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Sample records for subcanyon reaching knee

  1. Knee MRI

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Knee Magnetic resonance imaging (MRI) of the knee ... of a knee MRI? What is a Knee MRI? MRI of the knee provides detailed images of ...

  2. Runner's Knee

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Runner's Knee KidsHealth / For Teens / Runner's Knee What's in this ... told he had runner's knee. What Is Runner's Knee? Runner's knee is the term doctors use for ...

  3. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  4. Knee Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Knee Injuries KidsHealth / For Teens / Knee Injuries What's in ... can do to protect them. What's in a Knee? The knee is a joint , actually the largest ...

  5. Knee arthroscopy

    Science.gov (United States)

    ... be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year. If you also have arthritis in your knee, you will still have arthritis symptoms after surgery ...

  6. Knee Bursitis

    Science.gov (United States)

    ... volleyball — can increase your risk of knee bursitis. Runners can develop pain and inflammation in the pes anserine bursa, situated on the inner side of your knee below the joint. Obesity and osteoarthritis. Pes anserine bursitis, affecting the inner ...

  7. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, ...

  8. Jumper's Knee (Patellar Tendonitis)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee KidsHealth / For Teens / Jumper's Knee What's in this ... continued damage to the knee. How Does the Knee Work? To understand how jumper's knee happens, it ...

  9. Knee disarticulation

    Directory of Open Access Journals (Sweden)

    Antun Muljačić

    2009-08-01

    Full Text Available In this paper we presented three patients withknee disarticulation performed according toBaumgartner. The Baumgartner tehnique and theapplication of knee disarticulation prosthesis appearedto be superior in comparisson with othermethods.

  10. Knee Injuries and Disorders

    Science.gov (United States)

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

  11. Swollen Knee (Water on the Knee)

    Science.gov (United States)

    ... buildup in and around the knee joint include: Osteoarthritis Rheumatoid arthritis Infection Gout Pseudogout Bursitis Cysts Tumors Risk factors Age. Your likelihood of developing a swollen knee ...

  12. Knee Problems

    Science.gov (United States)

    ... Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath in Infants and Children Shoulder Problems Skin Rashes & Other Skin Problems Throat Problems Tooth Problems Urination Problems Back to Symptoms Step 2 Answering Questions Did your knee pain ...

  13. 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 ...

  14. Total Knee Replacement

    Science.gov (United States)

    ... activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and ... Total Knee Replacement cont. Preparing for Surgery Medical Evaluation If you decide to have total knee replacement ...

  15. Water on the Knee

    Science.gov (United States)

    ... your knee joint. Some people call this condition "water on the knee." A swollen knee may be ... Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don't place continuous weight- ...

  16. Preventing Knee Injuries

    Science.gov (United States)

    ... Our Newsletter Donate Blog Skip breadcrumb navigation Preventing Knee Injuries Knee injuries in children and adolescent athletes ... this PDF Share this page: WHAT ARE COMMON KNEE INJURIES? Pain Syndromes One of the most common ...

  17. Knee microfracture surgery

    Science.gov (United States)

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  18. SGA Reach Breaks

    Data.gov (United States)

    Vermont Center for Geographic Information — The stream geomorphic assessment (SGA) is a physical assessment competed by geomorphologists to determine the condition and sensitivity of a stream. The SGA Reach...

  19. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  20. Knee arthroscopy - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100117.htm Knee arthroscopy - series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The knee is a complex joint made up of the ...

  1. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  2. Knee braces - unloading

    Science.gov (United States)

    ... most people talk about the arthritis in their knees, they are referring to a type of arthritis ... is caused by wear and tear inside your knee joints. Cartilage, the firm, rubbery tissue that cushions ...

  3. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  4. What Are Knee Problems?

    Science.gov (United States)

    ... Health Topics English Español 한국어 繁體中文 tiếng Việt Knee Problems Basics In-Depth Download Download EPUB Download PDF What are they? Points To Remember About Knee Problems Knee problems may be caused by injury, ...

  5. Traumatic knee extension deficit (the locked knee)

    DEFF Research Database (Denmark)

    Helmark, I C; Neergaard, K; Krogsgaard, M R

    2007-01-01

    In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted...... of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. Following MRI and surgery, standardized forms were filled out, attempting to objectify the findings. The orthopaedic surgeon was not aware of the MRI result prior to surgery......, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one...

  6. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...

  7. REACH. Air Conditioning Units.

    Science.gov (United States)

    Garrison, Joe; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of air conditioning. The instructional units focus on air conditioning fundamentals, window air conditioning, system and installation, troubleshooting and…

  8. REACH. Electricity Units. Secondary.

    Science.gov (United States)

    Smith, Gene; Sappe, Hoyt

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of electricity. The instructional units focus on electricity fundamentals and electric motors. Each unit follows a typical format that includes a unit sheet,…

  9. Pretoria Centre Reaches Out

    Science.gov (United States)

    Olivier, Bosman

    2014-08-01

    On 5 July 2014 six members of the Pretoria Centre of ASSA braved the light pollution of one of the shopping malls in Centurion to reach out to shoppers a la John Dobson and to show them the moon, Mars and Saturn. Although the centre hosts regular monthly public observing evenings, it was felt that we should take astronomy to the people rather than wait for the people to come to us.

  10. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... of 34 patients (21%) underwent repeat arthrodesis, and 23 patients (14%) eventually underwent transfemoral amputation. CONCLUSIONS: The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. There was a significant decrease in the 5-year cumulative incidence...

  11. Parietal modules for reaching.

    Science.gov (United States)

    Blangero, A; Menz, M M; McNamara, A; Binkofski, F

    2009-05-01

    Optic ataxia (OA) is classically defined as a deficit of visually guided movements that follows lesions of the posterior part of the posterior parietal cortex (PPC). Since the formalisation of the double stream of visual information processing [Milner, A. D., & Goodale, M. A. (1995). The visual brain in action. Oxford: Oxford University Press] and the use of OA as an argument in favour of the involvement of the posterior parietal cortex (dorsal stream) in visually guided movements, many studies have looked at the visuomotor deficits of these patients. In parallel, the development of neuroimaging methods have led to increasing information about the role of the posterior parietal cortex in visually guided actions. In this article, we discuss the similarities and differences in the results that emerged from these two complementary viewpoints by combining a meta-analysis of neuroimaging data on reaching with lesion studies from OA patients and results of our own fMRI study on reaching in the ipsi- and contra-lateral visual field. We identified four bilateral parietal foci from the meta-analysis and found that the more posterior foci showed greater lateralisation for contralateral visual stimulation than more anterior ones Additionally, the more anterior foci showed greater lateralisation for the use of the contralateral hand than the more posterior ones. Therefore, we can demonstrate that they are organised along a postero-anterior gradient of visual-to-somatic information integration. Furthermore, from the combination of imaging and lesion data it can be inferred that a lesion of the three most posterior foci responsible for the target-hand integration could explain the hand and field effect revealed in OA reaching behaviour.

  12. UCI knee replacement.

    Science.gov (United States)

    Evanski, P M; Waugh, T R; Orofino, C F; Anzel, S H

    1976-10-01

    Between March 9, 1972 and December 31, 1973, a total of 103 UCI knee replacements were performed. Follow-up data are available on 83 knees with an average follow-up of 33 months. Patient evaluation of the end results indicates that 78.3 per cent were better, 9.6 per cent unchanged, and 12.1 per cent worse. Patient evaluation of their own knee function averaged 55 per cent preoperatively and 79 per cent postoperatively. Patients were also evaluated on a 100 point Modified Larson Analysis Form. The average preoperative score was 46, and the average postoperative score was 70. There were six (5.8%) biological complications in the 103 knee replacement. Biological complications included infections, wound healing problems and unexplained pain. Mechanical complications were seen in 18 (17.4%) knees, and included knee instability, tibial component loosening or deformation, and patellar problems. Additional surgery was required in 18 (17.4%) knees. Failure of the procedure eventually requiring removal of the prosthesis and fusion or amputation occurred in 4 (3.9%) knees. The intermediate-term results of UCI knee replacement have been clinically satisfactory. We currently recommend consideration of this procedure for patients with disabling arthritis of the knee.

  13. Older Adults without Radiographic Knee Osteoarthritis: Knee Alignment and Knee Range of Motion

    Directory of Open Access Journals (Sweden)

    Lissa Fahlman

    2014-01-01

    Full Text Available This study describes knee alignment and active knee range of motion (ROM in a community-based group of 78-year old adults (n = 143 who did not have radiographic evidence of knee osteoarthritis in either knee (KL 0.001 than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.

  14. Kinetic and kinematic changes with the use of valgus knee brace and lateral wedge insoles in patients with medial knee osteoarthritis.

    Science.gov (United States)

    Fantini Pagani, Cynthia H; Hinrichs, Maren; Brüggemann, Gert-Peter

    2012-07-01

    The effect of a valgus knee brace and a lateral wedged insole on knee and ankle kinematics and kinetics was evaluated in ten patients with medial knee osteoarthritis (OA). The knee orthosis was tested in two valgus adjustments (4° and 8°), and the laterally wedged insole was fabricated with an inclination of 4°. A motion capture system and force platforms were used for data collection and joint moments were calculated using inverse dynamics. The valgus moment applied by the orthosis was also measured using a strain gauge implemented in the orthosis' rotational axis. For the second peak knee adduction moment, decreases of 18%, 21%, and 7% were observed between baseline and test conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Similar decreases were observed for knee lever arm in the frontal plane. Knee adduction angular impulse decreased 14%, 18%, and 7% from baseline to conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Knee angle in the frontal plane reached a more valgus position during gait using the valgus knee brace. The valgus moment applied by the orthosis with 8° valgus adjustment was 30% higher than with 4° valgus adjustment. The valgus knee orthosis was more effective than the laterally wedged insole in reducing knee adduction moment in patients with medial knee OA. Copyright © 2011 Orthopaedic Research Society.

  15. Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review.

    Science.gov (United States)

    Whitchelo, Tara; McClelland, Jodie A; Webster, Kate E

    2014-01-01

    People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research. Implications for Rehabilitation People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement. For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce. Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.

  16. Jumper's Knee (Patellar Tendonitis) (For Parents)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee (Patellar Tendonitis) KidsHealth / For Parents / Jumper's Knee (Patellar ... prevent continued damage to the knee. How the Knee Works To understand how jumper's knee happens, it ...

  17. Wear in human knees

    Directory of Open Access Journals (Sweden)

    M.L. Wang

    2015-06-01

    Full Text Available Wear occurs in natural knee joints and plays a pivotal factor in causing articular cartilage degradation in osteoarthritis (OA processes. Wear particles are produced in the wear process and get involved in inflammation of human knees. This review presents progresses in the mechanical and surface morphological studies of articular cartilages, wear particles analysis techniques for wear studies and investigations of human knee synovial fluid in wear of human knees. Future work is also included for further understanding of OA symptoms and their relations which may shed light on OA causes.

  18. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  19. Modeling of the condyle elements within a biomechanical knee model

    DEFF Research Database (Denmark)

    Ribeiro, Ana; Rasmussen, John; Flores, Paulo

    2012-01-01

    and anatomic properties of the real bones. The biomechanical model characterization is developed under the framework of multibody systems methodologies using Cartesian coordinates. The type of approach used in the proposed knee model is the joint surface contact conditions between ellipsoids, representing...... for this fact is the elastic component of the secondary motions created by the combination of joint forces and soft tissue deformations. The proposed knee model is, therefore, used to investigate whether this observed behavior can be explained by reasonable elastic deformations of the points representing......The development of a computational multibody knee model able to capture some of the fundamental properties of the human knee articulation is presented. This desideratum is reached by including the kinetics of the real knee articulation. The research question is whether an accurate modeling...

  20. Reaching Beyond The Stars

    Science.gov (United States)

    Baker, Mariah; Rosenthal, L.; Gaughan, A.; Hopkins, E.

    2014-01-01

    Strawbridge Observatory at Haverford College is home to a undergraduate-led public observing program. Our program holds ~once monthly public events throughout the academic year that take advantage of eyepiece observing on our 16-inch and 12-inch telescopes as well as of the classroom, library, and projection system. These resources allow us to organize a variety of astronomy related activities that are engaging for individuals of all ages: accessible student talks, current film screenings and even arts and crafts for the families who attend with young children. These events aim to spark curiosity in others about scientific discovery and about the remarkable nature of the world in which we live. In addition to exciting local families about astronomy, this program has excited Haverford students from a range of disciplines about both science and education. Being entirely student led means that we are able to take the initiative in planning, coordinating and running all events, fostering an atmosphere of collaboration, experimentation and commitment amongst our volunteers. Additionally, this program is one of the few at Haverford that regularly reaches beyond the campus walls to promote and build relationships with the outside community. In light of this, our program presents a distinctive and enlightening opportunity for student volunteers: we get to use our scientific backgrounds to educate a general audience, while also learning from them about how to communicate and inspire in others the excitement we feel about the subject of astronomy. The work on this project has been supported by NSF AST-1151462.

  1. UX-15 Reaches LEP

    CERN Multimedia

    2001-01-01

    The creation of the world's largest sandstone cavern, not a small feat! At the bottom, cave-in preventing steel mesh can be seen clinging to the top of the tunnel. The digging of UX-15, the cavern that will house ATLAS, reached the upper ceiling of LEP on October 10th. The breakthrough which took place nearly 100 metres underground occurred precisely on schedule and exactly as planned. But much caution was taken beforehand to make the LEP breakthrough clean and safe. To prevent the possibility of cave-ins in the side tunnels that will eventually be attached to the completed UX-15 cavern, reinforcing steel mesh was fixed into the walls with bolts. Obviously no people were allowed in the LEP tunnels below UX-15 as the breakthrough occurred. The area was completely evacuated and fences were put into place to keep all personnel out. However, while personnel were being kept out of the tunnels below, this has been anything but the case for the work taking place up above. With the creation of the world's largest...

  2. GAP-REACH

    Science.gov (United States)

    Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

    2015-01-01

    Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

  3. Pneumatic osteoarthritis knee brace.

    Science.gov (United States)

    Stamenović, Dimitrije; Kojić, Milos; Stojanović, Boban; Hunter, David

    2009-04-01

    Knee osteoarthritis is a chronic disease that necessitates long term therapeutic intervention. Biomechanical studies have demonstrated an improvement in the external adduction moment with application of a valgus knee brace. Despite being both efficacious and safe, due to their rigid frame and bulkiness, current designs of knee braces create discomfort and difficulties to patients during prolonged periods of application. Here we propose a novel design of a light osteoarthritis knee brace, which is made of soft conforming materials. Our design relies on a pneumatic leverage system, which, when pressurized, reduces the excessive loads predominantly affecting the medial compartment of the knee and eventually reverses the malalignment. Using a finite-element analysis, we show that with a moderate level of applied pressure, this pneumatic brace can, in theory, counterbalance a greater fraction of external adduction moment than the currently existing braces.

  4. Musculoskeletal MR: knee

    Energy Technology Data Exchange (ETDEWEB)

    Staebler, A.; Glaser, C.; Reiser, M. [Dept. of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilian Universitaet Muenchen (Germany)

    2000-02-01

    Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage. (orig.)

  5. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise......, and - at least in the younger patients - more cementless implants. Trends related to organization are implementation of the fast track concept, which has reduced morbidity and length of stay, and concentration in larger units, which will also decrease morbidity and mortality. An annual volume of >25 TKAs per...

  6. riences from REACH Trust, Malawi

    African Journals Online (AJOL)

    Drawing on the experiences of REACH Trust, this paper highlights practical lessons of using research processes and outcomes to promote equity in health policy and practice. The REACH '11'ust is first introduced. Case studies are then used to highlight how REACH Trust has worked in a par- ticipatory manner with key ...

  7. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty.

    Science.gov (United States)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

    2010-11-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA). Prospective, descriptive, hypothesis-generating study. A fast-track orthopedic arthroplasty unit at a university hospital. Patients (N=24; mean age, 66y; 13 women) scheduled for primary unilateral TKA were investigated 1 week before surgery and on the day of hospital discharge 2.4 days postsurgery. Not applicable. We assessed all patients for knee-joint circumference, knee-extension strength, and functional performance using the Timed Up & Go, 30-second Chair Stand, and 10-m fast speed walking tests, together with knee pain during all active test procedures. All investigated variables changed significantly from pre- to postsurgery independent of knee pain. Importantly, knee circumference increased (knee swelling) and correlated significantly with the decrease in knee-extension strength (r=-.51; P=.01). Reduced fast-speed walking correlated significantly with decreased knee-extension strength (r=.59; P=.003) and decreased knee flexion (r=.52; P=.011). Multiple linear regression showed that knee swelling (P=.023), adjusted for age and sex, could explain 27% of the decrease in knee-extension strength. Another model showed that changes in knee-extension strength (P=.009) and knee flexion (P=.018) were associated independently with decreased performance in fast-speed walking, explaining 57% of the variation in fast-speed walking. Our results indicate that the well-known finding of decreased knee-extension strength, which decreases functional performance shortly after TKA, is caused in part by postoperative knee swelling. Future studies may look at specific interventions aimed at decreasing knee swelling postsurgery to preserve knee-extension strength and facilitate physical rehabilitation after TKA. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Runners knee (image)

    Science.gov (United States)

    ... forces on the knee, such as a misaligned patella. Chondromalacia is treated with rest or immobilization and nonsteroidal anti-inflammatory drugs for pain. Physical therapy, especially ... alignment of the patella that cannot be corrected with therapy.

  9. Knee MRI scan

    Science.gov (United States)

    ... pain that does not get better with treatment Instability of the knee You may also have this ... Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  10. Knee arthroscopy - discharge

    Science.gov (United States)

    ... your leg propped up on 1 or 2 pillows. Place the pillows under your foot or calf muscle. This helps ... Getting your home ready - knee or hip surgery Surgical wound care - open Review Date 11/27/2016 ...

  11. The relationship between knee joint angle and knee flexor and extensor muscle strength.

    Science.gov (United States)

    Ha, Misook; Han, Dongwook

    2017-04-01

    [Purpose] The aim of this study was to determine a relationship between joint angle and muscular strength. In particular, this research investigated the differences in maximum muscular strength and average muscular strength at the knee-joint posture. [Subjects and Methods] The study subjects comprised eight female students in their 20s attending S University in Busan. None of the subjects had functional disabilities or had experienced damage to the lower extremities in terms of measurement of muscular strength. A BIODEX system III model (Biodex medical system, USA) was used to measure joint angles and muscular strength. The axis of the dynamometer was consistent with the axis of motion, and measurements were made at 25° and 67° to examine differences in maximum muscular strength according to joint angle. [Results] The maximum muscular strength both knee-joint extension value, at 67° and flexion value, at 25° the value was larger. The average muscular strength both knee-joint extension value, at 67° and flexion value, at 25° the value was larger. [Conclusion] The results of this study reveal that muscular strength does not reach maximum at particular range angles, such as the knee-joint resting posture angle or the knee-joint middle range angle. Rather, a stretched muscle is stronger than a contracted muscle. Therefore, it is considered that it will be necessary to study the effects of the joint change ratio on muscular strength on the basis of the maximum stretched muscle.

  12. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders

    1998-01-01

    STUDY OBJECTIVE: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation. MEASUREMENTS: 339 athletes gave information about occupation, sports activity and different features of knee pain, based...... on a self-filled questionnaire. MAIN RESULTS: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging...... 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...

  13. Taking care of your new knee joint

    Science.gov (United States)

    Knee arthroplasty - precautions; Knee replacement - precautions ... After you have knee replacement surgery , you will need to be careful about how you move your knee, especially for the first few ...

  14. 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.

  15. Obesity, knee osteoarthritis and knee arthroplasty: a review

    OpenAIRE

    Salih, Saif; Sutton, Paul

    2013-01-01

    The incidence of obesity is rising worldwide. Obesity is a risk factor for developing osteoarthritis in the knee. Obesity and knee osteoarthritis are independently disabling conditions and in combination pose difficult therapeutic challenges. This review will discuss obesity, osteoarthritis, and the problems associated with knee osteoarthritis in an obese population. Treatment options including surgery and its success will be discussed.

  16. How to quantify knee function after total knee arthroplasty?

    NARCIS (Netherlands)

    Boonstra, M.C.; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2008-01-01

    Total knee arthroplasty (TKA) is being undertaken in a younger population than before and as a result the functional demands on the knee are likely to be increasing. As a consequence, it is important to define quantitative functional knee tests that can monitor any increase. A valuable functional

  17. Restorative Effect of Vitamin D Deficiency on Knee Pain and Quadriceps Muscle Strength in Knee Osteoarthritis.

    Science.gov (United States)

    Heidari, Behzad; Javadian, Yahya; Babaei, Mansour; Yousef-Ghahari, Behnaz

    2015-08-01

    Both vitamin D deficiency and quadriceps muscle weakness are associated with knee osteoarthritis (KOA) and pain. The aim of this study was to determine the restorative effect of vitamin D deficiency on pain and quadriceps muscle strength in knee osteoarthritis. Patients with KOA aged ≥30 years, the presence of knee pain for at least one month or longer and serum 25-hydroxyvitamin (25-OHD) deficiencies were recruited in the study. Participants with KOA compatible with Kellgren-Lawrence grade 4, joint instability, and effusion, history of surgery or inflammatory arthropathies were excluded. Serum 25-OHD was assessed by ELISA method and concentrationsmuscle strength was measured by dynamometry method and intensity of knee pain by Western Ontario and McMaster University Osteoarthritis index scored by Likert scale and visual analog scale. All participants received 50.000 IU oral cholecalciferol weekly for at least two months. The influence of raising serum 25-OHD on quadriceps muscle strength and pain was assessed by calculation of mean changes from baseline at the end of the treatment period using paired t-test. A total of 67 patients with mean age of 50±6.6 years of age were treated for 2 months. Serum 25-OHD reached to sufficient levels in all except one patient. At the end of the study period, serum 25-OHD and quadriceps muscle strength increased significantly as compared with baseline (P=0.007 and P=0.002, respectively), whereas knee pain decreased significantly based on Western Ontario and McMaster University Osteoarthritis index (P=0.001)as well as visual analogue scale scores (P=0.001). These findings indicated that correction of vitamin D deficiency in patients with KOA exerts a significant favorable effect on quadriceps muscle strength and knee pain.

