stress test, and to provide reference data for the increase in lateral compartment opening under varus stress for a combined ACL and PLC injury. Ten cadaveric lower extremities were fixed to a jig in 20° of knee flexion. Twelve Newton-meter (Nm) and clinician-applied varus loads were tested, first with intact knee ligaments, followed by sequential sectioning of the ACL, fibular collateral ligament (FCL), popliteus tendon and the popliteofibular ligament (PFL). Lateral compartment opening was measured after each sequential sectioning. Maximum increase in lateral compartment opening for an isolated ACL deficient knee was 1.06mm with mean increase of 0.52mm (p=0.021) for the clinician-applied load. Mean increase in lateral compartment opening in an ACL and FCL deficient knee compared to the intact knee was 1.48mm (pvarus stress radiographs though not sufficiently to confound previously established standards for lateral ligament knee injuries. We did not demonstrate the same magnitude of lateral compartment opening with sectioning of the PLC structures as previously reported, questioning the reproducibility of varus stress radiographic testing among institutions. Clinicians are cautioned against making surgical decisions based solely on current standards for radiographic stress examinations. Published by Elsevier B.V.

  15. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball.

    Science.gov (United States)

    Koga, Hideyuki; Nakamae, Atsuo; Shima, Yosuke; Iwasa, Junji; Myklebust, Grethe; Engebretsen, Lars; Bahr, Roald; Krosshaug, Tron

    2010-11-01

    The mechanism for noncontact anterior cruciate ligament injury is still a matter of controversy. Video analysis of injury tapes is the only method available to extract biomechanical information from actual anterior cruciate ligament injury cases. This article describes 3-dimensional knee joint kinematics in anterior cruciate ligament injury situations using a model-based image-matching technique. Case series; Level of evidence, 4. Ten anterior cruciate ligament injury video sequences from women's handball and basketball were analyzed using the model-based image-matching method. The mean knee flexion angle among the 10 cases was 23° (range, 11°-30°) at initial contact (IC) and had increased by 24° (95% confidence interval [CI], 19°-29°) within the following 40 milliseconds. The mean valgus angle was neutral (range, -2° to 3°) at IC, but had increased by 12° (95% CI, 10°-13°) 40 milliseconds later. The knee was externally rotated 5° (range, -5° to 12°) at IC, but rotated internally by 8° (95% CI, 2°-14°) during the first 40 milliseconds, followed by external rotation of 17° (95% CI, 13°-22°). The mean peak vertical ground-reaction force was 3.2 times body weight (95% CI, 2.7-3.7), and occurred at 40 milliseconds after IC (range, 0-83). Based on when the sudden changes in joint angular motion and the peak vertical ground-reaction force occurred, it is likely that the anterior cruciate ligament injury occurred approximately 40 milliseconds after IC. The kinematic patterns were surprisingly consistent among the 10 cases. All players had immediate valgus motion within 40 milliseconds after IC. Moreover, the tibia rotated internally during the first 40 milliseconds and then external rotation was observed, possibly after the anterior cruciate ligament had torn. These results suggest that valgus loading is a contributing factor in the anterior cruciate ligament injury mechanism and that internal tibial rotation is coupled with valgus motion. Prevention

  16. Influence of meteorological elements on balance control and pain in patients with symptomatic knee osteoarthritis

    Science.gov (United States)

    Peultier, Laetitia; Lion, Alexis; Chary-Valckenaere, Isabelle; Loeuille, Damien; Zhang, Zheng; Rat, Anne-Christine; Gueguen, René; Paysant, Jean; Perrin, Philippe P.

    2017-05-01

    This study aimed to determine if pain and balance control are related to meteorological modifications in patients with knee osteoarthritis (OA). One hundred and thirteen patients with knee OA (mean age = 65 ± 9 years old, 78 women) participated in this study. Static posturography was performed, sway area covered and sway path traveled by the center of foot pressure being recorded under six standing postural conditions that combine three visual situations (eyes open, eyes closed, vision altered) with two platform situations (firm and foam supports). Knee pain score was assessed using a visual analog scale. Balance control and pain measurements recorded in the morning were correlated with the meteorological data. Morning and daily values for temperature, precipitation, sunshine, height of rain in 1 h, wind speed, humidity, and atmospheric pressure were obtained from the nearest data collecting weather station. The relationship between postural control, pain, and weather variations were assessed for each patient on a given day with multiple linear regressions. A decrease of postural stability was observed when atmospheric pressure and maximum humidity decreased in the morning ( p knee pain was more enhanced when it is warmer in the morning ( p < 0.05) and when it is wetter and warmer within a day ( p < 0.05). The relationship between weather, pain, and postural control can help patients and health professionals to better manage daily activities.

  17. Obturat