  18. RECORDS REACHING RECORDING DATA TECHNOLOGIES

    OpenAIRE

    G. W. L. Gresik; S. Siebe; R. Drewello

    2013-01-01

    The goal of RECORDS (Reaching Recording Data Technologies) is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence...

  19. Association between serum vitamin D deficiency and knee osteoarthritis.

    Science.gov (United States)

    Heidari, Behzad; Heidari, Parham; Hajian-Tilaki, Karaim

    2011-11-01

    Insufficient levels of serum 25-hydroxyvitamin D (25-OHD) influence the knee joint cartilage and lead to development and progression of knee osteoarthritis (OA). The purpose of this study was to determine the status of serum 25-OHD levels in patients with knee OA compared with controls. A total of 148 patients with knee OA and 150 controls were studied. Serum 25-OHD was measured by the ELISA method and concentrations deficient levels. Mann-Whitney U test was used for comparisons of means and logistic regression analysis with calculation of odds ratio (OR) was applied to determine association. The mean ages of patients and controls were 60.2 ± 12.9 and 60.1 ± 10.2 years, respectively (P = 0.23). In the entire population the mean serum 25-OHD in OA patients was not significantly lower than controls (P = 0.28), but in subgroup analysis the mean 25-OHD in OA patients aged deficiency which remained significant after adjusting for age and sex (adjusted OR = 2.26, 95% CI 1.15-4.4, P = 0.018). A greater association was observed in patients aged deficiency in patients aged ≥60 years did not reach a significant level. These findings indicate a significant association between serum 25-OHD deficiency and knee OA in patients aged < 60 years and suggest serum 25-OHD measurement in any patient with symptoms suggestive of knee OA particularly at the initial stage of disease.

  20. Arthroscopic surgery for degenerative knee

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, C B; Roos, E M

    2015-01-01

    OBJECTIVE: To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURES: Pain and physical function....... RESULTS: The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

  1. Osteoarthritis of the Knee

    Directory of Open Access Journals (Sweden)

    Jun Iwamoto

    2011-01-01

    Full Text Available The objective of the present study was to identify factors correlated with the serum leptin concentration in women with knee OA. Fifty postmenopausal Japanese women with knee OA (age: 50–88 years were recruited in our outpatient clinic. Plain radiographs of the knee were taken, and urine and blood samples were collected. Dual-energy X-ray absorptiometry (DXA scanning was performed for the whole body and lumbar spine, and factors correlated with the serum leptin concentration were identified. A simple linear regression analysis showed that body weight, body mass index, whole-body bone mineral density (BMD, total fat mass, and total fat percentage, but not age, height, lumbar spine BMD, lean body mass, serum and urinary bone turnover markers, or the radiographic grade of knee OA, were significantly correlated with the serum leptin concentration. A multiple regression analysis showed that among these factors, only body weight and total fat mass exhibited a significant positive correlation with the serum leptin concentration. These results suggest that the serum leptin concentration might be related to increases in body weight and total fat mass, but not to BMD or bone turnover markers, in postmenopausal women with OA.

  2. Knee Osteoarthritis: A Primer

    Science.gov (United States)

    Lespasio, Michelle J; Piuzzi, Nicolas S; Husni, M Elaine; Muschler, George F; Guarino, AJ; Mont, Michael A

    2017-01-01

    The purpose of this article is to provide a synopsis of the current medical understanding of knee osteoarthritis. We describe the prevalence, causes and associated risk factors, symptoms, diagnosis and classification, and treatment options. A quiz serves to assist readers in their understanding of the presented material. PMID:29035179

  3. Knee CT scan

    Science.gov (United States)

    ... be used to detect: Abscess or infection Broken bone Examine fractures and pattern of fractures The cause of pain or other problems in the knee joint (usually when MRI can't be done) Masses and tumors, including cancer Healing problems or scar tissue following ...

  4. Alterations in walking knee joint stiffness in individuals with knee osteoarthritis and self-reported knee instability.

    Science.gov (United States)

    Gustafson, Jonathan A; Gorman, Shannon; Fitzgerald, G Kelley; Farrokhi, Shawn

    2016-01-01

    Increased walking knee joint stiffness has been reported in patients with knee osteoarthritis (OA) as a compensatory strategy to improve knee joint stability. However, presence of episodic self-reported knee instability in a large subgroup of patients with knee OA may be a sign of inadequate walking knee joint stiffness. The objective of this work was to evaluate the differences in walking knee joint stiffness in patients with knee OA with and without self-reported instability and examine the relationship between walking knee joint stiffness with quadriceps strength, knee joint laxity, and varus knee malalignment. Overground biomechanical data at a self-selected gait velocity was collected for 35 individuals with knee OA without self-reported instability (stable group) and 17 individuals with knee OA and episodic self-reported instability (unstable group). Knee joint stiffness was calculated during the weight-acceptance phase of gait as the change in the external knee joint moment divided by the change in the knee flexion angle. The unstable group walked with lower knee joint stiffness (p=0.01), mainly due to smaller heel-contact knee flexion angles (pknee flexion excursions (pknee stable counterparts. No significant relationships were observed between walking knee joint stiffness and quadriceps strength, knee joint laxity or varus knee malalignment. Reduced walking knee joint stiffness appears to be associated with episodic knee instability and independent of quadriceps muscle weakness, knee joint laxity or varus malalignment. Further investigations of the temporal relationship between self-reported knee joint instability and walking knee joint stiffness are warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. The effect of extension constraint knee bracing on dynamic balance, gait mechanics, and joint alignment.

    Science.gov (United States)

    Butler, Robert J; Queen, Robin M; Wilson, Becky; Stephenson, John; Barnes, C Lowry

    2014-04-01

    To examine how an extension constraint knee brace affects active and passive standing knee joint alignment, dynamic balance, and gait mechanics. Repeated-measures, within-subjects design. Research laboratory. Persons (N = 24) with no current diagnosed gait dysfunction or neuromuscular limitations that limit activities of daily living. All subjects were tested with use of dynamic balance and gait analysis. Dynamic balance was examined with the Lower Quarter Y Balance Test. Gait analysis was conducted at a freely chosen walking speed for 2 conditions: (1) use of a brace with free range of motion (FROM) and (2) use of a brace with 30-degree extension constraint (ECON). In a subset of subjects, radiographs were used to examine standing knee alignment for 3 conditions: (1) FROM, (2) use of a knee ECON brace in a relaxed position; and (3) use of a knee ECON brace with maximal volitional quadriceps contraction. Peak knee flexion, knee flexion range of motion, peak vertical ground reaction force during weight acceptance and propulsion, and maximum reach distance in the anterior, posteromedial, and posterolateral directions were measured. Differences in dynamic balance were observed between ECON and FROM for the anterior reach. Peak knee flexion increased 3.2° and peak knee extension decreased 7.4° in the ECON condition. Vertical GRF values were found to increase bilaterally during ECON at midstance but decreased bilaterally during propulsion. Radiographic images revealed that the ECON elicited a 22.2° flexion contracture with minimal quadriceps activation but only reduced motion by 4.8° with maximal volitional quadriceps activation. Extension constraint knee braces alter joint alignment, dynamic balance, knee mechanics during gait, and vertical loading during gait. However, the changes in motion observed were lower than those induced by the constraining mechanism. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc

  6. [Anatomic incidence of meniscochondrocalcinosis of the knee].

    Science.gov (United States)

    Mitrovic, D; Stankovic, A; Morin, J; Borda-Iriarte, O; Uzan, M; Quintero, M; Memin, Y; Bard, M; de Sèze, S; Richewaert, A

    1982-06-01

    The authors have studied the incidence of menisco-calcinosis (MC) and that of menisco-chondrocalcinosis (MCC) of knee joints of 108 non selected cadavera. The mean age of the subjects was 71.8 +/- 13.8 years. The study was performed by radiographic examination of the menisci and cartilagineous fragments of femoral condyles using high contrast films. The incidence of MC or MCC was found to be 18.5 per cent. It was slightly higher in females (21.5 p. cent) than in males (15.8 p. cent) subjects but this difference failed to reach the level of statistical significance. No positive case was detected before the age of 60 years. For the age groups of: 60-69, 70-79, 80-89 and over 90 years, its incidence was: 11.7; 26.9; 21.2 and 50 (4 subjects out of 8) per cent respectively. Approximately 40 per cent of all positive cases had meniscocalcinosis without associated chondrocalcinosis. No single case of chondrocalcinosis without meniscocalcinosis was observed. Six out of 8 cases with MC calcinosis and 2 out of 12 cases with MCC were unilateral. The external menisci were more frequently and more heavily affected than internal ones. Eighty per cent of the knees affected by either MC or MCC were at the same time associated to an osteoarthrotic lesion compared to 35 p. cent of the knees without MC or MCC matched for age: a result which appeared to be highly significant difference.

  7. Knee surgery and its evidence base.

    Science.gov (United States)

    Sharma, A; Hasan, K; Carter, A; Zaidi, R; Cro, S; Briggs, T; Goldberg, A

    2016-03-01

    Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.

  8. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be implanted...

  9. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made of...

  10. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral (hemi-knee...

  11. Does knee awareness differ between different knee arthroplasty prostheses?

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas

    2016-01-01

    BACKGROUND: Low knee awareness after Total Knee Arthroplasty (TKA) has become the ultimate goal in trying to achieve a natural feeling knee that meet patient expectations. To accommodate this manufacturers of TKAs have developed new prosthetic designs that potentially could give patients a more...... natural feeling knee during activities. The purpose af this study was to compare the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) of patients treated with a previous generation standard Cruciate Retaining (CR) TKA to the scores obtained by patients treated with a newer generation CR TKA...... and pre- and postoperative knee alignment. Patients were asked to complete the FJS and OKS questionnaires. Of the 316 patients completing the survey 64 standard CR TKAs to 35 new generation CR TKAs and 121 standard CR TKAs to 68 mobile bearing TKAs were matched. The FJS and OKS scores of the three TKA...

  12. Reaching with the sixth sense

    DEFF Research Database (Denmark)

    Reichenbach, Alexandra; Bresciani, Jean-Pierre; Bulthoff, Heinrich H.

    2016-01-01

    involvement. Here, we demonstrate for the first time with event-related TMS that the posterior part of the right medial intraparietal sulcus processes vestibular signals during a goal-directed reaching task with the dominant right hand. This finding suggests a qualitative difference between the processing......, and opens a window into their investigation in humans. (C) 2015 The Authors. Published by Elsevier Inc....

  13. Hyperextended Knee: Cause of Serious Injury?

    Science.gov (United States)

    ... Cause of serious injury? My daughter hyperextended her knee yesterday at school. Can this injury be serious? ... from Edward R. Laskowski, M.D. A hyperextended knee occurs when the knee is bent backward, often ...

  14. Treatment of knee osteoarthritis.

    Science.gov (United States)

    Ringdahl, Erika; Pandit, Sandesh

    2011-06-01

    Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.

  15. Total Knee Replacement

    Science.gov (United States)

    2005-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness, in terms of pain reduction and functional improvement, and costing of total knee replacement (TKR) for people with osteoarthritis for whom less invasive treatments (such as physiotherapy, analgesics, anti-inflammatory drugs, intra-articular steroids, hyaluronic acids, and arthroscopic surgery) have failed. Clinical Need Osteoarthritis affects an estimated 10% to 12% of Canadian adults. The therapeutic goals of osteoarthritis treatment are to improve joint mobility and reduce pain. Stepwise treatment options include exercise, weight loss, physiotherapy, analgesics, anti-inflammatory drugs, intra-articular steroids and hyaluronic acids, arthroscopic surgery, and, in severe cases, total joint replacement with follow-up rehabilitation. These treatments are delivered by a range of health care professionals, including physiotherapists, occupational therapists, family physicians, internists, rheumatologists, and orthopedic surgeons. TKR is an end-of-line treatment for patients with severe pain and functional limitations. More women than men undergo knee replacement, and most patients are between 55 and 84 years old. The Technology TKR is a surgical procedure in which an artificial joint or prosthesis replaces a damaged knee joint. The primary indication for TKR is pain, followed by functional limitation. Usually, a person’s daily activities must be substantially affected by pain and functional limitations for him or her to be considered a candidate for TKR. There are 3 different types of knee replacement prostheses. Non-constrained prostheses use the patient’s ligaments and muscles to provide the stability for the prosthesis. Semi-constrained prostheses provide some stability for the knee and do not rely entirely on the patient’s ligaments and muscles to provide the stability. Constrained prostheses are for patients whose ligaments and muscles are not able to provide stability for

  16. Knee Dislocations in Sports Injuries

    Science.gov (United States)

    Pardiwala, Dinshaw N; Rao, Nandan N; Anand, Karthik; Raut, Alhad

    2017-01-01

    Knee dislocations are devastating when they occur on the athletic field or secondary to motor sports. The complexity of presentation and spectrum of treatment options makes these injuries unique and extremely challenging to even the most experienced knee surgeons. An astute appreciation of the treatment algorithm is essential to plan individualized management since no two complex knee dislocations are ever the same. Moreover, attention to detail and finesse of surgical technique are required to obtain a good functional result and ensure return to play. Over the past 10 years, our service has treated 43 competitive sportsmen with knee dislocations, and this experience forms the basis for this narrative review. PMID:28966379

  17. Records Reaching Recording Data Technologies

    Science.gov (United States)

    Gresik, G. W. L.; Siebe, S.; Drewello, R.

    2013-07-01

    The goal of RECORDS (Reaching Recording Data Technologies) is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  18. RECORDS REACHING RECORDING DATA TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    G. W. L. Gresik

    2013-07-01

    Full Text Available The goal of RECORDS (Reaching Recording Data Technologies is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  19. Recruitment of knee joint ligaments

    NARCIS (Netherlands)

    Blankevoort, L.; Huiskes, R.; de Lange, A.

    1991-01-01

    On the basis of earlier reported data on the in vitro kinematics of passive knee-joint motions of four knee specimens, the length changes of ligament fiber bundles were determined by using the points of insertion on the tibia and femur. The kinematic data and the insertions of the ligaments were

  20. Osteotomy for treating knee osteoarthritis

    NARCIS (Netherlands)

    R.W. Brouwer (Reinoud); T.M. van Raaij (Tom); S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne); T.S. Jakma (Tijs); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractBackground: Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies

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

    Science.gov (United States)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

    2012-08-01

    To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty. A prospective, single-blinded, randomized, cross-over study. A fast-track orthopaedic arthroplasty unit at a university hospital. Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty. 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 minutes of elbow icing (control treatment). The order of treatments was randomized. Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments by an assessor blinded for active or control treatment. The change in knee extension strength associated with knee icing was not significantly different from that of elbow icing (knee icing change (mean (1 SD)) -0.01 (0.07) Nm/kg, elbow icing change -0.02 (0.07) Nm/kg, P = 0.493). Likewise, the changes 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. In contrast to observations in experimental knee effusion models and inflamed knee joints, knee joint icing for 30 minutes shortly after total knee arthroplasty had no acute effect on knee extension strength or knee pain.

  2. Anterior knee pain.

    Science.gov (United States)

    LLopis, Eva; Padrón, Mario

    2007-04-01

    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.

  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. Physical performance and knee osteoarthritis among community-dwelling women in Japan: the Hizen-Oshima Study, cross-sectional study.

    Science.gov (United States)

    Osaki, Makoto; Tomita, Masato; Abe, Yasuyo; Ye, Zhaojia; Honda, Sumihisa; Yoshida, Shoji; Shindo, Hiroyuki; Aoyagi, Kiyoshi

    2012-08-01

    Osteoarthritis (OA) is the most common chronic joint disorder. Relationships between knee OA and physical performance have been examined, but mainly in patients with knee OA. Clarifying the relationship between knee OA and physical performance among community-dwelling individuals is thus important. Subjects comprised 563 community-dwelling Japanese women. Radiographic knee OA was defined as Kellgren-Lawrence criteria grade 2 or higher. Painful knee OA was defined as radiographic OA combined with knee pain. We evaluated performance-based measures of physical functioning. Student's t tests were used to compare continuous variables. Adjusted means of performance-based measures were compared between groups using general linear modeling methods. Mean age was 64.3 years. Women with radiographic OA were older than those without OA (P women with radiographic OA than in women without OA (P women with radiographic OA displayed worse physical functioning than women without OA, with longer chair stand time, longer walking time, and shorter functional reach. Performance-based measurements with painful OA resembled those with radiographic OA. Age- and BMI-adjusted means of chair stand time and walking time were longer in women with radiographic or painful knee OA than in women without OA (P women with painful knee OA than for women with radiographic knee OA. Women with knee OA showed deteriorated performance of chair stand and walking. Painful knee OA was associated with poorer performance than radiographic knee OA.

  5. Knees Lifted High

    Centers for Disease Control (CDC) Podcasts

    2008-08-04

    The Eagle Books are a series of four books that are brought to life by wise animal characters - Mr. Eagle, Miss Rabbit, and Coyote - who engage Rain That Dances and his young friends in the joy of physical activity, eating healthy foods, and learning from their elders about health and diabetes prevention. Knees Lifted High gives children fun ideas for active outdoor play.  Created: 8/4/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/5/2008.

  6. Stroke rehabilitation reaches a threshold.

    Directory of Open Access Journals (Sweden)

    Cheol E Han

    2008-08-01

    Full Text Available Motor training with the upper limb affected by stroke partially reverses the loss of cortical representation after lesion and has been proposed to increase spontaneous arm use. Moreover, repeated attempts to use the affected hand in daily activities create a form of practice that can potentially lead to further improvement in motor performance. We thus hypothesized that if motor retraining after stroke increases spontaneous arm use sufficiently, then the patient will enter a virtuous circle in which spontaneous arm use and motor performance reinforce each other. In contrast, if the dose of therapy is not sufficient to bring spontaneous use above threshold, then performance will not increase and the patient will further develop compensatory strategies with the less affected hand. To refine this hypothesis, we developed a computational model of bilateral hand use in arm reaching to study the interactions between adaptive decision making and motor relearning after motor cortex lesion. The model contains a left and a right motor cortex, each controlling the opposite arm, and a single action choice module. The action choice module learns, via reinforcement learning, the value of using each arm for reaching in specific directions. Each motor cortex uses a neural population code to specify the initial direction along which the contralateral hand moves towards a target. The motor cortex learns to minimize directional errors and to maximize neuronal activity for each movement. The derived learning rule accounts for the reversal of the loss of cortical representation after rehabilitation and the increase of this loss after stroke with insufficient rehabilitation. Further, our model exhibits nonlinear and bistable behavior: if natural recovery, motor training, or both, brings performance above a certain threshold, then training can be stopped, as the repeated spontaneous arm use provides a form of motor learning that further bootstraps performance and

  7. Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

    DEFF Research Database (Denmark)

    Clausen, M B; Tang, L; Zebis, M K

    2015-01-01

    Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study...... was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS...... questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (

  8. Anterior cruciate ligament fatigue failures in knees subjected to repeated simulated pivot landings.

    Science.gov (United States)

    Lipps, David B; Wojtys, Edward M; Ashton-Miller, James A

    2013-05-01

    It is not known whether the human anterior cruciate ligament (ACL) is susceptible to fatigue failure as a result of repetitive loading or whether certain knee morphologic characteristics increase that risk. The number of knee loading cycles required to fail an ACL by fatigue failure is unaffected by the magnitude of the external load delivered to the knee joint. Furthermore, sex, ACL cross-sectional area, and lateral tibial slope will not affect the number of loading cycles to ACL failure. Controlled laboratory study. Knee pairs from 10 cadaveric donors (5 female) of similar age, height, and weight were imaged with 3-T magnetic resonance imaging to measure lateral tibial slope and ACL cross-sectional area. One knee from each pair was then subjected to repeated application of a load of 3 times body weight (3*BW), while the other knee was subjected to a 4*BW load, both involving impulsive compression force, knee flexion moment, and internal tibial torque combined with realistic trans-knee muscle forces. The resulting 3-dimensional tibiofemoral kinematics and kinetics were recorded, along with ACL relative strain and quadriceps, hamstring, and gastrocnemius muscle forces. The loading cycle was repeated until the ACL ruptured, a 3-mm increase in cumulative anterior tibial translation occurred, or a minimum of 50 trials was reached. Eight of 10 knees failed under the 4*BW load (mean ± SD cycles to failure, 21 ± 18), while 5 of 10 knees failed under the 3*BW load (mean ± SD cycles to failure, 52 ± 10). Four knees exhibited a 3-mm increase in anterior tibial translation, 7 knees developed partial or complete visible ACL tears, and 2 knees developed complete ACL tibial avulsions. A Cox regression showed that the number of cycles to ACL failure was influenced by the simulated landing force (P = .012) and ACL cross-sectional area (P = .022). Donor sex and lateral tibial slope did not influence the number of cycles to ACL failure. The human ACL is susceptible to fatigue

  9. Mechanics of the knee. A study of joint and muscle load with clinical applications.

    Science.gov (United States)

    Nisell, R

    1985-01-01

    The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m - 1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early

  10. 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 knee extension and flexion at all angular velocities. The reduction in muscle strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension...

  11. 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.......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...... minutes of elbow icing (control treatment). The order of treatments was randomized.Main outcome measures: Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments...

  12. Restorative Effect of Vitamin D Deficiency on Knee Pain and Quadriceps Muscle Strength in Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Behzad Heidari

    2015-10-01

    Full Text Available Both vitamin D deficiency and quadriceps muscle weakness are associated with kneeosteoarthritis (KOA and pain. The aim of this study was to determine the restorative effect of vitamin Ddeficiency on pain and quadriceps muscle strength in knee osteoarthritis. Patients with KOA aged≥30years, the presence of knee pain for at least one month or longer and serum 25-hydroxyvitamin (25-OHDdeficiencies were recruited in the study. Participants with KOA compatible with Kellgren-Lawrence grade4, joint instability, and effusion, history of surgery or inflammatory arthropathies were excluded. Serum25-OHD was assessed by ELISA method and concentrationsQuadriceps muscle strength was measured by dynamometry method and intensity of knee pain by WesternOntario and McMaster University Osteoarthritis index scored by Likert scale and visual analog scale. Allparticipants received 50.000 IU oral cholecalciferol weekly for at least two months. The influence ofraising serum 25-OHD on quadriceps muscle strength and pain was assessed by calculation of meanchanges from baseline at the end of the treatment period using paired t-test. A total of 67 patients withmean age of 50±6.6 years of age were treated for 2 months. Serum 25-OHD reached to sufficient levels inall except one patient. At the end of the study period, serum 25-OHD and quadriceps muscle strengthincreased significantly as compared with baseline (P=0.007 and P=0.002, respectively, whereas knee paindecreased significantly based on Western Ontario and McMaster University Osteoarthritis index (P=0.001as well as visual analogue scale scores (P=0.001.These findings indicated that correction of vitamin Ddeficiency in patients with KOA exerts a significant favorable effect on quadriceps muscle strength andknee pain.

  13. New Generation Lockable Knee Brace

    Science.gov (United States)

    2000-01-01

    A knee brace that uses Space Shuttle propulsion technology has moved a step closer to being available to help knee injury and stroke patients and may possibly benefit patients with birth defects, spinal cord injuries, and post-polio conditions. After years of hard work, inventors at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama, have turned over the final design and prototype to industry partners at Horton's Orthotic Lab in Little Rock, Arkansas for further clinical testing. The device, called the Selectively Lockable Knee Brace, may mean faster, less painful rehabilitation for patients by allowing the knee to move when weight is not on the heel. Devices currently on the market lock the knee in a rigid, straight-leg position, or allow continuous free motion. The knee brace is just one example of how space technology is being used to improve the lives of people on Earth. NASA's MSFC inventors Michael Shadoan and Neill Myers are space propulsion engineers who use the same mechanisms and materials to build systems for rockets that they used to design and develop the knee brace.

  14. Standardized Loads Acting in Knee Implants

    Science.gov (United States)

    Bergmann, Georg; Bender, Alwina; Graichen, Friedmar; Dymke, Jörn; Rohlmann, Antonius; Trepczynski, Adam; Heller, Markus O.; Kutzner, Ines

    2014-01-01

    The loads acting in knee joints must be known for improving joint replacement, surgical procedures, physiotherapy, biomechanical computer simulations, and to advise patients with osteoarthritis or fractures about what activities to avoid. Such data would also allow verification of test standards for knee implants. This work analyzes data from 8 subjects with instrumented knee implants, which allowed measuring the contact forces and moments acting in the joint. The implants were powered inductively and the loads transmitted at radio frequency. The time courses of forces and moments during walking, stair climbing, and 6 more activities were averaged for subjects with I) average body weight and average load levels and II) high body weight and high load levels. During all investigated activities except jogging, the high force levels reached 3,372–4,218N. During slow jogging, they were up to 5,165N. The peak torque around the implant stem during walking was 10.5 Nm, which was higher than during all other activities including jogging. The transverse forces and the moments varied greatly between the subjects, especially during non-cyclic activities. The high load levels measured were mostly above those defined in the wear test ISO 14243. The loads defined in the ISO test standard should be adapted to the levels reported here. The new data will allow realistic investigations and improvements of joint replacement, surgical procedures for tendon repair, treatment of fractures, and others. Computer models of the load conditions in the lower extremities will become more realistic if the new data is used as a gold standard. However, due to the extreme individual variations of some load components, even the reported average load profiles can most likely not explain every failure of an implant or a surgical procedure. PMID:24465856

  15. Standardized loads acting in knee implants.

    Directory of Open Access Journals (Sweden)

    Georg Bergmann

    Full Text Available The loads acting in knee joints must be known for improving joint replacement, surgical procedures, physiotherapy, biomechanical computer simulations, and to advise patients with osteoarthritis or fractures about what activities to avoid. Such data would also allow verification of test standards for knee implants. This work analyzes data from 8 subjects with instrumented knee implants, which allowed measuring the contact forces and moments acting in the joint. The implants were powered inductively and the loads transmitted at radio frequency. The time courses of forces and moments during walking, stair climbing, and 6 more activities were averaged for subjects with I average body weight and average load levels and II high body weight and high load levels. During all investigated activities except jogging, the high force levels reached 3,372-4,218N. During slow jogging, they were up to 5,165N. The peak torque around the implant stem during walking was 10.5 Nm, which was higher than during all other activities including jogging. The transverse forces and the moments varied greatly between the subjects, especially during non-cyclic activities. The high load levels measured were mostly above those defined in the wear test ISO 14243. The loads defined in the ISO test standard should be adapted to the levels reported here. The new data will allow realistic investigations and improvements of joint replacement, surgical procedures for tendon repair, treatment of fractures, and others. Computer models of the load conditions in the lower extremities will become more realistic if the new data is used as a gold standard. However, due to the extreme individual variations of some load components, even the reported average load profiles can most likely not explain every failure of an implant or a surgical procedure.

  16. Hierarchical imaging of the human knee

    Science.gov (United States)

    Schulz, Georg; Götz, Christian; Deyhle, Hans; Müller-Gerbl, Magdalena; Zanette, Irene; Zdora, Marie-Christine; Khimchenko, Anna; Thalmann, Peter; Rack, Alexander; Müller, Bert

    2016-10-01

    Among the clinically relevant imaging techniques, computed tomography (CT) reaches the best spatial resolution. Sub-millimeter voxel sizes are regularly obtained. For investigations on true micrometer level lab-based μCT has become gold standard. The aim of the present study is the hierarchical investigation of a human knee post mortem using hard X-ray μCT. After the visualization of the entire knee using a clinical CT with a spatial resolution on the sub-millimeter range, a hierarchical imaging study was performed using a laboratory μCT system nanotom m. Due to the size of the whole knee the pixel length could not be reduced below 65 μm. These first two data sets were directly compared after a rigid registration using a cross-correlation algorithm. The μCT data set allowed an investigation of the trabecular structures of the bones. The further reduction of the pixel length down to 25 μm could be achieved by removing the skin and soft tissues and measuring the tibia and the femur separately. True micrometer resolution could be achieved after extracting cylinders of several millimeters diameters from the two bones. The high resolution scans revealed the mineralized cartilage zone including the tide mark line as well as individual calcified chondrocytes. The visualization of soft tissues including cartilage, was arranged by X-ray grating interferometry (XGI) at ESRF and Diamond Light Source. Whereas the high-energy measurements at ESRF allowed the simultaneous visualization of soft and hard tissues, the low-energy results from Diamond Light Source made individual chondrocytes within the cartilage visual.

  17. Metasurface holograms reaching 80% efficiency.

    Science.gov (United States)

    Zheng, Guoxing; Mühlenbernd, Holger; Kenney, Mitchell; Li, Guixin; Zentgraf, Thomas; Zhang, Shuang

    2015-04-01

    Surfaces covered by ultrathin plasmonic structures--so-called metasurfaces--have recently been shown to be capable of completely controlling the phase of light, representing a new paradigm for the design of innovative optical elements such as ultrathin flat lenses, directional couplers for surface plasmon polaritons and wave plate vortex beam generation. Among the various types of metasurfaces, geometric metasurfaces, which consist of an array of plasmonic nanorods with spatially varying orientations, have shown superior phase control due to the geometric nature of their phase profile. Metasurfaces have recently been used to make computer-generated holograms, but the hologram efficiency remained too low at visible wavelengths for practical purposes. Here, we report the design and realization of a geometric metasurface hologram reaching diffraction efficiencies of 80% at 825 nm and a broad bandwidth between 630 nm and 1,050 nm. The 16-level-phase computer-generated hologram demonstrated here combines the advantages of a geometric metasurface for the superior control of the phase profile and of reflectarrays for achieving high polarization conversion efficiency. Specifically, the design of the hologram integrates a ground metal plane with a geometric metasurface that enhances the conversion efficiency between the two circular polarization states, leading to high diffraction efficiency without complicating the fabrication process. Because of these advantages, our strategy could be viable for various practical holographic applications.

  18. Unusual Cause of Knee Locking

    OpenAIRE

    Huri, Gazi; Bi?er, Omer Sunkar

    2013-01-01

    We report a case of partial intrasubstance tear of popliteus tendon as an unusual cause of pseudolocking of the knee. A 13-year-old semiprofessional soccer player applied to our clinic with a locked right knee in spite of the therapy applied (cold pack, NSAID, and immobilization) in another institution 20 days after the injury. Significant extension loss was observed in his right knee with 30∘–90∘ ROM. Magnetic resonance imaging (MRI) and arthroscopy confirmed the intrasubstance tear of popli...

  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. Tourniquet in knee surgery.

    Science.gov (United States)

    Papalia, Rocco; Zampogna, Biagio; Franceschi, Francesco; Torre, Guglielmo; Maffulli, Nicola; Denaro, Vincenzo

    2014-09-01

    The tourniquet is a surgical device composed of a round pneumatic cuff in which air at high pressure can be inflated with an automatic programmable pump to avoid bleeding and technical impediment. Comprehensive searches of Medline, Cochrane and Google Scholar databases were performed for studies regarding tourniquet application in arthroscopic and open surgery of the knee. The methodological quality of each study was evaluated using the Coleman methodology score (CMS). The use of a tourniquet does not lead to significant increase in the risk of major complications, and there is no difference in clinical outcome in the medium term. The inflated cuff does prevent intraoperative blood loss, but hidden blood loss is not avoided completely. There is a statistically significantly higher occurrence of deep vein thrombosis in patients who undergo surgery with tourniquet, but the clinical relevance of this finding is uncertain. The heterogeneity in terms of inflating pressure and duration of application of tourniquet in the single studies makes it very difficult to compare the outcomes of different investigations to draw definitive conclusions. Standardization of pressure and application time of the cuff could allow a comparison of the data reported by the trials. Better study methodology should be also implemented since the mean CMS considering all the reviewed articles was 57.6 of 100. More and better designed studies are needed to produce clear guidelines to standardize the use of tourniquet in knee procedures. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Unusual Cause of Knee Locking

    Directory of Open Access Journals (Sweden)

    Gazi Huri

    2013-01-01

    Full Text Available We report a case of partial intrasubstance tear of popliteus tendon as an unusual cause of pseudolocking of the knee. A 13-year-old semiprofessional soccer player applied to our clinic with a locked right knee in spite of the therapy applied (cold pack, NSAID, and immobilization in another institution 20 days after the injury. Significant extension loss was observed in his right knee with 30∘–90∘ ROM. Magnetic resonance imaging (MRI and arthroscopy confirmed the intrasubstance tear of popliteus tendon and synovitis. The ruptured part of the tendon was debrided, and the inflammatory tissue around the tendon, which may lead to pseudolocking, was gently removed with a shaver in order to regain the normal ROM. The patient was discharged with full ROM and weight bearing first day after the surgery. To our knowledge, this is the first case demonstrating intrasubstance tear of popliteus tendon causing pseudolocking of the knee.

  2. Arthroplasty of a Charcot knee

    Science.gov (United States)

    Babazadeh, Sina; Stoney, James D.; Lim, Keith; Choong, Peter F.M.

    2010-01-01

    The Charcot knee - or neuropathic arthropathy - presents a considerable challenge to the orthopaedic surgeon. Caused by a combination of sensory, motor and autonomic neuropathy, it was originally described as an arthritic sequelae of neurosyphilis. In today's western orthopaedics it is more often caused by diabetes. A Charcot knee is often symptomatically painful and unstable. Traditional management has usually been conservative or arthrodesis, with limited success. Arthroplasty of a Charcot joint has commonly been avoided at all costs. However, in the right patient, using the right technique, arthroplasty can significantly improve the symptoms of a Charcot joint. This article explores the evidence surrounding the role of arthroplasty in the management of a Charcot knee. Arthroplasty is compared to other forms of treatment and specific patient demographics and surgical techniques are explored in an attempt to define the role of arthroplasty in the management of a Charcot knee. PMID:21808708

  3. Arthroplasty of a Charcot knee

    Directory of Open Access Journals (Sweden)

    Sina Babazadeh

    2010-08-01

    Full Text Available The Charcot knee - or neuropathic arthropathy - presents a considerable challenge to the orthopaedic surgeon. Caused by a combination of sensory, motor and autonomic neuropathy, it was originally described as an arthritic sequelae of neurosyphilis. In today’s western orthopaedics it is more often caused by diabetes. A Charcot knee is often symptomatically painful and unstable. Traditional management has usually been conservative or arthrodesis, with limited success. Arthroplasty of a Charcot joint has commonly been avoided at all costs. However, in the right patient, using the right technique, arthroplasty can significantly improve the symptoms of a Charcot joint. This article explores the evidence surrounding the role of arthroplasty in the management of a Charcot knee. Arthroplasty is compared to other forms of treatment and specific patient demographics and surgical techniques are explored in an attempt to define the role of arthroplasty in the management of a Charcot knee.

  4. Minimally invasive total knee arthroplasty.

    Science.gov (United States)

    Bonutti, Peter M; Mont, Michael A; McMahon, Margo; Ragland, Phillip S; Kester, Mark

    2004-01-01

    Currently, minimally invasive total knee arthroplasty is defined as an incision length of definition are: 1. The amount of soft-tissue dissection (including muscle, ligament, and capsular damage). 2. Patellar retraction or eversion. 3. Tibiofemoral dislocation. Minimally invasive surgery should not be considered to be a cosmetic procedure but rather one that addresses patients' concerns with regard to postoperative pain and slow rehabilitation. Standard total knee arthroplasties provide pain relief, but returning to activities of daily living remains a challenge for some individuals, who may take several weeks to recover. Several studies have demonstrated long-term success (at more than ten years) of standard total knee arthroplasties. However, many patients remain unsatisfied with the results of the surgery. In a study of functional limitations of patients with a Knee Society score of > or = 90 points after total knee arthroplasty, only 35% of patients stated that they had no limitations. This finding was highlighted in a study by Dickstein et al., in which one-third of the elderly patients who underwent knee replacement were unhappy with the outcome at six and twelve months postoperatively. Although many surgeons utilize objective functional scoring systems to evaluate outcome, it is likely that the criteria for a successful result of total knee arthroplasty differ between the patient and the surgeon. This was evident in a report by Bullens et al., who concluded that surgeons are more satisfied with the results of total knee arthroplasty than are their patients. Trousdale et al. showed that, in addition to concerns about long-term functional outcome, patients' major concerns were postoperative pain and the time required for recovery. Patients undergoing total knee arthroplasty have specific functional goals, such as climbing stairs, squatting, kneeling, and returning to some level of low-impact sports after surgery. Our clinical investigations demonstrated that

  5. Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness

    DEFF Research Database (Denmark)

    Nielsen, Katrine Abildgaard; Thomsen, Morten Grove; Latifi, Roshan

    2016-01-01

    PURPOSE: To evaluate the difference in post-operative knee awareness between knees in patients undergoing bilateral simultaneous total knee arthroplasty (TKA) and to assess factors predicting high or low knee awareness. METHODS: This study was conducted on 99 bilateral simultaneous TKAs performed...... at our institution from 2008 to 2012. All patients received one set of questionnaires [Forgotten Joint Score (FJS) and Oxford Knee Score (OKS)] for each knee. Based on the FJS, the patients' knees were divided into two groups: "best" and "worst" knees. The median of the absolute difference in FJS and OKS...... within each patient was calculated. Multivariate linear regression was performed to identify factors affecting FJS. RESULTS: The difference between knees was 1 point (CI 0-5) for the FJS and 1 point (CI 0-2) for the OKS. The FJS for females increased (decreasing awareness) with increasing age. Males had...

  6. Tackling obesity in knee osteoarthritis.

    Science.gov (United States)

    Wluka, Anita E; Lombard, Cate B; Cicuttini, Flavia M

    2013-04-01

    Obesity and knee osteoarthritis (OA), two of the most common chronic diseases, are often comorbid. Obesity increases the risk of knee OA by a variety of mechanisms, such as increased joint loading and changes in body composition, with detrimental effects related to metainflammation and behavioural factors, including diminished physical activity and subsequent loss of protective muscle strength. These complex interactions present a challenge to the managing physician. The risk of knee OA related to weight gain and obesity begins from an early age. Weight loss reduces the risk of incident knee OA, and, in established disease, reduces symptoms, improves function and is likely to reduce disease progression. We review strategies to facilitate weight loss, with particular reference to their application in people with knee OA. Although knee OA presents intrinsic barriers to weight management, weight loss is possible at all stages of disease. Exercise or muscle strengthening are desirable for general health and to improve function, but are not essential to achieve weight loss and a successful symptomatic result. The degree of weight loss required to achieve benefit might be greater with increasing disease severity. Finally, we outline the need for a societal approach to tackle obesity-related OA.

  7. Quadriceps strength in relation to total knee arthroplasty outcomes.

    Science.gov (United States)

    Saleh, Khaled J; Lee, Laura W; Gandhi, Rajiv; Ingersoll, Christopher D; Mahomed, Nizar N; Sheibani-Rad, Shahin; Novicoff, Wendy M; Mihalko, William M

    2010-01-01

    After total knee arthroplasty, quadriceps femoris muscle strength is an important determinant of physical function. Quadriceps weakness is often present in the osteoarthritic limb and worsens after total knee arthroplasty. Although some quadriceps strength is regained, it may take more than 2 years to achieve preoperative levels, and it is unclear if quadriceps strength in the operated limb ever reaches that of the nondiseased contralateral limb or the quadriceps strength of healthy controls. Studies point to volitional muscle activation rather than muscle atrophy or joint pain as the cause of the weakness. The unresolved challenge lies in clarifying the optimal surgical and rehabilitation course that will reverse the weakness early or prevent its occurrence. Studies suggest that progressive resistive strengthening exercises and neuromuscular electrical stimulation, possibly along with "prehabilitation," improve quadriceps volitional force output. Well-designed, controlled studies are necessary to determine efficacy. Because knee osteoarthritis and total knee arthroplasty are highly prevalent, improving quadriceps weakness is an important goal for orthopaedic surgeons and rehabilitation specialists.

  8. Interpretation of cosmic ray spectrum above the knee measured by the Tunka-133 array

    Energy Technology Data Exchange (ETDEWEB)

    Sveshnikova, Lyubov, E-mail: tfl10@mail.ru [Skobeltsyn Institute of Nuclear Physics MSU, Leninskie Gory GSP 1, Moscow 119992 (Russian Federation); Kuzmichev, Leonid; Korosteleva, Elena; Prosin, Vasiliy [Skobeltsyn Institute of Nuclear Physics MSU, Leninskie Gory GSP 1, Moscow 119992 (Russian Federation); Ptuskin, V.S. [Pushkov Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propogation (IZMIRAN), Russian Academy of Sciences, Troitsk, Moscow region 142092 (Russian Federation)

    2014-11-15

    A probable interpretation of the fine structure of all particle energy spectrum between the knee and the ankle (the sharp first knee at 3–4 PeV, the spectrum hardening at 20–30 PeV, the second knee at 200–300 PeV) as well as a (E) dependence measured recently by the Tunka-133 experiment, is presented. We show that these features are compatible with the combined model where cosmic rays around the knee are produced by the group of dedicated sources and the extragalactic light component appears in the energy region of 10{sup 16}–10{sup 17} eV and reaches about 50% of all particles around (2–3)×10{sup 17} eV.

  9. MRI of knee ligament injury and reconstruction.

    Science.gov (United States)

    Farshad-Amacker, Nadja A; Potter, Hollis G

    2013-10-01

    Knee ligament instability may lead to meniscal and chondral damage, resulting in early osteoarthritis. Due to its superior soft tissue contrast and avoidance of harmful ionizing radiation, MRI has become the most important imaging modality for early recognition of structural defects of the knee joint. This review aims to the understanding of MRI appearances of knee ligament structures associated with knee instability, and to review the common patterns of altered knee mechanics that lead to ligament failure. Normal anatomy of the knee ligaments, pathologic conditions, and postsurgical appearances of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterolateral corner are described. Copyright © 2013 Wiley Periodicals, Inc.

  10. Acute effects of kinesio taping on knee extensor peak torque and electromyographic activity after exhaustive isometric knee extension in healthy young adults.

    Science.gov (United States)

    Yeung, Simon S; Yeung, Ella W; Sakunkaruna, Yosawin; Mingsoongnern, Sutida; Hung, Wing Y; Fan, Yun L; Iao, Heng C

    2015-05-01

    To evaluate the effect of Kinesio Tex tape and its method of application, Kinesio Taping (KT) on knee extensor performance before and after an exhaustive isometric knee extension exercise. Single-blinded, randomized control trial. Centre for Sports Training and Rehabilitation at The Hong Kong Polytechnic University. Twenty-six healthy volunteers with no history of knee injuries. Subjects were randomized to either the KT or sham taping group. The effects of KT on the neuromuscular performance of the knee extensors were measured before and after KT application, and immediately and 5 and 10 minutes after an exhaustive isometric knee extension exercise. Within-group analyses revealed a significant effect of time on the peak torque in isometric knee extension (F2.73,65.44 = 24.5, P Kinesio taping is commonly seen in the sports arena. The popularity is presumably due to the general belief in its injury prevention and enhancement of muscle performance. The results of the present findings suggested that KT shortens the time to reach peak torque generation. Aside from this, there is no other significant positive effect on muscle performance. Further investigation on the effects of KT on muscle performance is warranted.

  11. ALMA Telescope Reaches New Heights

    Science.gov (United States)

    2009-09-01

    ball at a distance of nine miles, and to keep their smooth reflecting surfaces accurate to less than the thickness of a human hair. Once the transporter reached the high plateau it carried the antenna to a concrete pad -- a docking station with connections for power and fiber optics -- and positioned it with an accuracy of a small fraction of an inch. The transporter is guided by a laser steering system and, just like some cars, also has ultrasonic collision detectors. These sensors ensure the safety of the state-of-the-art antennas as the transporter drives them across what will soon be a rather crowded plateau. Ultimately, ALMA will have at least 66 antennas distributed over about 200 pads, spread over distances of up to 11.5 miles and operating as a single, giant telescope. Even when ALMA is fully operational, the transporters will be used to move the antennas between pads to reconfigure the telescope for different kinds of observations. This first ALMA antenna at the high site will soon be joined by others, and the ALMA team looks forward to making their first observations from the Chajnantor plateau. They plan to link three antennas by early 2010, and to make the first scientific observations with ALMA in the second half of 2011. ALMA will help astronomers answer important questions about our cosmic origins. The telescope will observe the Universe using light with millimeter and submillimeter wavelengths, between infrared light and radio waves in the electromagnetic spectrum. Light at these wavelengths comes from some of the coldest, and from some of the most distant objects in the cosmos. These include cold clouds of gas and dust where new stars are being born, or remote galaxies towards the edge of the observable universe. The Universe is relatively unexplored at submillimeter wavelengths, as the telescopes need extremely dry atmospheric conditions, such as those at Chajnantor, and advanced detector technology. The Atacama Large Millimeter/submillimeter Array

  12. Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females.

    Science.gov (United States)

    Runhaar, Jos; de Vos, Bastiaan C; van Middelkoop, Marienke; Vroegindeweij, Dammis; Oei, Edwin H G; Bierma-Zeinstra, Sita M A

    2016-10-01

    This study evaluated the effect of moderate weight loss on the incidence of knee osteoarthritis (OA) in middle-aged overweight and obese women, without clinical and radiologic knee OA at baseline. A total of 353 women (87%) with followup data available were selected from the Prevention of Knee Osteoarthritis in Overweight Females study, which evaluated the preventive effect of a diet and exercise intervention and of oral glucosamine sulfate on the incidence of knee OA. This was an exploratory proof-of-concept analysis, which compared the incidence of knee OA between women who reached the clinically relevant weight loss target of 5 kg or 5% of body weight after 30 months and those who did not reach this target. The weight loss group showed a significantly lower incidence of knee OA according to the primary outcome measure, which was composed of the American College of Rheumatology criteria (clinical and radiographic), Kellgren/Lawrence grade ≥2, and joint space narrowing ≥1.0 mm (15% versus 20%; odds ratio 0.5, 95% confidence interval 0.3-0.9). Moreover, the weight loss also positively affected several health measures, such as blood glucose level, body fat percentage, and blood pressure. A reduction of ≥5 kg or 5% of body weight over a 30-month period reduces the risk for the onset of radiographic knee OA in middle-aged overweight and obese women. Because of the slow progression of the disease, a longer followup period will be necessary before the number of prevented cases of knee OA by moderate weight loss becomes clinically more relevant. © 2016, American College of Rheumatology.

  13. Stream Habitat Reach Summary - NCWAP [ds158

    Data.gov (United States)

    California Department of Resources — The Stream Habitat - NCWAP - Reach Summary [ds158] shapefile contains in-stream habitat survey data summarized to the stream reach level. It is a derivative of the...

  14. 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

  15. RECENT VIEW AT UNICOMPARTMENTAL KNEE ARTHROPLASTY AMONG OTHER SURGICAL APPROACHES TO PATIENTS WITH KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    N. N. Kornilov

    2012-01-01

    Full Text Available In the article recent publications dedicated to unicompartmental knee arthroplasty are analyzed. Evolution of indications and contraindications, mid- and late term results, difference in functional outcomes in comparison with total knee arthroplasty are discussed. Taking into consideration all relevant information unicompartmental knee arthroplasty may be considered as effective and reliable method of treatment of patients with knee osteoarthrosis and osteonecrosis.

  16. Patients Unicondylar Knee Replacement vs. Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Hedra Eskander

    2017-02-01

    Full Text Available The aim of this review article is to analyse the clinical effectiveness of total knee replacement (TKR compared to unicondylar knee replacement (UKR on patients. In terms of survival rates, revision rates and postoperative complications. The keywords used were: knee arthroplasty. Nearly three thousand articles were found on 25 August 2016. Of those, only twenty-five were selected and reviewed because they were strictly focused on the topic of this article. Compared with those who have TKR, patients who undergo UKR have higher revision rates at 5, 10 and 15 years. The reported overall risk of postoperative complications for patients undergoing TKR is 11%, compared with 4.3% for patients undergoing UKR. In conclusion, UKR have higher revision rates than TKR. However, an increased risk of postoperative complications after TKR.

  17. Developing prescribing guidelines for microprocessor-controlled prosthetic knees in the South East England.

    Science.gov (United States)

    Sedki, Imad; Fisher, Keren

    2015-06-01

    Microprocessor-controlled prosthetic knees have gained increasing popularity over the last decade. Research supports their provision to address specific problems or to achieve certain rehabilitation goals. However, there are yet no agreed protocols or prescribing criteria to assist clinicians in the identification and appropriate selection of suitable users. The aim is to reach professionals' agreement on specific prescribing guidelines for microprocessor-controlled prosthetic knees. The study involved multidisciplinary teams from the Inter Regional Prosthetic Audit Group, representing nine Prosthetic Rehabilitation Centres in the South East England region. We used the Delphi technique with a total of three rounds to reach professionals' agreement. The prescribing guidelines were agreed and will be reviewed and updated depending on new research evidence and technical advances. This project is highly useful for professionals in a clinic setting to aid in appropriate patient selection and to justify the cost of prescribing microprocessor-controlled prosthetic knees. © The International Society for Prosthetics and Orthotics 2014.

  18. Knee joint forces: prediction, measurement, and significance

    Science.gov (United States)

    D’Lima, Darryl D.; Fregly, Benjamin J.; Patil, Shantanu; Steklov, Nikolai; Colwell, Clifford W.

    2011-01-01

    Knee forces are highly significant in osteoarthritis and in the survival and function of knee arthroplasty. A large number of studies have attempted to estimate forces around the knee during various activities. Several approaches have been used to relate knee kinematics and external forces to internal joint contact forces, the most popular being inverse dynamics, forward dynamics, and static body analyses. Knee forces have also been measured in vivo after knee arthroplasty, which serves as valuable validation of computational predictions. This review summarizes the results of published studies that measured knee forces for various activities. The efficacy of various methods to alter knee force distribution, such as gait modification, orthotics, walking aids, and custom treadmills are analyzed. Current gaps in our knowledge are identified and directions for future research in this area are outlined. PMID:22468461

  19. Deciding to have knee or hip replacement

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000368.htm Deciding to have knee or hip replacement To use the sharing ... date. Why you may not be Able to Have Replacement Surgery Your provider may recommend against knee ...

  20. Studies Spotlight Diet, Supplements for Knee Pain

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_165863.html Studies Spotlight Diet, Supplements for Knee Pain Could fiber ... keep the bowels running smoothly, but a new study suggests it can also reduce knee pain from ...

  1. Isokinetic test and exercises in knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Neslihan Gokcen

    2015-06-01

    Full Text Available Osteoarthritis is the most common type of arthritis and knee is the most frequently affected joint. Several risk factors including age, gender, body mass index and quadriceps muscle strength may contribute to knee osteoarthritis. Quadriceps muscle is the dynamic stabilizer of the knee. Besides the studies arguing that quadriceps muscle weakness might lead to knee osteoarthritis, there are also studies suggesting that muscle weakness might occur due to knee osteoarthritis. Authors, arguing that quadriceps muscle weakness has a deteriorating affect on knee osteoarthritis, also come to a conclusion that strengthening this muscle has a beneficial effect on knee osteoarthritis. Isometric, isotonic and isokinetic exercises are used in order to strengthen this muscle. Quantitative measurement of the muscle strength, as well as isokinetic exercises can be performed with the help of isokinetic devices. Isokinetic evaluation and isokinetic exercises in knee osteoarthritis are overviewed in this review. [Archives Medical Review Journal 2015; 24(2.000: 228-238

  2. Active knee joint flexibility and sports activity

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders; Vestergaard, E

    1999-01-01

    The aim of the study was to estimate active knee flexion and active knee extension in athletes and to investigate the potential association of each to different types of sports activity. Active knee extension and active knee flexion was measured in 339 athletes. Active knee extension...... was significantly higher in women than in men and significantly positively associated with weekly hours of swimming and weekly hours of competitive gymnastics. Active knee flexion was significantly positively associated with participation in basketball, and significantly negatively associated with age and weekly...... hours of soccer, European team handball and swimming. The results point to sport-specific adaptation of active knee flexion and active knee extension. Udgivelsesdato: 1999-Apr...

  3. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis

    DEFF Research Database (Denmark)

    Oiestad, B E; Juhl, C B; Eitzen, I

    2015-01-01

    extensor muscle strength were defined prior to data extraction. Meta-analysis was applied on the basis of the odds ratios (ORs) of developing symptomatic knee osteoarthritis or radiographic knee osteoarthritis in subjects with knee extensor muscle weakness. ORs for knee osteoarthritis and 95% confidence......The objective of this study was to perform a systematic review and meta-analysis on the association between knee extensor muscle weakness and the risk of developing knee osteoarthritis. A systematic review and meta-analysis was conducted with literature searches in Medline, SPORTDiscus, EMBASE......, CINAHL, and AMED. Eligible studies had to include participants with no radiographic or symptomatic knee osteoarthritis at baseline; have a follow-up time of a minimum of 2 years, and include a measure of knee extensor muscle strength. Hierarchies for extracting data on knee osteoarthritis and knee...

  4. Designing prosthetic knee joints with bio-inspired bearing surfaces.

    Science.gov (United States)

    Qiu, Mingfeng; Chyr, Anthony; Sanders, Anthony P; Raeymaekers, Bart

    2014-09-01

    It has long been known that articular cartilage exhibits a surface microtexture with shallow indentations. By contrast, prosthetic joints consist of ultra-smooth bearing surfaces, the longevity of which does not reach that of natural cartilage. We show that adding a microtexture to the smooth femoral component of a prosthetic knee joint reduces friction by increasing the lubricant film thickness between the bearing surfaces of the knee. We have implemented an elastohydrodynamic lubrication model to optimize the geometry of the microtexture, while taking into account the deformation of the polyethylene tibial insert. We have manufactured several microtexture designs on a surrogate femoral component, and experimentally demonstrate that the microtexture reduces friction between the surrogate femoral component and tibial insert.

  5. The most common knee injury in volleyball

    OpenAIRE

    Přádová, Kateřina

    2012-01-01

    A knee is the most complicated joint in our body. It is commonly injured during volleyball, mainly resulting as a knee pain syndrome or an acute rupture of an anterior cruciate ligament. In its theoretical part this bachelor thesis gives an overview of basic anatomy and biomechanics of the knee joint, it deals with the gender differences in morfology and neurophysiology and it contains a chapter dealing with biomechanics of the knee joint in volleyball. The second part of this bachelor thesis...

  6. REACH: impact on the US cosmetics industry?

    Science.gov (United States)

    Pouillot, Anne; Polla, Barbara; Polla, Ada

    2009-03-01

    The Registration, Evaluation, Authorization and restriction of Chemicals (REACH) is a recent European regulation on chemical substances meant to protect human health and the environment. REACH imposes the "precautionary principle" where additional data and definitive action are required when uncertainty is identified. The cosmetics industry is only partially concerned by REACH: while the stages of registration and evaluation apply to cosmetics, those of authorization and restriction most likely will not, as cosmetic ingredients are already subject to regulation by various agencies and directives. REACH has potential benefits to the industry including the possibility of reassuring consumers and improving their image of chemicals and cosmetics. However, REACH also has potential disadvantages, mainly with regard to impeding innovation. The American cosmetics industry will be affected by REACH, because all US manufacturers who export substances to Europe will have to fully comply with REACH.

  7. Effects of a Custom-Made Hinged Knee Brace with Knee Flexion Support for Patients with Knee Osteoarthritis: A Preliminary Study

    OpenAIRE

    OTA, Susumu; KANAI, AKIRA; TORII, YOSHIYA; TANIYAMA, Hiroyuki; IMAIZUMI, FUMIO; MATSUI, YASUMOTO

    2015-01-01

    ABSTRACT A knee brace for medial knee osteoarthritis (OA) is required to restrict knee adduction moment (KAM), but must not restrict knee flexion during swing phase. There is no report of a knee brace with both functions. The purpose of this study is to investigate the effect of the custom-made hinged knee brace for patients with knee OA compared to the hinged knee brace generally used, and to assess the KAM and knee flexion angle during swing phase. Fifteen patients (average age: 71.6 ? 7.8 ...

  8. Proprioception in knee osteoarthritis: a narrative review

    NARCIS (Netherlands)

    Knoop, J.; Steultjens, M.P.M.; van der Leeden, M.; van der Esch, M.; Thorstensson, C.A.; Roorda, L.D.; Lems, W.F.; Dekker, J.

    2011-01-01

    Objective: To give an overview of the literature on knee proprioception in knee osteoarthritis (OA) patients. Method: A literature search was performed and reviewed using the narrative approach. Results: (1) Three presumed functions of knee proprioception have been described in the literature:

  9. Knee extensor strength does not protect against incident knee symptoms at 30 months in the multicenter knee osteoarthritis (MOST) cohort.

    Science.gov (United States)

    Segal, Neil A; Torner, James C; Felson, David T; Niu, Jingbo; Sharma, Leena; Lewis, Cora E; Nevitt, Michael

    2009-05-01

    Knee extensor weakness has not been associated consistently with the risk for incident knee pain. Additionally, the balance of hamstring-to-quadriceps strength (H:Q ratio) may affect risk and has not been studied. The authors determined whether knee extensor weakness or muscle imbalance is a risk factor for development of frequent knee pain or stiffness and whether the effect is modified by lower limb alignment. Observational study. Community. Community-dwelling adults ages 50-79 years with or at risk of knee osteoarthritis based on obesity, knee injury, or surgery. A total of 1269 knees from women and 1006 knees from men without frequent knee symptoms at baseline and with 15- or 30- month follow-up outcome data were included. Isokinetic knee extensor and flexor strength as well as radiographic hip-knee-ankle alignment were measured at baseline. H:Q ratio was dichotomized, with normal being considered to be >/=0.6. Frequent knee symptoms at 15- or 30-month follow-up (frequent knee pain, aching, or stiffness on most days of the past month reported at both telephone contact just before and at visit). Mean +/- SD age was 62.2 +/- 8.0 years and mean body mass index (BMI) was 30.1 +/- 5.4 kg/m(2). Mean peak knee extensor strength (KES) was 132.6 +/- 42.4 and 76.9 +/- 25.3 N.m in men and women, respectively. Approximately 50% of knees in men and 59% of knees in women had an H:Q ratio knees developed frequent knee symptoms at follow-up. Logistic regression controlling for age, BMI, femoral neck bone mineral density, activity score, and baseline Kellgren Lawrence grade revealed that neither KES nor H:Q ratio predicted the development of knee symptoms in gender-stratified or combined analyses. These results were unaffected by adjusting for lower limb alignment. Neither concentric quadriceps strength nor H:Q ratios predicted the development of frequent knee symptoms at 15- or 30-month follow-up in this cohort.

  10. Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis.

    Science.gov (United States)

    Khalaj, Nafiseh; Abu Osman, Noor A; Mokhtar, Abdul H; Mehdikhani, Mahboobeh; Wan Abas, Wan A B

    2014-02-01

    The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.

  11. RELIABILITY AND RESPONSIVENESS OF THE DANISH MODIFIED INTERNATIONAL KNEE DOCUMENTATION COMMITTEE SUBJECTIVE KNEE FORM FOR CHILDREN WITH KNEE DISORDERS

    DEFF Research Database (Denmark)

    Jacobsen, Julie Sandell; Knudsen, Pernille; Fynbo, Charlotte

    2016-01-01

    Introduction The modified international Knee Documentation Committee Subjective Knee Form (Pedi-IKDC) is a widely used patient-reported tool applicable for children with knee disorders ranging on a scale from 0-100. We aimed to translate the Pedi-IKDC Subjective Knee Form into Danish......, and furthermore to assess its reliability and responsiveness. Material and Methods The Pedi-IKDC Subjective Knee Form was translated to Danish according to international guidelines. Reliability was assessed with Bland Altman plots, standard error of measurement (SEM), Minimal Detectable Change (MDC) and the Intra....... Reliability and responsiveness were assessed in 50 children (median 15 years) referred to hospital due to different knee disorders. Results The SEM was 4.2 points and the MDC was 11.5 points. The ICC was 0.91 (0.9-1.0). The change score of the Pedi-IKDC Subjective Knee form was correlated to the external...

  12. Knee Muscles Power Evolution in Patients with Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ileana Monica BORDA

    2012-09-01

    Full Text Available Purpose: To measure changes in muscle power from before to 6 months after total knee arthroplasty and to compare outcomes with those from a control group of healthy adults. Material and Methods: 26 patients who underwent a total knee replacement were compared with 12 healthy age-matched adults in a prospective cohort study. Patients’ assessment was performed preoperatively, as well as at 1, 2 and 6 months postoperatively, by the isokinetic method. Healthy adults were assessed once by the same method. Isokinetic evaluation of knee extensor and flexor muscles was performed using a Gimnex Iso 2 dynamometer. After a warm-up protocol, measurements were done at angular velocities of 90 and 180°/sec. Results: Compared to healthy adults, patients performed significantly worse at all evaluation times, for both extensors and flexors of the knee, except for the 6-month evaluation at 180°/sec. One month postoperatively losses from preoperative levels were registered in patients, but without statistically significance, except for extension at 180°/sec. At 6 months postoperatively patients surpassed the preoperative levels, with statistical significance at 180°/sec. Conclusions: Power is an important parameter to follow after TKA, in parallel with peak torque. Increasing muscle power should be one of the central issues to address during postoperative rehabilitation.

  13. Knee flexion after total knee arthroplasty reduces blood loss.

    Science.gov (United States)

    Panni, Alfredo Schiavone; Cerciello, Simone; Vasso, Michele; Del Regno, Chiara

    2014-08-01

    Extensive blood loss after total knee arthroplasty (TKA) may be a potential problem since it leads to anaemia, increased need for transfusion and prolonged hospitalization. Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion. One hundred consecutive patients undergoing primary TKA from 2012 to 2013 were randomizely divided into two groups. In one group, the knee was extended for the first 6 h after surgery, whereas in the other was flexed at 90° for the same time. Two doses of endovenous tranexamic acid were administered in all subjects. Patients were homogeneous for all the possible confounding factors. Calculated blood loss was 846 ± 197 (ml) in the flexion group and 1,242 ± 228 (ml) in the extension group (p extension group (p extension group. Knee flexion at 90° after TKA, associated with the intraoperative use of tranexamic, acid is an effective method to reduce blood loss and the need for blood transfusion. The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures.

  14. Open Knee: Open Source Modeling and Simulation in Knee Biomechanics.

    Science.gov (United States)

    Erdemir, Ahmet

    2016-02-01

    Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical functions of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor-intensive reproduction of model development steps can be avoided. Interested parties can immediately utilize readily available models for scientific discovery and clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes the detailed anatomical representation of the joint's major tissue structures and their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next-generation knee models is noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age

  15. Knee Confidence as it Relates to Self-Reported and Objective Correlates of Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Skou, Søren T; Rasmussen, Sten; Simonsen, Ole

    2015-01-01

    Study Design Cross-sectional study. Objective The objective was to validate, if possible, previously reported associations and to investigate other potential associations between knee confidence and various self-reported and objective measures in an independent cohort of patients with knee...... confidence, assessed using item Q3 of the Knee injury and Osteoarthritis Outcome Score, as the dependent variable and self-reported (pain on walking, general health, fear of movement, self-efficacy, function, and previous serious injury) and objective measures (muscle strength, 20-m walk time...... osteoarthritis (OA). Background Lack of knee confidence is a frequent symptom in patients with knee OA, but little is known of associations between knee confidence and other common correlates of knee OA. Methods Baseline data from 220 patients with knee OA were applied in ordinal regression analyses, with knee...

  16. 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.

  17. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review.

    Science.gov (United States)

    Décary, Simon; Ouellet, Philippe; Vendittoli, Pascal-André; Desmeules, François

    2016-12-01

    Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Muscle contributions to knee extension in the early stance phase in patients with knee osteoarthritis.

    Science.gov (United States)

    Ogaya, Shinya; Kubota, Ryo; Chujo, Yuta; Hirooka, Eiko; Kwang-Ho, Kim; Hase, Kimitaka

    2017-10-01

    The aim of this study was to analyze individual muscle contributions to knee angular acceleration using a musculoskeletal simulation analysis and evaluate knee extension mechanics in the early stance phase in patients with knee osteoarthritis (OA). The subjects comprised 15 patients with medial knee OA and 14 healthy elderly individuals. All participants underwent gait performance test using 8 infrared cameras and two force plates to measure the kinetic and kinematic data. The simulation was driven by 92 Hill-type muscle-tendon units of the lower extremities and a trunk with 23° of freedom. We analyzed each muscle contribution to knee angular acceleration in the 5%-15% and 15%-25% periods of the stance phase (% SP) using an induced acceleration analysis. We compared accelerations by individual muscles between the two groups using an analysis of covariance for controlling gait speed. Patients with knee OA had a significantly lesser knee extension acceleration by the vasti muscles and higher knee acceleration by hip adductors than those in controls in 5-15% SP. In addition, knee OA resulted in significantly lesser knee extension acceleration by the vasti muscles in 15-25% SP. These results indicate that patients with knee OA have decreased dependency on the vasti muscles to control knee movements during early stance phase. Hip adductor muscles, which mainly control mediolateral motion, partly compensate for the weak knee extension by the vasti muscles in patients with knee OA. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Knee motion variability in patients with knee osteoarthritis: the effect of self-reported instability

    Science.gov (United States)

    Gustafson, Jonathan A.; Robinson, Megan E.; Fitzgerald, G. Kelley; Tashman, Scott; Farrokhi, Shawn

    2015-01-01

    Background Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. Methods Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. Findings The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (pknee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation. PMID:25796536

  20. Knee bursitis: a sonographic evaluation

    National Research Council Canada - National Science Library

    Draghi, Ferdinando; Corti, Riccardo; Urciuoli, Luigi; Alessandrino, Francesco; Rotondo, Antonio

    2015-01-01

    ... of experience.Of these patients, 15 (7 men, 8 women) had bursitis, while 143 (76 men, 67 women) had no bursitis. In evaluating knee bursitis, US, when compared to MRI, correctly identified 13 out of 15 cases of bursitis, showing a sensitivity...

  1. Phaeohyphomycosis infection in the knee

    Directory of Open Access Journals (Sweden)

    David Sadigursky

    2016-04-01

    Full Text Available Phaeohyphomycosis is caused by cutaneous fungi and rarely affects large joints. This is a case report on phaeohyphomycosis in the left knee of an elderly individual without immunosuppression. It was accompanied by pain and swelling the anterior knee. The case was first suspected to be suprapatellar bursitis, and was treated with nonsteroidal anti-inflammatory drugs, without remission of symptoms. Surgical treatment was performed, with resection of the suprapatellar bursa and anterior region of the quadriceps tendon. The material was sent for anatomopathological examination and culturing. The pathological examination showed phaeohyphomycosis. The treatment instituted consisted of itraconazole, 200 mg/day for six weeks, and complete remission of symptoms was achieved. The physical examination remained normal after one year of follow-up. This is the first published case of phaeohyphomycosis infection in the suprapatellar region of the knee. Although almost all the cases reported have been associated with immunosuppressed patients, this was an exception. It is important to suspect phaeohyphomycosis in cases of knee infection, in the area of the suprapatellar bursa, when the symptoms do not resolve after clinical treatment.

  2. Multiple Ligament Knee Injury: Complications

    OpenAIRE

    Manske, Robert C.; Hosseinzadeh, Pooya; Giangarra, Charles E.

    2008-01-01

    Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications ...

  3. Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients

    DEFF Research Database (Denmark)

    Jensen, Claus Hjorth; Rofail, S

    1999-01-01

    The prevalence of obesity and previous knee injury was assessed in a retrospective study of 115 patients under-going total knee replacement due to osteoarthritis. Obesity was considered a contributing factor in the development of osteoarthritis in 37% of the patients, and 33% of the patients had...... had an injury to the knee in question. Unilateral osteoarthritis was significantly more frequent than bilateral osteoarthritis among patients with a history of previous knee injury. The association of previous injury to the knee and unilateral osteoarthritis was stronger in men than women. Aggressive...... treatment of patients with knee injuries seems warranted....

  4. 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

    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...... 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...

  5. How Crouch Gait Can Dynamically Induce Stiff-Knee Gait

    NARCIS (Netherlands)

    Van der Krogt, M.M.; Bregman, D.J.J.; Wisse, M.; Doorenbosch, C.A.M.; Harlaar, J.; Collins, S.H.

    Children with cerebral palsy frequently experience foot dragging and tripping during walking due to a lack of adequate knee flexion in swing (stiff-knee gait). Stiff-knee gait is often accompanied by an overly flexed knee during stance (crouch gait). Studies on stiff-knee gait have mostly focused on

  6. How Crouch Gait Can Dynamically Induce Stiff-Knee Gait

    NARCIS (Netherlands)

    van der Krogt, M.M.; Bregman, D.J.J.; Wisse, M.; Doorenbosch, C.A.M.; Harlaar, J.

    2010-01-01

    Children with cerebral palsy frequently experience foot dragging and tripping during walking due to a lack of adequate knee flexion in swing (stiff-knee gait). Stiff-knee gait is often accompanied by an overly flexed knee during stance (crouch gait). Studies on stiff-knee gait have mostly focused on

  7. Rotational constraint in posterior-stabilized total knee prostheses.

    Science.gov (United States)

    Klein, R; Serpe, L; Kester, M A; Edidin, A; Fishkin, Z; Mahoney, O M; Schmalzried, T P

    2003-05-01

    Rotational stresses from box-post impingement have been implicated in the loosening of posterior-stabilized total knee prostheses. A bench model was constructed to assess the forces generated by tibiofemoral rotation. Rotational torque under load was measured in two different posteriorstabilized total knee prostheses using an axial-torsion load cell at 0 degrees, 20 degrees, and 40 degrees flexion over 20 degrees internal and external rotation. The Sigma posterior-stabilized prosthesis generated little torque through 5 degrees internal and external rotation. An increase in torque then occurred because of box-post impingement, generating peak torques of 17 to 18 N-m at 12 degrees to 14 degrees rotation. The bench model produced the same deformation of the polyethylene post as seen on retrieved specimens. The Scorpio posterior-stabilized prosthesis had a relatively continuous rise in generated torque from tibiofemoral conformity. Box-post impingement did not occur resulting in 32% lower torque between 12 degrees and 14 degrees rotation. Peak rotational torques of 15 to 16 N-m were reached at 19 degrees to 20 degrees rotation. Tibiofemoral conformity is the primary source of rotational constraint. Box-post impingement can be a source of additional rotational constraint. Depending on specific design features, small changes in relative tibiofemoral component rotation can more than double the generated torque. Axial rotation of the knee in vivo can generate substantial torque. Relative tibiofemoral rotational position is an important factor influencing component function and fixation.

  8. 3D intersegmental knee loading in below-knee amputees across steady-state walking speeds.

    Science.gov (United States)

    Fey, Nicholas P; Neptune, Richard R

    2012-05-01

    Unilateral below-knee amputees often develop comorbidities that include knee joint disorders (e.g., intact leg knee osteoarthritis), with the mechanisms leading to these comorbidities being poorly understood. Mechanical knee loading of non-amputees has been associated with joint disorders and shown to be influenced by walking speed. However, the relationships between amputee knee loading and speed have not been identified. This study examined three-dimensional mechanical knee loading of amputees across a wide range of steady-state walking speeds. Fourteen amputees and 10 non-amputee control subjects were analyzed at four overground walking speeds. At each speed, intersegmental joint moment and force impulses (i.e., time-integrals over the stance phase) were compared between the control, intact and residual knees using repeated-measures ANOVAs. There were no differences in joint force impulses between the intact and control knees. The intact knee abduction moment impulse was lower than the non-amputees at 0.6 and 0.9 m/s. The intact knee flexion moment impulses at 0.6, 1.2 and 1.5m/s and knee external rotation moment impulses at all speeds were greater than the residual knee. The residual knee extension moment and posterior force impulses were insensitive to speed increases, while these quantities increased in intact and control knees. These results suggest the intact knees of asymptomatic and relatively new amputees are not overloaded during walking compared to non-amputees. Increased knee loads may develop in response to prolonged prosthesis usage or joint disorder onset. Further study is needed to determine if the identified bilateral loading asymmetries across speeds lead to diminished knee joint health. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Nottingham knee osteoarthritis risk prediction models.

    Science.gov (United States)

    Zhang, Weiya; McWilliams, Daniel F; Ingham, Sarah L; Doherty, Sally A; Muthuri, Stella; Muir, Kenneth R; Doherty, Michael

    2011-09-01

    (1) To develop risk prediction models for knee osteoarthritis (OA) and (2) to estimate the risk reduction that results from modification of potential risk factors. This was a 12-year retrospective cohort study undertaken in the general population in Nottingham, UK. Baseline risk factors were collected by questionnaire. Incident radiographic knee OA was defined by Kellgren and Lawrence (KL) score ≥2. Incident symptomatic knee OA was defined by KL ≥2 plus knee pain. Progression of knee OA was defined by KL ≥1 grade increase from baseline. A logistic regression model was used for prediction. Calibration and discrimination of the models were tested in the Osteoarthritis Initiative (OAI) population and Genetics of Osteoarthritis and Lifestyle (GOAL) population. ORs of the models were compared with those obtained from meta-analysis of existing literature. From a community sample of 424 people aged over 40, 3 risk prediction models were developed. These included incidence of radiographic knee OA, incidence of symptomatic knee OA and progression of knee OA. All models had good calibration and moderate discrimination power in OAI and GOAL. The ORs lied within the 95% CIs of the published studies. The risk reduction due to modifying obesity at the individual and the population levels were demonstrated. Risk prediction of knee OA based on the well established, common modifiable risk factors has been established. The models may be used to predict the risk of knee OA, and risk reduction due to preventing a specific risk factor.

  10. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis.

    Science.gov (United States)

    Cudejko, Tomasz; van der Esch, Martin; van der Leeden, Marike; van den Noort, Josien C; Roorda, Leo D; Lems, Willem; Twisk, Jos; Steultjens, Martijn; Woodburn, James; Harlaar, Jaap; Dekker, Joost

    2017-12-01

    We aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA). Forty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace. Wearing a soft brace significantly reduced pain during level walking (B - 0.60, P = 0.001) and perturbed walking (B - 0.80, P self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P confidence in the knees during level walking (OR 0.45, P self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life. trialregister.nl, NTR6363 . Retrospectively registered on 15 May 2017.

  11. Arthroscopic knee anatomy in young achondroplasia patients

    Science.gov (United States)

    del Pilar Duque Orozco, M.; Record, N. C.; Rogers, K. J; Bober, M. B.; Mackenzie, W. G.; Atanda, A.

    2017-01-01

    Abstract Purpose Achondroplasia is the most common form of skeletal dysplasia, affecting more than 250 000 individuals worldwide. In these patients, the developing knee undergoes multiple anatomical changes. The purpose of this study was to characterise the intra-articular knee anatomy in children with achondroplasia who underwent knee arthroscopy. Methods Records of achondroplasia patients who underwent knee arthroscopy between 2009 and 2014 were reviewed. Demographic data, operative reports, follow-up notes, MRI and arthroscopy images were reviewed. Bony, cartilaginous and ligamentous changes were noted. The trochlea sulcus angle was measured from intra-operative arthroscopic images. Results A total of 12 knee arthroscopies in nine patients were performed. The mean age at surgery was 16.9 years (12 to 22). In all patients, the indication for surgery was knee pain and/or mechanical symptoms that were refractory to non-operative treatment. Three anatomical variations involving the distal femur were found in all knees: a deep femoral trochlea; a high A-shaped intercondylar notch; and a vertically oriented anterior cruciate ligament. The average trochlea sulcus angle measured 123°. Pathology included: synovial plica (one knee); chondral lesions (three knees); discoid lateral meniscus (11 knees); and meniscal tears (six knees). All patients were pain-free and returned to normal activity at final follow-up. Conclusion Children with achondroplasia have characteristic distal femur anatomy noted during knee arthroscopy. These variations should be considered normal during knee arthroscopy in these patients. Arthroscopic findings confirmed previous MRI findings within this specific population with the addition of a deep trochlear groove which was not previously reported. PMID:28828058

  12. The database for reaching experiments and models.

    Directory of Open Access Journals (Sweden)

    Ben Walker

    Full Text Available Reaching is one of the central experimental paradigms in the field of motor control, and many computational models of reaching have been published. While most of these models try to explain subject data (such as movement kinematics, reaching performance, forces, etc. from only a single experiment, distinct experiments often share experimental conditions and record similar kinematics. This suggests that reaching models could be applied to (and falsified by multiple experiments. However, using multiple datasets is difficult because experimental data formats vary widely. Standardizing data formats promises to enable scientists to test model predictions against many experiments and to compare experimental results across labs. Here we report on the development of a new resource available to scientists: a database of reaching called the Database for Reaching Experiments And Models (DREAM. DREAM collects both experimental datasets and models and facilitates their comparison by standardizing formats. The DREAM project promises to be useful for experimentalists who want to understand how their data relates to models, for modelers who want to test their theories, and for educators who want to help students better understand reaching experiments, models, and data analysis.

  13. Primary total knee arthroplasty for acute fracture around the knee.

    Science.gov (United States)

    Parratte, S; Ollivier, M; Argenson, J-N

    2018-02-01

    Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high

  14. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort

    NARCIS (Netherlands)

    van der Esch, M.; Knoop, J.; van der Leeden, M.; Voorneman, R.; Gerritsen, M.; Reiding, D.; Romviel, S.; Knol, D.L.; Lems, W.F.; Dekker, J.; Roorda, L.D.

    2012-01-01

    The objective of this study was to evaluate whether self-reported knee instability is associated with activity limitations in patients with knee osteoarthritis (OA), in addition to knee pain and muscle strength. A cohort of 248 patients diagnosed with knee OA was examined. Self-reported knee

  15. 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 Bøgh

    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...

  16. EFFECTS OF A CUSTOM-MADE HINGED KNEE BRACE WITH KNEE FLEXION SUPPORT FOR PATIENTS WITH KNEE OSTEOARTHRITIS:A PRELIMINARY STUDY

    Science.gov (United States)

    OTA, SUSUMU; KANAI, AKIRA; TORII, YOSHIYA; TANIYAMA, HIROYUKI; IMAIZUMI, FUMIO; MATSUI, YASUMOTO

    2015-01-01

    ABSTRACT A knee brace for medial knee osteoarthritis (OA) is required to restrict knee adduction moment (KAM), but must not restrict knee flexion during swing phase. There is no report of a knee brace with both functions. The purpose of this study is to investigate the effect of the custom-made hinged knee brace for patients with knee OA compared to the hinged knee brace generally used, and to assess the KAM and knee flexion angle during swing phase. Fifteen patients (average age: 71.6 ± 7.8 years old) with medial knee OA participated. Gait analysis was performed using a 3-D motion analysis system to measure two conditions: hinged knee brace (KB), and a custom-made hinged knee brace with knee-flexion support- equipped rubber tubes at the posterior of the lateral and medial side poles (KBF). The peak KAM with KBF was significantly smaller than those with the KB (P=0.004, the difference between these conditions of KAM: 0.06 Nm/kg). The peak knee flexion angles during swing phase with KBF were also significantly larger than those with the KB (P=0.004, the difference between these conditions of knee flexion angle: 1.5 degrees). The custom-made brace with one type of tube actuator in the present study could decrease KAM and make for a small increase of knee flexion angle as opposed to the hinged knee brace. PMID:25797974

  17. Magnetic resonance imaging-based cartilage loss in painful contralateral knees with and without radiographic joint space narrowing: Data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Eckstein, Felix; Benichou, Olivier; Wirth, Wolfgang; Nelson, David R; Maschek, Susanne; Hudelmaier, Martin; Kwoh, C Kent; Guermazi, Ali; Hunter, David

    2009-09-15

    To determine by magnetic resonance imaging (MRI), whether knees with advanced radiographic disease (medial joint space narrowing [mJSN]) encounter greater longitudinal cartilage loss than contralateral knees with earlier disease (no or less mJSN). Participants were selected from 2,678 cases in the Osteoarthritis Initiative, based on exhibition of bilateral pain, body mass index >25 (kg/m(2)), mJSN in 1 knee, no or less mJSN in the contralateral knee, and no lateral JSN in both knees. Eighty participants (mean +/- SD age 60.6 +/- 9.1 years) fulfilled these criteria. Medial tibial and femoral cartilage morphology was analyzed from the baseline and the 1-year followup MRI (sagittal double echo at steady state by 3.0T) of both knees by experienced readers blinded to the time point and mJSN status. Knees with more radiographic mJSN displayed greater medial cartilage loss (-80 mum) assessed by MRI than contralateral knees with less mJSN (-57 mum). The difference reached statistical significance in participants with an mJSN grade of 2 or 3 (P = 0.005-0.08), but not in participants with an mJSN grade of 1 (P = 0.28-0.98). In knees with more mJSN, cartilage loss increased with higher grades of mJSN (P = 0.003 in the medial femur). Knees with an mJSN grade of 2 or 3 displayed greater cartilage loss in the weight-bearing medial femur than in the posterior femur or in the medial tibia (P = 0.048). Knees with advanced mJSN displayed greater cartilage loss than contralateral knees with less mJSN. These data suggest that radiography can be used to stratify fast structural progressors, and that MRI cartilage thickness loss is more pronounced at advanced radiographic disease stage.

  18. Hanford Reach - Ringold Russian Knapweed Treatment

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Increase the diversity of the seed mix on approximately 250 acres in the Ringold Unit of the Hanford Reach National Monument (Monument) treated with aminopyralid as...

  19. Reaching the Overlooked Student in Physical Education

    Science.gov (United States)

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad

    2015-01-01

    This article describes the use of live action role-playing, or "LARPing," as a non-traditional activity that has the potential to reach students who are not interested in traditional physical education.

  20. An ultrasound score for knee osteoarthritis

    DEFF Research Database (Denmark)

    Riecke, B F; Christensen, R.; Torp-Pedersen, S

    2014-01-01

    OBJECTIVE: To develop standardized musculoskeletal ultrasound (MUS) procedures and scoring for detecting knee osteoarthritis (OA) and test the MUS score's ability to discern various degrees of knee OA, in comparison with plain radiography and the 'Knee injury and Osteoarthritis Outcome Score' (KOOS......) domains as comparators. METHOD: A cross-sectional study of MUS examinations in 45 patients with knee OA. Validity, reliability, and reproducibility were evaluated. RESULTS: MUS examination for knee OA consists of five separate domains assessing (1) predominantly morphological changes in the medial...... coefficients ranging from 0.75 to 0.97 for the five domains. Construct validity was confirmed with statistically significant correlation coefficients (0.47-0.81, P knee OA. In comparison with standing radiographs...

  1. Difference between right and left side in total knee and unicondylar knee replacement: An interesting observation

    Directory of Open Access Journals (Sweden)

    Vasudevan Thirumal Selvan

    2005-02-01

    Full Text Available We report an observation made about the differences between right and left side in case of total knee and unicondylar knee replacement. It was found that unicondylar knee replacement was performed more commonly on the left side (66%, as compared to only 34% on right side, where as total knee replacement was more common on the right side (64% as compared to 36% on left side. The exact clinical utility of this difference is yet to be known.

  2. Guiding Warfare to Reach Sustainable Peace

    DEFF Research Database (Denmark)

    Vestenskov, David; Drewes, Line

    The conference report Guiding Warfare to Reach Sustainable Peace constitutes the primary outcome of the conference It is based on excerpts from the conference presenters and workshop discussions. Furthermore, the report contains policy recommendations and key findings, with the ambition of develo......The conference report Guiding Warfare to Reach Sustainable Peace constitutes the primary outcome of the conference It is based on excerpts from the conference presenters and workshop discussions. Furthermore, the report contains policy recommendations and key findings, with the ambition...

  3. Vitamin D deficiency is associated with progression of knee osteoarthritis

    National Research Council Canada - National Science Library

    Zhang, Fang Fang; Driban, Jeffrey B; Lo, Grace H; Price, Lori Lyn; Booth, Sarah; Eaton, Charles B; Lu, Bing; Nevitt, Michael; Jackson, Becky; Garganta, Cheryl; Hochberg, Marc C; Kwoh, Kent; McAlindon, Timothy E

    2014-01-01

    Knee osteoarthritis causes functional limitation and disability in the elderly. Vitamin D has biological functions on multiple knee joint structures and can play important roles in the progression of knee osteoarthritis...

  4. Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty

    OpenAIRE

    Heyse, Thomas J.; El-Zayat, Bilal F.; De Corte, Ronny; Scheys, Lennart; Chevalier, Yan; Fuchs-Winkelmann, Susanne; Labey, Luc

    2014-01-01

    Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this.

  5. Reverse Anterolateral Thigh Flap to Revise a Below-knee Amputation Stump at the Mid-tibial Level

    Directory of Open Access Journals (Sweden)

    Parviz Lionel Sadigh, MB ChB

    2013-12-01

    Full Text Available Summary: The reconstruction of defects around the knee often poses a challenge due to the limited availability of local soft tissues. Indeed, this same problem is encountered when attempting to revise a below-knee amputation stump. Moreover, due to a paucity of recipient vessels in those who have undergone previous amputation secondary to trauma, free-flap reconstruction is often challenging and not always successful. We report a case of a reverse anterolateral thigh (ALT flap used to revise a long below-knee amputation stump. Previous reports in the literature attest to the versatility of the reverse ALT to cover defects around the knee and proximal tibia, but to our knowledge, this is the first report of a reverse ALT reaching to the mid-tibial level.

  6. Ultrasonographic Diagnosis of the Knee

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Il; Cho, Kil Ho [Dept. of Radiology, College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Kim, Mi Jeong [Dept. of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2012-06-15

    Knee ultrasonography is a feasible and useful diagnostic method not only for the evaluation of periarticular soft tissues but also for intra-articular lesions and for the diagnosis of tumorous disease. Joint effusion, synovial thickening, intra-articular loose bodies, bursal and/or other fluid collection, ganglionic cysts, ligament and tendon injuries, tendinosis, osteomyelitis, and symptoms related to metallic hardware can be diagnosed using ultrasonography.

  7. Basic biomechanic principles of knee instability

    OpenAIRE

    Zlotnicki, Jason P.; Naendrup, Jan-Hendrik; Ferrer, Gerald A.; Debski, Richard E.

    2016-01-01

    Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a...

  8. Knee Pain in a Renal Transplant Patient

    Science.gov (United States)

    2017-04-26

    HUBBARD FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 25 APR 2017 1. Your paper, entitled Knee Pain In A Renal T ransplant Patient...MATERIAL TO BE PUBLISHED OR PRESENTED: Knee Pain in a Renal Transplant Patient 7. FUNDING RECEIVED FOR THIS STUDY? 0 YES IZJNO FUNDING SOURCE: 8. DO...41-108 PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 3 Pages Title: Knee Pain in a Rena l Transplant Patient Authors: Matthew Hubbard, DO. Liem

  9. A prosthetic knee using magnetorhelogical fluid damper for above-knee amputees

    Science.gov (United States)

    Park, Jinhyuk; Choi, Seung-Bok

    2015-04-01

    A prosthetic knee for above-knee (AK) amputees is categorized into two types; namely a passive and an active type. The passive prosthetic knee is generally made by elastic materials such as carbon fiber reinforced composite material, titanium and etc. The passive prosthetic knee easy to walk. But, it has disadvantages such that a knee joint motion is not similar to ordinary people. On the other hand, the active prosthetic knee can control the knee joint angle effectively because of mechanical actuator and microprocessor. The actuator should generate large damping force to support the weight of human body. But, generating the large torque using small actuator is difficult. To solve this problem, a semi-active type prosthetic knee has been researched. This paper proposes a semi-active prosthetic knee using a flow mode magneto-rheological (MR) damper for AK amputees. The proposed semi-active type prosthetic knee consists of the flow mode MR damper, hinge and prosthetic knee body. In order to support weight of human body, the required energy of MR damper is smaller than actuator of active prosthetic leg. And it can control the knee joint angle by inducing the magnetic field during the stance phase.

  10. How does knee pain affect trunk and knee motion during badminton forehand lunges?

    Science.gov (United States)

    Huang, Ming-Tung; Lee, Hsing-Hsan; Lin, Cheng-Feng; Tsai, Yi-Ju; Liao, Jen-Chieh

    2014-01-01

    Badminton requires extensive lower extremity movement and a precise coordination of the upper extremity and trunk movements. Accordingly, this study investigated motions of the trunk and the knee, control of dynamic stability and muscle activation patterns of individuals with and without knee pain. Seventeen participants with chronic knee pain and 17 healthy participants participated in the study and performed forehand forward and backward diagonal lunges. This study showed that those with knee pain exhibited smaller knee motions in frontal and horizontal planes during forward lunge but greater knee motions in sagittal plane during backward lunge. By contrast, in both tasks, the injured group showed a smaller value on the activation level of the paraspinal muscles in pre-impact phase, hip-shoulder separation angle, trunk forward inclination range and peak centre of mass (COM) velocity. Badminton players with knee pain adopt a more conservative movement pattern of the knee to minimise recurrence of knee pain. The healthy group exhibit better weight-shifting ability due to a greater control of the trunk and knee muscles. Training programmes for badminton players with knee pain should be designed to improve both the neuromuscular control and muscle strength of the core muscles and the knee extensor with focus on the backward lunge motion.

  11. Variable stiffness actuated prosthetic knee to restore knee buckling during stance: a modeling study

    NARCIS (Netherlands)

    Wentink, E.C.; Koopman, Hubertus F.J.M.; Stramigioli, Stefano; Rietman, Johan Swanik; Veltink, Petrus H.

    Most modern intelligent knee prosthesis use dampers to modulate dynamic behavior and prevent excessive knee flexion, but they dissipate energy and do not assist in knee extension. Energy efficient variable stiffness control (VSA) can reduce the energy consumption yet effectively modulate the dynamic

  12. Knee extension and flexion weakness in people with knee osteoarthritis: is antagonist cocontraction a factor?

    Science.gov (United States)

    Heiden, Tamika L; Lloyd, David G; Ackland, Timothy R

    2009-11-01

    Controlled laboratory study, cross-sectional data. To investigate isometric knee flexion and extension strength, failure of voluntary muscle activation, and antagonist cocontraction of subjects with knee osteoarthritis (OA) compared with age-matched asymptomatic control subjects. Quadriceps weakness is a common impairment in individuals with knee OA. Disuse atrophy, failure of voluntary muscle activation, and antagonist muscle cocontraction are thought to be possible mechanisms underlying this weakness; but antagonist cocontraction has not been examined during testing requiring maximum voluntary isometric contraction. Fifty-four subjects with knee OA (mean +/- SD age, 65.6 +/- 7.6 years) and 27 similarly aged control subjects (age, 64.2 +/- 5.1 years) were recruited for this study. Isometric knee flexion and extension strength were measured, and electromyographic data were recorded, from 7 muscles crossing the knee and used to calculate cocontraction ratios during maximal effort knee flexion and extension trials. The burst superimposition technique was used to measure failure of voluntary activation. Knee extension strength of subjects with knee OA (mean +/- SD, 115.9 +/- 6.7 Nm) was significantly lower than for those in the control group (152.3 +/- 9.6 Nm). No significant between-group difference was found for failure of voluntary muscle activation, or the cocontraction ratios during maximum effort knee flexion or extension. These results demonstrate that the reduction in isometric extension strength, measured with a 90 degrees knee flexion angle, in subjects with knee OA is not associated with increased antagonist cocontraction.

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

    DEFF Research Database (Denmark)

    Henriksen, Marius; Graven-Nielsen, Thomas; 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 progress...

  14. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Lluch, Enrique; Nijs, Jo; Courtney, Carol A

    2017-01-01

    and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal......BACKGROUND: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. AIM: The objective of this perspective is to design a set...... of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. METHODS: A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement...

  15. Impact of Canadian tobacco packaging policy on quitline reach and reach equity.

    Science.gov (United States)

    Baskerville, N Bruce; Hayward, Lynda; Brown, K Stephen; Hammond, David; Kennedy, Ryan David; Campbell, H Sharon

    2015-12-01

    To examine the impact of the new Canadian tobacco package warning labels with a quitline toll-free phone number for seven provincial quitlines, focusing on treatment reach and reach equity in selected vulnerable groups. A quasi-experimental design assessed changes in new incoming caller characteristics, treatment reach for selected vulnerable sub-populations and the extent to which this reach is equitable, before and after the introduction of the labels in June, 2012. Administrative call data on smokers were collected at intake. Pre- and post-label treatment reach and reach equity differences were analysed by comparing the natural logarithms of the reach and reach equity statistics. During the six months following the introduction of the new warning labels, 86.4% of incoming new callers indicated seeing the quitline number on the labels. Treatment reach for the six-month period significantly improved compared to the same six-month period the year before from .042% to .114% (p<.0001) and reach equity significantly improved for young males (p<.0001) and those with high school education or less (p=.004). The introduction of the new tobacco warning labels with a quitline toll-free number in Canada was associated with an increase in treatment reach. The toll-free number on tobacco warning labels aided in reducing tobacco related inequalities, such as improved reach equity for young males and those with high school or less education. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Posteromedial corner injuries of the knee

    Energy Technology Data Exchange (ETDEWEB)

    House, C.V. [Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom) and Institute of Orthopaedics and Musculoskeletal Sciences, Stanmore (United Kingdom)]. E-mail: charles.house@uclh.nhs.uk; Connell, D.A. [Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom); Institute of Orthopaedics and Musculoskeletal Sciences, Stanmore (United Kingdom); Saifuddin, A. [Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom); Institute of Orthopaedics and Musculoskeletal Sciences, Stanmore (United Kingdom)

    2007-06-15

    Magnetic resonance imaging (MRI) depicts in exquisite detail the supporting structures of the posteromedial corner of the knee. This musculoligamentous unit plays a central role as a dynamic stabilizer of the knee joint and the recognition of injury to the posteromedial corner carries important implications in terms of management and prognosis, most particularly in the anterior cruciate ligament-deficient knee. This article provides a resume of the functional anatomy of the posteromedial corner of the knee as seen with MRI and follows with a review of the MRI appearances of injury to the posteromedial corner.

  17. Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden.

    Science.gov (United States)

    Mattila, Ville M; Sihvonen, Raine; Paloneva, Juha; Felländer-Tsai, Li

    2016-02-01

    Knee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden. We conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012. In Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 10(5) person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 10(5) person-years in 1997 to 97 per 10(5) person-years in 2012, but not in Sweden. The incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.

  18. Knee Joint Stabilization Therapy in Patients with Osteoarthritis of the Knee and Knee Instability: Subgroup Analyses in A Randomized, Controlled Trial

    NARCIS (Netherlands)

    Knoop, J.; van der Leeden, M.; Roorda, L.D.; Thorstensson, C.A.; van der Esch, M.; Peter, W.F.; de Rooij, M.; Lems, W.F.; Dekker, J.; Steultjens, M.P.M.

    2014-01-01

    Objective: To test whether knee stabilization therapy, prior to strength/functional training, may have added value in reducing activity limitations only in patients with knee osteoarthritis who have knee instability and (i) low upper leg muscle strength, (ii) impaired knee proprioception, (iii) high

  19. Immediate effects of an elastic knee sleeve on frontal plane gait biomechanics in knee osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Raphael Schween

    Full Text Available Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics.18 subjects (8 women, 10 men with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests.With the sleeve, knee adduction angle at ground contact was reduced by 1.9 ± 2.1° (P = 0.006. Peak knee adduction was reduced by 1.5 ± 1.6° (P = 0.004. The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74 ± 0.9 Nm • kg-1; P = 0.002 and 12.9% (0.28 ± 0.3 Nm • s • kg-1; P < 0.004, respectively.Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup.

  20. Quadriceps tendon pie-crusting release of stiff knees in total knee arthroplasty.

    Science.gov (United States)

    Zhang, Yu; Ye, Lu-you; Liu, Hai-xiao; Wen, Hong

    2015-07-01

    Traditional treatments for stiff knees, such as quadriceps snip and V-Y quadricepsplasty, require extensive soft tissue exposure and lead to recurrent poor arc of motion and a permanent extensor lag. In this study, we evaluated the effect of the quadriceps tendon pie-crusting release for treating limited knee flexion in total knee arthroplasty (TKA) and compared the outcomes of two surgical approaches. Sixteen knees with severe osteoarthritis were treated with TKA using either a midvastus (eight knees) or parapatellar (eight knees) approach. Quadriceps tendon pie-crusting release was performed after fixation of the knee prosthesis. Maximum knee flexion, Knee Society Score (KSS), and quadriceps strength were recorded and compared between the two surgical approach groups at different time points. The average maximum flexion angle of the knee increased from 40.6 ± 11.8 preoperatively to 63.1 ± 8.4 after fixation of the knee prosthesis in the midvastus group and from 38.8 ± 10.3 to 65.6 ± 9.0 in the parapatellar group. TKA did not lead to adequate correction of extension contracture in these stiff knees. The quadriceps tendon pie-crusting release further improved knee flexion by 35.0 ± 4.6 and 25.6 ± 4.2 in the midvastus and parapatellar groups, respectively (p pie-crusting release technique was an effective procedure for improving knee flexion in cases of stiff knee. The midvastus approach maintained the integrity of the extensor mechanism and resulted in better outcomes than the parapatellar approach.

  1. Quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis – data from the Osteoarthritis Initiative

    Science.gov (United States)

    Emmanuel, K.; Quinn, E.; Niu, J.; Guermazi, A.; Roemer, F.; Wirth, W.; Eckstein, F.; Felson, D.

    2017-01-01

    SUMMARY Objective To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease. Methods 206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade ≥1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year [Y] 1/2) and late (Y3/4) incidence was performed. Results Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4. Conclusion Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA. PMID:26318658

  2. Do working environment interventions reach shift workers?

    Science.gov (United States)

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene; Clausen, Thomas

    2016-01-01

    Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. We used questionnaire data from 5361 female care workers in the Danish eldercare sector. The questions concerned usual working hours, quality of leadership, and self-reported implementation of workplace activities aimed at stress reduction, reorganization of the working hours, and participation in improvements of working procedures or qualifications. Compared with day workers, shift workers were less likely to be reached by workplace interventions. For example, night workers less frequently reported that they had got more flexibility (OR 0.5; 95 % CI 0.3-0.7) or that they had participated in improvements of the working procedures (OR 0.6; 95 % CI 0.5-0.8). Quality of leadership to some extent explained the lack of reach of interventions especially among fixed evening workers. In the light of the evidence of shift workers' stressful working conditions, we suggest that future studies focus on the generalizability of results of the present study and on how to reach this group and meet their needs when designing and implementing workplace interventions.

  3. Do working environment interventions reach shift workers?

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene

    2016-01-01

    workers were less likely to be reached by workplace interventions. For example, night workers less frequently reported that they had got more flexibility (OR 0.5; 95 % CI 0.3-0.7) or that they had participated in improvements of the working procedures (OR 0.6; 95 % CI 0.5-0.8). Quality of leadership......PURPOSE: Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether...... the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. METHODS: We used questionnaire data from 5361 female care workers in the Danish eldercare sector...

  4. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement

    National Research Council Canada - National Science Library

    Williamson, L; Wyatt, M. R; Yein, K; Melton, J. T. K

    2007-01-01

    Objective. To evaluate the effects of standardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty. Methods...

  5. Knee joint stabilization therapy in patients with osteoarthritis of the knee and knee instability: subgroup analyses in a randomized, controlled trial.

    Science.gov (United States)

    Knoop, Jesper; van der Leeden, Marike; Roorda, Leo D; Thorstensson, Carina A; van der Esch, Martin; Peter, Wilfred F; de Rooij, Mariëtte; Lems, Willem F; Dekker, Joost; Steultjens, Martijn P M

    2014-07-01

    To test whether knee stabilization therapy, prior to strength/functional training, may have added value in reducing activity limitations only in patients with knee osteoarthritis who have knee instability and (i) low upper leg muscle strength, (ii) impaired knee proprioception, (iii) high knee laxity, or (iv) frequent episodes of knee instability. Subgroup analyses in a randomized controlled trial comparing 2 exercise programmes (with/without knee stabilization therapy) (STABILITY; NTR1475). Participants from the STABILITY-trial with clinical knee osteoarthritis and knee instability (n = 159). Effect modification by upper leg muscle strength, knee proprioception, knee laxity, and patient-reported knee instability were determined using the interaction terms "treatment group subgroup factor", with the outcome measures WOMAC physical function (primary), numeric rating scale pain and the Get up and Go test (secondary). Effect modification by muscle strength was found for the primary outcome (p = 0.01), indicating that patients with greater muscle strength tend to benefit more from the experimental programme with additional knee stabilization training, while patients with lower muscle strength benefit more from the control programme. Knee stabilization therapy may have added value in patients with instability and strong muscles. Thus it may be beneficial if exercises target muscle strength prior to knee stabilization.

  6. Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial.

    Science.gov (United States)

    Knoop, J; Dekker, J; van der Leeden, M; van der Esch, M; Thorstensson, C A; Gerritsen, M; Voorneman, R E; Peter, W F; de Rooij, M; Romviel, S; Lems, W F; Roorda, L D; Steultjens, M P M

    2013-08-01

    To investigate whether an exercise program, initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only, in reducing activity limitations in patients with knee osteoarthritis (OA) and instability of the knee joint. A single-blind, randomized, controlled trial involving 159 knee OA patients with self-reported and/or biomechanically assessed knee instability, randomly assigned to two treatment groups. Both groups received a supervised exercise program for 12 weeks, consisting of muscle strengthening exercises and training of daily activities, but only in the experimental group specific knee joint stabilization training was provided. Outcome measures included activity limitations (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function, primary outcome), pain, global perceived effect and knee stability. Both treatment groups demonstrated large (∼20-40%) and clinically relevant reductions in activity limitations, pain and knee instability, which were sustained 6 months post-treatment. No differences in effectiveness between experimental and control treatment were found on WOMAC physical function (B (95% confidence interval - CI) = -0.01 (-2.58 to 2.57)) or secondary outcome measures, except for a higher global perceived effect in the experimental group (P = 0.04). Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee. In knee OA patients suffering from knee instability, specific knee joint stabilization training, in addition to muscle strengthening and functional exercises, does not seem to have any additional value. Dutch Trial Register (NTR) registration number: NTR1475. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier

  7. KNEE-JOINT LOADING IN KNEE OSTEOARTHRITIS: INFLUENCE OF ABDOMINAL AND THIGH FAT

    Science.gov (United States)

    Messier, Stephen P.; Beavers, Daniel P.; Loeser, Richard F.; Carr, J. Jeffery; Khajanchi, Shubham; Legault, Claudine; Nicklas, Barbara J.; Hunter, David J.; DeVita, Paul

    2014-01-01

    Purpose Using three separate models that included total body mass, total lean and total fat mass, and abdominal and thigh fat as independent measures, we determined their association with knee-joint loads in older overweight and obese adults with knee osteoarthritis (OA). Methods Fat depots were quantified using computed tomography and total lean and fat mass determined with dual energy x-ray absorptiometry in 176 adults (age = 66.3 yr., BMI = 33.5 kg·m−2) with radiographic knee OA. Knee moments and joint bone-on-bone forces were calculated using gait analysis and musculoskeletal modeling. Results Higher total body mass was significantly associated (p ≤ 0.0001) with greater knee compressive and shear forces, compressive and shear impulses (p knee extensor moments (p = 0.003). Regression analysis with total lean and total fat mass as independent variables revealed significant positive associations of total fat mass with knee compressive (p = 0.0001), shear (p knee extension moment (p = 0.008). Gastrocnemius and quadriceps forces were positively associated with total fat mass. Total lean mass was associated with knee compressive force (p = 0.002). A regression model that included total thigh and total abdominal fat found both were significantly associated with knee compressive and shear forces (p ≤ 0.04). Thigh fat was associated with the knee abduction (p = 0.03) and knee extension moment (p = 0.02). Conclusions Thigh fat, consisting predominately of subcutaneous fat, had similar significant associations with knee joint forces as abdominal fat despite its much smaller volume and could be an important therapeutic target for people with knee OA. PMID:25133996

  8. Prophylactic Knee Braces: Where Do They Stand?

    Science.gov (United States)

    McCarthy, Paul

    1988-01-01

    The effectiveness of knee braces in preventing knee injuries in football is inconclusive. This article reviews research from epidemiologic, cadaver, and surrogate studies; discusses reasons for conflicting study results, including research design problems; and describes alternative approaches that have been suggested. (IAH)

  9. Knee injury patterns in young irish dancers.

    Science.gov (United States)

    Beasley, Michael A; Stracciolini, Andrea; Tyson, Kesley D; Stein, Cynthia J

    2014-06-01

    To characterize knee injury patterns in Irish dancers. A retrospective chart review was performed for Irish dancers under age 19 who presented with knee injuries to the sports medicine or orthopedic clinic from January 1, 2000 to December 31, 2010. Data were collected on all knee injuries partially or directly related to Irish dance. Injury was defined as dance-related pain or damage to the structures in the knee that resulted in evaluation in the clinic. Survey data were collected to determine the number of different schools/studios represented by the dancers in the study. Sixty-seven Irish dancers with 86 knee injuries were evaluated. Half (50.7%) of these patients received more than one diagnosis during these visits. Overuse injuries accounted for 90.7% of knee injuries. Time to presentation ranged from less than 1 week to over 1 year. There was a significant difference in time to presentation, with traumatic injuries being evaluated sooner than overuse injuries. The most common diagnoses, accounting for 53.5% of injuries, were patellar tracking disorders, including patellofemoral syndrome, hypermobile patella, and patellar subluxation. In Irish dance overuse injuries represent the great majority of knee injuries, and patellofemoral tracking disorders are the most common diagnosis. For many dancers, there is often a delay of weeks to months between the onset of symptoms and evaluation in clinic. Prevention programs could potentially eliminate a large portion of knee pain experienced by young Irish dancers.

  10. Basic biomechanic principles of knee instability.

    Science.gov (United States)

    Zlotnicki, Jason P; Naendrup, Jan-Hendrik; Ferrer, Gerald A; Debski, Richard E

    2016-06-01

    Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.

  11. Current Surgical Treatment of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Karolin Rönn

    2011-01-01

    Full Text Available Osteoathritis (OA of the knee is common, and the chances of suffering from OA increase with age. Its treatment should be initially nonoperative—and requires both pharmacological and nonpharmacological treatment modalities. If conservative therapy fails, surgery should be considered. Surgical treatments for knee OA include arthroscopy, cartilage repair, osteotomy, and knee arthroplasty. Determining which of these procedures is most appropriate depends on several factors, including the location, stage of OA, comorbidities on the one side and patients suffering on the other side. Arthroscopic lavage and débridement is often carried out, but does not alter disease progression. If OA is limited to one compartment, unicompartmental knee arthroplasty or unloading osteotomy can be considered. They are recommended in young and active patients in regard to the risks and limited durability of total knee replacement. Total arthroplasty of the knee is a common and safe method in the elderly patients with advanced knee OA. This paper summarizes current surgical treatment strategies for knee OA, with a focus on the latest developments, indications and level of evidence.

  12. Knee Braces to Prevent Injuries in Football.

    Science.gov (United States)

    Physician and Sportsmedicine, 1986

    1986-01-01

    Five physicians discuss the use of knee braces to prevent injuries in football players. Questions are raised regarding the strength and design of the braces, whether they prestress the knee in some cases, and whether they actually reduce injuries. More clinical and biomechanical research is called for. (MT)

  13. Observer-Based Human Knee Stiffness Estimation.

    Science.gov (United States)

    Misgeld, Berno J E; Luken, Markus; Riener, Robert; Leonhardt, Steffen

    2017-05-01

    We consider the problem of stiffness estimation for the human knee joint during motion in the sagittal plane. The new stiffness estimator uses a nonlinear reduced-order biomechanical model and a body sensor network (BSN). The developed model is based on a two-dimensional knee kinematics approach to calculate the angle-dependent lever arms and the torques of the muscle-tendon-complex. To minimize errors in the knee stiffness estimation procedure that result from model uncertainties, a nonlinear observer is developed. The observer uses the electromyogram (EMG) of involved muscles as input signals and the segmental orientation as the output signal to correct the observer-internal states. Because of dominating model nonlinearities and nonsmoothness of the corresponding nonlinear functions, an unscented Kalman filter is designed to compute and update the observer feedback (Kalman) gain matrix. The observer-based stiffness estimation algorithm is subsequently evaluated in simulations and in a test bench, specifically designed to provide robotic movement support for the human knee joint. In silico and experimental validation underline the good performance of the knee stiffness estimation even in the cases of a knee stiffening due to antagonistic coactivation. We have shown the principle function of an observer-based approach to knee stiffness estimation that employs EMG signals and segmental orientation provided by our own IPANEMA BSN. The presented approach makes realtime, model-based estimation of knee stiffness with minimal instrumentation possible.

  14. Efficacy of Glucosomine Iontophoresis in knee osteoarthritis ...

    African Journals Online (AJOL)

    The purpose of this study was to compare the relative efficacy of glucosamine iontophoresis with that of massage and a control group in managing osteoarthritic knee pain. Fifteen subjects with radiological evidence of knee osteoarthritis participated in this study. Participants were randomly assigned into three (3) groups; ...

  15. Knee arthroplasty: are patients' expectations fulfilled?

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Toksvig-Larsen, Sören; Roos, Ewa

    2009-01-01

    to pain and physical function after knee arthroplasty. PATIENTS AND METHODS: 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction...

  16. IBADAN KNEE/HIP OSTEOARTHRITIS OUTCOME MEASURE ...

    African Journals Online (AJOL)

    and psychometric properties.15 The Ibadan Knee/Hip. Osteoarthritis Outcome Measure was developed as an environment and culture friendly tool for the assessment of therapeutic interventions in Nigerian patients with osteoarthritis of the knee and/or hip. However, many of these published existing instruments do not have ...

  17. The smallest refrigerators can reach maximal efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Skrzypczyk, Paul; Brunner, Nicolas; Popescu, Sandu [H H Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol BS8 1TL (United Kingdom); Linden, Noah, E-mail: paul.skrzypczyk@bristol.ac.uk, E-mail: n.brunner@bristol.ac.uk [Department of Mathematics, University of Bristol, University Walk, Bristol BS8 1TW (United Kingdom)

    2011-12-09

    We investigate whether size imposes a fundamental constraint on the efficiency of small thermal machines. We analyse in detail a model of a small self-contained refrigerator consisting of three qubits. We show analytically that this system can reach the Carnot efficiency, thus demonstrating that there exists no complementarity between size and efficiency. (fast track communication)

  18. Enforcing order : Territorial reach and maritime piracy

    NARCIS (Netherlands)

    Daxecker, U.; Prins, B.C.

    2015-01-01

    Existing studies of piracy focus attention on the institutional determinants of maritime piracy, but neglect variation in governments’ reach over territory. We argue that the effect of state capacity on piracy is a function of states’ ability to extend authority over the country’s entire territory.

  19. ATLAS Barrel Toroid magnet reached nominal field

    CERN Multimedia

    2006-01-01

     On 9 November the barrel toroid magnet reached its nominal field of 4 teslas, with an electrical current of 21 000 amperes (21 kA) passing through the eight superconducting coils as shown on this graph

  20. REACH. Electricity Units, Post-Secondary.

    Science.gov (United States)

    Smith, Gene; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this postsecondary student manual contains individualized instructional units in the area of electricity. The instructional units focus on electricity fundamentals, electric motors, electrical components, and controls and installation.…

  1. Improving exposure scenario definitions within REACH

    DEFF Research Database (Denmark)

    Lee, Jihyun; Pizzol, Massimo; Thomsen, Marianne

    the different background exposure between two countries allows in fact the definition of a common framework for improving exposure scenarios within REACH system, for monitoring environmental health, and for increasing degree of circularity of resource and substance flows. References 1. European Commission...

  2. [Jumper's knee--a review].

    Science.gov (United States)

    Tibesku, C O; Pässler, H H

    2005-06-01

    Jumper's knee has been defined as painful chronic overuse injury of the extensor mechanism of the knee joint. The disease has a high incidence in jumping sports and depends on training frequency and level of performance. Its natural course is protracted, repetitive, and often bilaterally occurring. Its etiology is a chronic overload of the knee extensor mechanism which is triggered by jumping sports (volleyball, basketball etc.) as well as different intrinsic (ligamentous laxity, Q-angle, patella height, tenderness, pattern of force development) and extrinsic dispositions (frequency of training, level of performance, hardness of underground). The place of pathology most often is the osteo-tendinous transition zone of the proximal patellar tendon. Histologic evaluation of the tendon showed that the disease is rather degenerative than inflammatory. The diagnosis is primarily based on the typical sports history, physical examination, and ultrasound. MRI is helpful in operation planning. Plain radiography, CT, and bone scans are used to rule out differential diagnoses. Therapy should be chosen according to the stage of the disease and usually starts with a non-surgical approach. This includes rest from sports activities, immobilisation, non-steroid antiphlogistics, para-tendinous cortisone injections, massage, electric therapy, ultrasound and extracorporal shock waves. Afterwards an increase of activities is begun (moderate training, adequate warm-up, ice cooling after activity, muscle stretching, eccentric strengthening of the quadriceps). Patella straps and soft insoles are used as prevention. Up to 42 % of patients need surgical therapy after failure of long-lasting non-surgical measures, carried out either open or arthroscopically. Surgical principles include excision of the para-tendon, excision of the degenerative tissue, resection of the lower patella pole, and longitudinal incisions into the tendon. Most patients are pain-free after surgery but return to sports

  3. Osteoarthritis of the knee after meniscal resection

    DEFF Research Database (Denmark)

    Paradowski, P T; Lohmander, L S; Englund, M

    2016-01-01

    OBJECTIVE: To determine prevalence, incidence and progression of radiographic knee osteoarthritis (OA) in a cohort of subjects with previous meniscectomy. METHODS: We assessed 221 subjects (177 men and 44 women) with weight bearing knee radiography twice (assessment A and B) with a follow-up time...... Kellgren and Lawrence grade 2 or worse. RESULTS: At assessment A, we found tibiofemoral radiographic OA in 107 subjects' index knee (48%) of which 41 subjects (38%) had bilateral tibiofemoral OA. At assessment B, the corresponding figures were 151 (68%) and 71 (32%). At assessment A, we found...... patellofemoral OA in 32 subjects' index knee (14%) of which 11 (34%) had bilateral patellofemoral OA. At assessment B, the corresponding figures were 51 (23%) and 19 (37%). There was an increase of the sum of joint space narrowing (JSN) and osteophyte grades in the tibiofemoral joint of 144 subjects' index knee...

  4. Generalised joint hypermobility and knee joint hypermobility

    DEFF Research Database (Denmark)

    Junge, Tina; Henriksen, Peter; Hansen, Sebrina

    2017-01-01

    AIM: Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility...... (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult...... population. METHOD: This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. RESULTS: Total response rate was 49% (n = 1006). The prevalence of self...

  5. Transfemoral Amputation After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-01-01

    BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...

  6. Rothia prosthetic knee joint infection.

    Science.gov (United States)

    Trivedi, Manish N; Malhotra, Prashant

    2015-08-01

    Rothia species - Gram-positive pleomorphic bacteria that are part of the normal oral and respiratory flora - are commonly associated with dental cavities and periodontal disease although systemic infections have been described. We describe a 53-year-old female with rheumatoid arthritis complicated by prosthetic knee joint infection due to Rothia species, which was successfully treated by surgical removal of prosthesis and prolonged antimicrobial therapy. The issue of antibiotic prophylaxis before dental procedures among patients with prosthetic joint replacements is discussed. Copyright © 2012. Published by Elsevier B.V.

  7. Arthroscopic surgery for degenerative knee

    DEFF Research Database (Denmark)

    Thorlund, J B; Juhl, C B; Roos, E M

    2015-01-01

    . DATA SOURCES: Systematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms. ELIGIBILITY CRITERIA FOR SELECTING...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

  8. The associations between quadriceps muscle strength, power, and knee joint mechanics in knee osteoarthritis: A cross-sectional study.

    Science.gov (United States)

    Murray, Amanda M; Thomas, Abbey C; Armstrong, Charles W; Pietrosimone, Brian G; Tevald, Michael A

    2015-12-01

    Abnormal knee joint mechanics have been implicated in the pathogenesis and progression of knee osteoarthritis. Deficits in muscle function (i.e., strength and power) may contribute to abnormal knee joint loading. The associations between quadriceps strength, power and knee joint mechanics remain unclear in knee osteoarthritis. Three-dimensional motion analysis was used to collect peak knee joint angles and moments during the first 50% of stance phase of gait in 33 participants with knee osteoarthritis. Quadriceps strength and power were assessed using a knee extension machine. Strength was quantified as the one repetition maximum. Power was quantified as the peak power produced at 40-90% of the one repetition maximum. Quadriceps strength accounted for 15% of the variance in peak knee flexion angle (P=0.016). Quadriceps power accounted for 20-29% of the variance in peak knee flexion angle (Ppower at 90% of one repetition maximum accounted for 9% of the variance in peak knee adduction moment (P=0.05). These data suggest that quadriceps power explains more variance in knee flexion angle and knee adduction moment during gait in knee osteoarthritis than quadriceps strength. Additionally, quadriceps power at multiple loads is associated with knee joint mechanics and therefore should be assessed at a variety of loads. Taken together, these results indicate that quadriceps power may be a potential target for interventions aimed at changing knee joint mechanics in knee osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. The stationary configuration of the knee.

    Science.gov (United States)

    Kim, Wangdo; Veloso, Antonio P; Vleck, Veronica E; Andrade, Carlos; Kohles, Sean S

    2013-01-01

    Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear. We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion. These components include the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments and cartilage contact surfaces in the medial and lateral compartments. Their influence on the bony rotation about the instantaneous screw axis is governed by restraining forces along the constraints explored using the principle of reciprocity. Published kinetic and kinematic joint data (American Society of Mechanical Engineers Grand Challenge Competition to Predict In Vivo Knee Loads) are applied to define knee joint function for verification using an available instrumented knee data set. We found that the line of the ground reaction force (GRF) vector is very close to the axis of the knee joint. It aligns the knee joint with the GRF such that the reaction torques are eliminated. The reaction to the GRF will then be carried by the structural components of the knee instead. The use of this reciprocal system introduces a new dimension of foot loading to the knee axis alignment. This insight shows that locating knee functional axes is equivalent to the static alignment measurement. This method can be used for the optimal design of braces and orthoses for conservative treatment of knee osteoarthritis.

  10. Compliance With the AAOS Guidelines for Treatment of Osteoarthritis of the Knee: A Survey of the American Association of Hip and Knee Surgeons.

    Science.gov (United States)

    Carlson, Victor Rex; Ong, Alvin Chua; Orozco, Fabio Ramiro; Hernandez, Victor Hugo; Lutz, Rex William; Post, Zachary Douglas

    2018-02-01

    The American Academy of Orthopaedic Surgeons (AAOS) published a series of evidence-based guidelines for treatment of knee osteoarthritis (OA). We studied compliance with these guidelines among orthopaedic surgeons. We sent a survey to members of the American Association of Hip and Knee Surgeons. It included five clinical vignettes based on the Kellgren-Lawrence radiographic system for classification of knee OA. Respondents selected treatment currently supported or not supported by the AAOS guidelines. Of 345 responses, the frequency of use of recommended interventions was 80%, 82%, 21%, 50%, and 98% for OA at stages 0 through 4, respectively. For stage 2 and stage 3 OA, intra-articular hyaluronic acid was the most commonly selected intervention not recommended by the AAOS. Apparently, AAOS guidelines on the treatment of OA have not reached the orthopaedic community, resulting in lack of treatment consensus and continued use of modalities with no proven patient benefits. Management of moderate to severe knee OA does not align with AAOS guidelines. We encourage researchers to conduct clinical trials to identify the role of intra-articular corticosteroids in treating this condition.

  11. Acti-Tape™ (elastic therapeutic tape as compared with a knee guard in providing support to the knee joint: an open-label, randomized, crossover study

    Directory of Open Access Journals (Sweden)

    Hui HK

    2014-04-01

    Full Text Available Hoong Keong Hui,1 Narayan J Karne,2 Navneet Sonawane31Nutriworks Ltd, Kowloon, Hong Kong; 2Karne Hospital, Pune, India; 3Vedic Lifesciences Pvt Ltd, Mumbai, IndiaStudy design: Randomized, open-label, crossover, controlled study.Background: Elastic taping methods are used to provide support to the musculoskeletal system in athletes. Acti-Tape™ (an elastic therapeutic tape has been marketed for the last 2–3 years and has shown good results in providing support to the joints. This pilot study was planned to collect data on the clinical outcomes and to assess if a single tape application of Acti-Tape over the knee joint could provide benefits similar to a traditionally used knee guard.Methods: Thirteen subjects aged 30–65 years visiting an orthopedic center in Pune, India who were suffering from osteoarthritis were randomly assigned to either Acti-Tape (n=6 or a knee guard (n=7 in the first intervention period (6 days and were crossed over to the other group in the second intervention period (6 days after a washout of 1 day. Main outcome measures were change from day 0 to day 6 in pain visual analog score (VAS; timed up and go (TUG, medial step down (MSD, and unilateral anterior reach (UAR tests; and subject's preference.Results: Data for all the 13 subjects were pooled and analyzed by Student's t-test as treatment-by-period interaction was not significant by analysis of variance (P>0.05. The changes (mean ± standard deviation after using Acti-Tape and a knee guard, respectively, were pain VAS, –10±5.4 versus (vs –11.5±5.83; TUG, –0.62±1.33 vs –0.46±1.56; UAR, 0.15±1.07 vs 0.75±0.44; and MSD, 1.08±095 vs 0.85±1.14. These were statistically significant with both devices for pain VAS, UAR, and MSD, but not for TUG. Between the treatments however, no statistically significant difference was seen. Eleven of 13 (85% subjects preferred Acti-Tape for future use (P<0.05 by McNemar’s χ2 test. No safety concerns were reported by the

  12. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

    Science.gov (United States)

    Raja, Kavitha; Dewan, Neha

    2011-03-01

    A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.

  13. Are external knee load and EMG measures accurate indicators of internal knee contact forces during gait?

    Science.gov (United States)

    Meyer, Andrew J; D'Lima, Darryl D; Besier, Thor F; Lloyd, David G; Colwell, Clifford W; Fregly, Benjamin J

    2013-06-01

    Mechanical loading is believed to be a critical factor in the development and treatment of knee osteoarthritis. However, the contact forces to which the knee articular surfaces are subjected during daily activities cannot be measured clinically. Thus, the ability to predict internal knee contact forces accurately using external measures (i.e., external knee loads and muscle electromyographic [EMG] signals) would be clinically valuable. We quantified how well external knee load and EMG measures predict internal knee contact forces during gait. A single subject with a force-measuring tibial prosthesis and post-operative valgus alignment performed four gait patterns (normal, medial thrust, walking pole, and trunk sway) to induce a wide range of external and internal knee joint loads. Linear regression analyses were performed to assess how much of the variability in internal contact forces was accounted for by variability in the external measures. Though the different gait patterns successfully induced significant changes in the external and internal quantities, changes in external measures were generally weak indicators of changes in total, medial, and lateral contact force. Our results suggest that when total contact force may be changing, caution should be exercised when inferring changes in knee contact forces based on observed changes in external knee load and EMG measures. Advances in musculoskeletal modeling methods may be needed for accurate estimation of in vivo knee contact forces. Copyright © 2012 Orthopaedic Research Society.

  14. The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review.

    Science.gov (United States)

    Maleki, Maryam; Arazpour, Mokhtar; Joghtaei, Mahmoud; Hutchins, Stephen W; Aboutorabi, Atefeh; Pouyan, Ali

    2016-04-01

    Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented. The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients. Literature review According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria. The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee. Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis. Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2014.

  15. The effect of prophylactic knee bracing on proprioception ...

    African Journals Online (AJOL)

    ... knee brace (p < 0.01). Conclusion. Prophylactic knee bracing improved proprioception performance of playing (uninjured) rugby players, and therefore may be responsible for the improvement in knee injury statistics reported in some studies on knee bracing. South African Journal of Sports Medicine Vol.16(1) 2004: 33- ...

  16. 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 ...

  17. Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial.

    Science.gov (United States)

    Lluch, Enrique; Dueñas, Lirios; Falla, Deborah; Baert, Isabel; Meeus, Mira; Sánchez-Frutos, José; Nijs, Jo

    2018-01-01

    This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.

  18. 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.

  19. Does workplace health promotion reach shift workers?

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Garde, Anne Helene; Clausen, Thomas

    2015-01-01

    OBJECTIVES: One reason for health disparities between shift and day workers may be that workplace health promotion does not reach shift workers to the same extent as it reaches day workers. This study aimed to investigate the association between shift work and the availability of and participation...... in workplace health promotion. METHODS: We used cross-sectional questionnaire data from a large representative sample of all employed people in Denmark. We obtained information on the availability of and participation in six types of workplace health promotion. We also obtained information on working hours, ie......). RESULTS: In the general working population, fixed evening and fixed night workers, and employees working variable shifts including night work reported a higher availability of health promotion, while employees working variable shifts without night work reported a lower availability of health promotion...

  20. Reaching Travelers Through Digital Marketing Channels

    OpenAIRE

    RATIU, Monica Paula; PURCAREA, Ioan Matei

    2015-01-01

    It is time for going beyond tourist experience by offering the necessary transformations, better understanding a digital marketplace more centered on a complex consumer journey, monitoring travel and digital trends and ensuring an adequate experience across all channels and interactions. Travel organizations need to have an adequate infrastructure and to offer this engagement experience in the traveler’s language and on the device of their choosing, reaching travelers through digital marketin...

  1. Project Outreach: Organizations Unified to Reach Youth.

    OpenAIRE

    Dunnington, B C; Hayes, M L

    1989-01-01

    Youths of today are forced to deal with the external pressures of alcohol and drug abuse on all levels-from the older youngsters across the street pressuring them to be "cool," to the "cute dog" enticing them with the glamour of being the original "party animal." Through today's mass communications, young people are exposed to negative, self-destructive attitudes. It is important, therefore, to expose them to a more positive influence and try to reach them through parental guidance, personal ...

  2. Clinically assessed mediolateral knee motion: impact on gait

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Creaby, Mark W; Simic, Milena

    2011-01-01

    Mediolateral knee movement can be assessed visually with clinical tests. A knee-medial-to-foot position is associated with an increased risk of knee injuries and pathologies. However, the implications of such findings on daily tasks are not well understood. The aim of this study was to investigate...... if a knee-medial-to-foot position assessed during a clinical test was associated with altered hip and knee joint kinematics and knee joint kinetics during gait compared with those with a knee-over-foot position....

  3. Sex Differences in Frontal and Transverse Plane Hip and Knee Kinematics During the Modified Star Excursion Balance Test

    Directory of Open Access Journals (Sweden)

    Willis Brad W.

    2017-09-01

    Full Text Available Purpose. The modified Star Excursion Balance Test (mSEBT assesses dynamic neuromuscular control, with predictive ability regarding lower extremity injury risk. Previous kinematic mSEBT analyses are limited to sex differences between injured or fatigued populations or non-fatigued groups in the sagittal plane only. We hypothesize that sex differences exist in the frontal and transverse plane kinematics of the hip and knee in healthy, non-fatigued subjects during the mSEBT. Methods. The descriptive laboratory study involved 38 healthy subjects: 20 males (aged 24.8 ± 2.7 years and 18 females (24.1 ± 3.7 years. Peak kinematics, obtained by a VICONTM motion system, of the hip and knee in the sagittal, frontal, and transverse plane were compared during the anterior, posteromedial, and posterolateral reach of the mSEBT. Wilcoxon rank test with significant differences at p < 0.05 was used. Results. Kinematic differences existed between the groups in the frontal and transverse plane of the hip and knee in all reach directions (p < 0.05. No differences were found in the sagittal plane of the hip or knee between the groups. Conclusions. Sex differences exist in frontal and transverse plane kinematics of the hip and knee during the mSEBT. The mSEBT may be enhanced as an injury prediction tool, if frontal and transverse plane kinematics were included during risk assessment screening.

  4. Action sounds modulate arm reaching movements

    Directory of Open Access Journals (Sweden)

    Ana Tajadura-Jiménez

    2016-09-01

    Full Text Available Our mental representations of our body are continuously updated through multisensory bodily feedback as we move and interact with our environment. Although it is often assumed that these internal models of body-representation are used to successfully act upon the environment, only a few studies have actually looked at how body-representation changes influence goal-directed actions, and none have looked at this in relation to body-representation changes induced by sound. The present work examines this question for the first time. Participants reached for a target object before and after adaptation periods during which the sounds produced by their hand tapping a surface were spatially manipulated to induce a representation of an elongated arm. After adaptation, participants’ reaching movements were performed in a way consistent with having a longer arm, in that their reaching velocities were reduced. These kinematic changes suggest auditory-driven recalibration of the somatosensory representation of the arm morphology. These results provide support to the hypothesis that one’s represented body size is used as a perceptual ruler to measure objects’ distances and to accordingly guide bodily actions.

  5. A preliminary assessment of a novel pneumatic unloading knee brace on the gait mechanics of patients with knee osteoarthritis.

    Science.gov (United States)

    Della Croce, Ugo; Crapanzano, Fausto; Li, Ling; Kasi, Patrick K; Patritti, Benjamin L; Mancinelli, Chiara; Hunter, David J; Stamenović, Dimitrije; Harvey, William F; Bonato, Paolo

    2013-10-01

    To determine whether a knee brace incorporating inflatable air bladders can alter the net peak external knee adduction moment in persons with medial compartment knee osteoarthritis. Prospective cohort study. Motion analysis laboratory. Subjects (n = 18) diagnosed with knee osteoarthritis as defined by the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Instrumented gait analysis was performed while subjects walked with and without the knee brace. When subjects wore the knee brace, the air bladders were either uninflated or inflated to 7 psi. The net external knee adduction moment was obtained by subtracting the abduction moment produced by the knee brace (estimated using a finite element analysis model) from the external knee adduction moment (estimated using a camera-based motion analysis system). The net external knee adduction moment was compared across all testing conditions. A 7.6% decrease in net peak external knee adduction moment was observed when subjects wore the knee brace uninflated compared with when they did not wear the brace. Inflation of the bladders to 7 psi led to a 26.0% decrease in net peak external knee adduction moment. The results of the study suggest that the effects of an unloading knee brace may be enhanced by incorporating inflatable air bladders into the design of the brace, thus leading to an improved correction of the excessive peak external knee adduction moment observed in patients with medial compartment knee osteoarthritis. Copyright © 2013. Published by Elsevier Inc.

  6. Patients with total knee arthroplasty do not use all of their available range of knee flexion during functional activities.

    Science.gov (United States)

    McClelland, Jodie A; Feller, Julian A; Menz, Hylton B; Webster, Kate E

    2017-03-01

    Recent research designed to improve outcome from total knee arthroplasty has included focus on strategies that increase the range of post-operative knee flexion. Patients with knee arthroplasty can now expect >100° of knee flexion following surgery, but it is not clear whether this improved range of motion facilitates outcome or whether patients take advantage of this range when completing daily functional activities. The aim of this study was to investigate the knee flexion angles used during daily functional activities that specifically required high degrees of knee flexion. It was hypothesised that patients with greater range of passive knee flexion would achieve higher degrees of knee flexion during functional activities. Motion analysis was used to assess the maximum knee flexion of 40 patients with total knee arthroplasty and 40 control participants as they performed maximum flexion squatting and lunging activities. Patients with knee arthroplasty used between 80.8 and 91.4° of knee flexion to complete these activities, which was 20 to 30% less than that used by the control participants. Patients with greater ranges of passive knee flexion had greater maximum knee flexion during functional activities. However, they used only between 68% and 77% of their full passive range when lunging and squatting. The development of rehabilitation strategies that aim to increase weightbearing knee flexion capacity may be warranted to improve functional performance following total knee arthroplasty. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis

    DEFF Research Database (Denmark)

    Aaboe, J; Bliddal, H; Messier, S P

    2011-01-01

    To determine the effect of an intensive weight loss program on knee joint loads during walking in obese patients with knee osteoarthritis (OA).......To determine the effect of an intensive weight loss program on knee joint loads during walking in obese patients with knee osteoarthritis (OA)....

  8. Reaching Constructive Compromise: Steps, Tactics, and Strategies

    Directory of Open Access Journals (Sweden)

    MA. Arben Salihu

    2014-02-01

    Full Text Available The history of war and conflicts is as old as human history itself. Along with it always existed attempts to find ways and means to reconcile conflicting parties and reach peace. In today’s world, more than ever, where war and conflicts are everyday occurrence is imperative to find faster and reliable ways how to resolve conflicts. Reaching a constructive compromise is extremely difficult (very often even the implementation phase creates additional hitches as the parties involved pretend or believe that all of their demands for peace deal are rational and thus should be fulfilled. While one party may have expertise in negotiation process itself, the other may be unwittingly unprepared, and believing that honesty and fairness will result in impartial peace deal. This is, unfortunately, not always so. The aim of this paper, besides targeting these types of naïve perceptions, is to inspire others to be fully prepared prior entering negotiation process. The negotiation strategy, along with steps and tactics is the fundament of this research. History of negotiations teaches us that often the strong and more prepared side tends to win more than the weak and unprepared one in a negotiation process. Yet studying and exploring the approach to reach a constructive compromise is essential and conducive even if you happen to find yourself as the weaker party vis-à-vis a stronger opposing rival. The purpose of this study is to analyse the implications of negotiating strategies in the course of reaching the eventual constructive compromise. Throughout, this paper has endeavoured to answer numerous but distinct issues related to the topic and offer a balanced analysis on the arguments explored. The study also delves into some international conflicts (resolved and unresolved examining them in light of potential constructive compromise. Finally the study ends up by concluding that constructive compromise strategy that focuses, above all, on creativity

  9. The unstable knee in congenital limb deficiency.

    Science.gov (United States)

    Mindler, Gabriel T; Radler, Christof; Ganger, Rudolf

    2016-12-01

    Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee. A review of pediatric orthopaedic literature on different factors of knee instability, state-of-the-art treatment options in congenital limb deficiency and in cases of lengthening-related knee subluxation is presented and the authors' preferred treatment methods are described. Leg lengthening and deformity correction in patients with congenital limb deficiencies can be achieved with various techniques, such as guided growth, monolateral or circular external fixation and intramedullary lengthening nails. Radiographic assessment and clinical examination of the knee stability are obligatory to estimate the grade of instability prior to surgical procedures. Preparatory surgery, as well as preventive measures such as bracing, bridging of the knee and intensive physical therapy, can help to avoid subluxation during lengthening in unstable knees. Adequate surgical techniques, preventive measures and early detection of signs of subluxation can lead to good functional results in patients with congenital limb deficiency.

  10. Knee pain among workers and associated occupational factors: a systematic

    OpenAIRE

    Silva,Marcelo Cozzensa da

    2006-01-01

    Com o objetivo de reunir informações sobre dor nos joelhos entre trabalhadores e fatores ocupacionais associados, foi realizada uma revisão sistemática nas bases de dados Medline, Lilacs, Scielo, Free Medical Journals, entre outros, referentes ao período 1990-2006, usando os descritores knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, osteoarthritis e seus equivalentes em portugu...

  11. Quadriceps weakness and osteoarthritis of the knee.

    Science.gov (United States)

    Slemenda, C; Brandt, K D; Heilman, D K; Mazzuca, S; Braunstein, E M; Katz, B P; Wolinsky, F D

    1997-07-15

    The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis. To explore the relation between lower-extremity weakness and osteoarthritis of the knee. Cross-sectional prevalence study. Population-based, with recruitment by random-digit dialing. 462 volunteers 65 years of age or older. Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry. Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 lb-ft for those with osteoarthritis and 34.8 lb-ft for those without osteoarthritis; P osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 lb-ft loss of strength, 0.8 [95% CI, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [CI, 0.51 to 0.87] for symptomatic osteoarthritis). Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.

  12. Knee extensor strength and risk of structural, symptomatic and functional decline in knee osteoarthritis

    DEFF Research Database (Denmark)

    Culvenor, Adam G; Ruhdorfer, Anja; Juhl, Carsten

    2017-01-01

    OBJECTIVE: To perform a systematic review and meta-analysis on the association between knee extensor strength and the risk of structural, symptomatic, or functional deterioration in individuals with or at risk of knee osteoarthritis (KOA). METHODS: We systematically identified and methodologically....... CONCLUSION: Meta-analysis showed that lower knee extensor strength is associated with an increased risk of symptomatic and functional deterioration, but not tibiofemoral JSN. The risk of patellofemoral deterioration in the presence of knee extensor strength deficits is inconclusive. This article is protected...... appraised all longitudinal studies (≥1-year follow-up) reporting an association between knee extensor strength and structural (tibiofemoral, patellofemoral), symptomatic (self-reported, knee replacement), or functional (subjective, objective) decline in individuals with or at risk of radiographic...

  13. Knee arthrodesis – ultima ratio for the treatment of the infected knee

    Directory of Open Access Journals (Sweden)

    Tiemann, Andreas H. H.

    2013-04-01

    Full Text Available The irretrievable destruction of the knee due to trauma, tumor or infection is the indication for knee arthrodesis. The main reason for knee arthrodesis in terms of infection ist the infected total knee arthroplasty. Central problem is the definition of the term “irretrievable”. It is based on the subjective opinion of the attending physician and depends on his expert knowledge of this specific entity. The preservation of a functioning extremity is the main goal.This article shows the typical indications and contraindications for knee arthrodesis following septic knee diseases. In addition it gives insight into the biomechanical and technical considerations to be kept in mind. Finally the postoperative care and outcome of different techniques are analysed.

  14. Is there a causal link between knee loading and knee osteoarthritis progression?

    DEFF Research Database (Denmark)

    Henriksen, Marius; Creaby, Mark W; Lund, Hans

    2014-01-01

    OBJECTIVE: We performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression. DESIGN: Systematic review, meta-analysis and application of Bradford Hill's considerations....... The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies. CONCLUSIONS: There is very limited and low-quality evidence to support for a causal link between knee joint loading...... on causation. DATA SOURCES: We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. STUDY ELIGIBILITY CRITERIA: We selected cohort studies and RCTs in which estimates of knee joint loading during walking...

  15. Knee Osteoarthritis Treatment with the KineSpring Knee Implant System: A Report of Two Cases.

    Science.gov (United States)

    Hayes, David A; Miller, Larry E; Block, Jon E

    2012-01-01

    Osteoarthritis (OA) is a leading cause of disability in middle-aged and older adults with the prevalence expected to increase by 40% by 2025. This dramatic projected increase in OA reflects, in large part, the alarming obesity epidemic. Indeed, it is now well understood that abnormal loading across the knee joint due to malalignment and/or excessive weight gain is responsible for accelerating OA progression. Consequently, there is a therapeutic need for alternative knee OA treatments that directly address joint overload to fill the gap between ineffective conservative care and invasive joint-modifying surgical procedures. We describe two cases that presented with bilateral knee OA resistant to conservative treatments, each with one knee previously and unsuccessfully treated with high tibial osteotomy to improve alignment and the contralateral knee successfully treated with a joint-preserving, load-absorbing implant (KineSpring Knee Implant System).

  16. Knee Osteoarthritis Treatment with the KineSpring Knee Implant System: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    David A. Hayes

    2012-01-01

    Full Text Available Osteoarthritis (OA is a leading cause of disability in middle-aged and older adults with the prevalence expected to increase by 40% by 2025. This dramatic projected increase in OA reflects, in large part, the alarming obesity epidemic. Indeed, it is now well understood that abnormal loading across the knee joint due to malalignment and/or excessive weight gain is responsible for accelerating OA progression. Consequently, there is a therapeutic need for alternative knee OA treatments that directly address joint overload to fill the gap between ineffective conservative care and invasive joint-modifying surgical procedures. We describe two cases that presented with bilateral knee OA resistant to conservative treatments, each with one knee previously and unsuccessfully treated with high tibial osteotomy to improve alignment and the contralateral knee successfully treated with a joint-preserving, load-absorbing implant (KineSpring Knee Implant System.

  17. Men's shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.

    Science.gov (United States)

    Kerrigan, D Casey; Karvosky, Mark E; Lelas, Jennifer L; Riley, Patrick O

    2003-03-01

    To determine if men's dress shoes and sneakers increase knee joint torques and play the same role in the development and/or progression of knee osteoarthritis (OA) as women's high-heeled dress shoes. Three-dimensional data regarding lower extremity torques and motion were collected during walking in 22 healthy men while (1) wearing dress shoes, (2) wearing sneakers, and (3) barefoot. Data were plotted and qualitatively compared; major peak values were statistically compared between conditions. The external knee varus torque in early stance was slightly greater with the dress shoes and sneakers, but this slight increase can be explained by the faster walking speed with shoes. No significant increases were found in any other of the sagittal, coronal, or transverse knee torques when walking with dress shoes and sneakers compared to barefoot. Men's dress shoes and sneakers do not significantly affect knee joint torques that may have relevance to the development and/or progression of knee OA.

  18. Effect of workstation height and distance on upper extremity muscle activity during repetitive below-the-knee assembly work.

    Science.gov (United States)

    Shin, Seung-Je; Yoo, Won-Gyu

    2015-01-01

    To determine the activity of the upper trapezius, serratus anterior, anterior deltoid, biceps brachii. and lower trapezius muscles in healthy adults during below-the-knee assembly work. Fifteen right-handed male subjects participated in this study. The electrical activities, measured by EMG, of the right upper trapezius, serratus anterior, anterior deltoid, biceps brachii. and lower trapezius were measured during below-the-knee assembly work at four workstations of varying height and distance from the participant (workstation 1, below-the-knee assembly work with a height of 15 cm above the floor and a reach distance of 30 cm; workstation 2, height of 15 cm and distance of 45 cm; workstation 3, height of 30 cm and distance of 30 cm; workstation 4, height of 30 cm and distance of 45 cm). Muscle activity at the four workstations was represented as a percentage of the reference voluntary isometric contraction (RVIC). Height: Upper and lower trapezius activity increased significantly during below the knee assembly work as height above the floor increased. The activities of the serratus anterior and biceps brachii muscles increased significantly during low-height below-the-knee assembly work. Distance: The activities of the upper trapezius, serratus anterior, anterior deltoid and biceps brachii increased significantly during below-the-knee assembly work at a far distance (45 cm). The lower trapezius muscle activity increased significantly during below-the-knee assembly work at a close distance (30 cm). Below-knee workers should engage in work close to themselves, since distance appears to be a stronger risk factor for injury than height above the floor.

  19. Proprioception and Knee Arthroplasty: A Literature Review.

    Science.gov (United States)

    Wodowski, Andrew J; Swigler, Colin W; Liu, Hongchao; Nord, Keith M; Toy, Patrick C; Mihalko, William M

    2016-04-01

    Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. SYNOVIAL GIANT CELL TUMOR OF THE KNEE.

    Science.gov (United States)

    Abdalla, Rene Jorge; Cohen, Moisés; Nóbrega, Jezimar; Forgas, Andrea

    2009-01-01

    Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection.

  1. Knee joint vibroarthrographic signal processing and analysis

    CERN Document Server

    Wu, Yunfeng

    2015-01-01

    This book presents the cutting-edge technologies of knee joint vibroarthrographic signal analysis for the screening and detection of knee joint injuries. It describes a number of effective computer-aided methods for analysis of the nonlinear and nonstationary biomedical signals generated by complex physiological mechanics. This book also introduces several popular machine learning and pattern recognition algorithms for biomedical signal classifications. The book is well-suited for all researchers looking to better understand knee joint biomechanics and the advanced technology for vibration arthrometry. Dr. Yunfeng Wu is an Associate Professor at the School of Information Science and Technology, Xiamen University, Xiamen, Fujian, China.

  2. Return to preinjury status after routine knee arthroscopy in military population.

    Science.gov (United States)

    Joshi, A; Kayastha, N; Maharjan, R; Chand, P; K C, B R

    2014-01-01

    Knee arthroscopy is frequently advised procedure for knee-related problems in serving soldiers. The scanty published literatures have documented wide range of recovery duration ranging from nine days to four weeks even for routine uncomplicated arthroscopy. However, neither of these studies evaluated military population, where arthroscopic procedures are frequent and physical demands are different. The aim of this study was to ascertain the time required to return to unrestricted physical activities in serving military population. This was a prospective descriptive study enrolling 51 patients who underwent two portal arthroscopic procedures like diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these. A uniform home based physiotherapy protocol was used for everyone. All of them were followed up at 2nd, 4th, 6th, 8th and 12th postoperative weeks. At each follow up, 2000 International Knee Documentation Committee subjective knee evaluation form was filled and submitted for analysis. Although all of our patients were able to walk around without any support at two weeks follow up, 88% had restriction to activities of daily living because of knee related problems. The mean International Knee Documentation Committee score was 41 at 1st follow up, which gradually improved to 64, 86, 94, 94 at 4th, 6th, 8th and 12th week follow up respectively. At 6 weeks 91% resumed their preinjury status which reached 94% in eight weeks. Most of the soldiers return to unrestricted activities within six to eight weeks after diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these procedures.

  3. Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

    Directory of Open Access Journals (Sweden)

    Karade Vikas

    2012-10-01

    Full Text Available Abstract Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees than the intramedullary guide (−0.34 +/− 2.31 degrees but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees than intramedullary guide (0.50 +/− 3.80 degrees for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

  4. Effects of prophylactic knee bracing on knee joint kinetics and kinematics during netball specific movements

    OpenAIRE

    Sinclair, Jonathan Kenneth; Vincent, Hayley; Richards, Jim

    2016-01-01

    Objective\\ud To investigate the effects of a prophylactic knee brace on knee joint kinetics and kinematics in netball specific movements.\\ud \\ud Design\\ud Repeated measures; Setting: Laboratory; Participants: Twenty university first team level female netball players.\\ud \\ud Outcome measurements\\ud Participants performed three movements, run, cut and vertical jump under two conditions (brace and no-brace). 3-D knee joint kinetics and kinematics were measured using an eight-camera motion analys...

  5. The potential role of prophylactic/functional knee bracing in preventing knee ligament injury.

    Science.gov (United States)

    Rishiraj, Neetu; Taunton, Jack E; Lloyd-Smith, Robert; Woollard, Robert; Regan, William; Clement, D B

    2009-01-01

    It is estimated that knee injuries account for up to 60% of all sport injuries, with the anterior cruciate ligament (ACL) accounting for almost half of these knee injuries. These knee injuries can result in high healthcare costs, as an ACL injury is often associated with surgery, long and costly rehabilitation, differing degrees of impairment and potential long-term consequences such as osteoarthritis. The interest in ACL injury prevention has been extensive for the past decade. Over this period, many ACL (intrinsic and extrinsic) injury risk factors have been identified and investigated by numerous researchers. Although prevention programmes have shown potential in decreasing knee ligament injuries, several researchers have suggested that no conclusive evidence has been presented in reducing the rate and/or severity of ACL injuries during sporting competition. Knee braces have been available for the last 30 years and have been used to assist individuals with ACL-deficient and ACL-reconstructed knees. However, research is limited on the use of knee braces (prophylactic and functional) to potentially prevent knee ligament injury in the non-injured population. One possible explanation for the limited research could be that the use of these devices has raised concerns of decreased or impaired athletic performance. In summary, the review of subjective and some objective publications suggests that a functional knee brace may offer stability to an ACL-deficient knee joint; however, research is limited on the use of a knee brace for prophylactic use in non-injured athletes. The limited research could be a result of fear of performance hindrance that has led to poor knee brace compliance.

  6. Unicompartmental Knee Osteoarthritis (UKOA: Unicompartmental Knee Arthroplasty (UKA or High Tibial Osteotomy (HTO?

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2016-10-01

    Full Text Available Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis.   Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. Results: In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years. However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion: The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty. However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies

  7. Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty

    OpenAIRE

    Lindberg-Larsen, Viktoria; Bandholm, Thomas Q; Zilmer, Camilla K; Bagger, Jens; Hornsleth, Mette; Kehlet, Henrik

    2017-01-01

    Background and purpose Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss of knee-extension strength at discharge after fast-track TKA. Patients and methods 70 patients undergoing elective unilateral TKA were randomized (1:1) to preoperative intravenous (IV) MP 125 mg (gro...

  8. Evaluation of unipodal stance in knee osteoarthritis patients using knee accelerations and center of pressure.

    Science.gov (United States)

    Turcot, K; Hagemeister, N; de Guise, J A; Aissaoui, R

    2011-03-01

    This study aims to compare knee joint instability and postural impairments during the performance of a unipodal stance task between patients having knee osteoarthritis (OA) and healthy elderly subjects using knee accelerations and center of pressure (COP) measurements. Twenty patients with medial knee OA and nine healthy individuals participated in this study. Three-dimensional (3D) knee joint accelerations and COP were measured during unipodal stance. The range and the root mean square (RMS) were extracted from medial lateral (ML) and anterior-posterior (AP) knee accelerations, whereas sway area, velocity, and ML and AP ranges were measured from the COP. The average parameters of three trials for each subject were compared between groups. Results show that knee OA patients exhibited a significantly higher range of knee acceleration in both ML (0.22±0.08 g vs 0.15±0.05 g) and AP (0.17±0.06 g vs 0.06±0.01 g) directions and a lower COP velocity (136.6±22.3 mm/s vs 157.6±18.4 mm/s) than did the healthy age-matched group. Significant correlations between the COP and knee acceleration parameters were also obtained. This study confirmed that patients with knee OA displayed greater body sway than did able-bodied subjects. Moreover, using an accelerometric-based method, this study highlighted the higher knee joint instability in the frontal and sagittal planes in knee OA patients compared with able-bodied subjects during a unipodal standing task. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies.

    Science.gov (United States)

    Muthuri, S G; McWilliams, D F; Doherty, M; Zhang, W

    2011-11-01

    Although knee injury has been implicated as a risk factor for the development of knee osteoarthritis (OA), there is great disparity in the magnitude of quantifiable risk. Our aim was to systematically review the relationship between history of knee injuries and knee OA. Six electronic databases were searched between August and October 2010. Relative risk estimates or odds ratio (OR) and 95% confidence intervals (95% CI) were extracted or calculated from observational studies meeting the inclusion criteria. Publication bias was determined using funnel plot and the Egger's test. Heterogeneity was examined using Cochran Q test and I(2) statistic. Random effects model was used to pool the heterogeneous results and OR was used to present the results. Subgroup analyses were performed to examine potential causes of heterogeneity. Twenty-four observational studies (20,997 subjects) were included in the meta-analysis of which there were seven cohort, five cross-sectional and 12 case-control studies. The overall pooled OR was 4.20 (95% CI 3.11-5.66, I(2) = 81.0%). Association between history of knee injuries and knee OA was significantly different for specified injuries such as ligament or tendon injuries; meniscus damage or meniscectomy; and fracture of femur, knee or lower part of the leg (OR = 5.95, 95% 4.57-7.75), compared to unspecified injuries (OR = 3.12, 95% 2.17-4.50). History of knee injury is a major risk factor for the development of knee OA irrespective of study design and definition of knee injury. As one of the few modifiable/preventable risk factors, knee injury should be part of the future prevention programme in reducing the risk of knee OA. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  10. 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...

  11. City Reach Code Technical Support Document

    Energy Technology Data Exchange (ETDEWEB)

    Athalye, Rahul A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Chen, Yan [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhang, Jian [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Frankel, Mark [New Buildings Inst., Portland, OR (United States); Lyles, Mark [New Buildings Inst., Portland, OR (United States)

    2017-10-31

    This report describes and analyzes a set of energy efficiency measures that will save 20% energy over ASHRAE Standard 90.1-2013. The measures will be used to formulate a Reach Code for cities aiming to go beyond national model energy codes. A coalition of U.S. cities together with other stakeholders wanted to facilitate the development of voluntary guidelines and standards that can be implemented in stages at the city level to improve building energy efficiency. The coalition's efforts are being supported by the U.S. Department of Energy via Pacific Northwest National Laboratory (PNNL) and in collaboration with the New Buildings Institute.

  12. Feldenkrais sensory imagery and forward reach.

    Science.gov (United States)

    Dunn, P A; Rogers, D K

    2000-12-01

    To investigate the effect of sensory imagery on subsequent movement, a unilateral Fleldenkrais lesson of imaging a soft bristle brush passing over one half of the body and in which no movement occurred, was given to 12 naive subjects. Forward flexion for each side of the body was measured at a sit-and-reach box. For 8 and 10 subjects who reported the perception of a side as being longer and lighter following the sensory imagery, there was also a significant increase in the forward flexion range on that side.

  13. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Shelbourne, K Donald; Klotz, Christine

    2006-05-01

    Anterior cruciate ligament surgery and rehabilitation have changed drastically during the past 30 years. The patellar tendon autograft fixed with buttons provides tight bone-to-bone placement of the graft and quick bony healing, which allows accelerated rehabilitation to obtain full range of motion and strength. Although surgical stability is easily reproducible, long-term patient satisfaction is difficult to guarantee. Full knee range of motion should be compared to that of the contralateral normal knee, including full hyperextension. We followed the progress of all patients to gauge the utility of our rehabilitation program. In order of importance, the lack of normal knee range of motion (within 2 degrees extension and 5 degrees of flexion compared with that of the normal knee), partial or total medial meniscectomy, partial or total lateral meniscectomy, and articular cartilage damage were related to lower subjective scores. Rehabilitation after ACL reconstruction must first strive to achieve full symmetrical knee range of motion before aggressive strengthening can begin. Our current perioperative rehabilitation starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises. When using a graft from the contralateral knee, the conflicting goals of strengthening the donor site and achieving full knee range of motion are divided between the knees. Thus, normal range of motion and strength can be achieved more easily and more quickly than when using an ipsilateral graft. Regardless of the graft source, a systematic rehabilitation program that emphasizes the return to symmetrical knee motion, including hyperextension, is necessary to achieve the optimum result.

  14. Determination of representative dimension parameter values of Korean knee joints for knee joint implant design.

    Science.gov (United States)

    Kwak, Dai Soon; Tao, Quang Bang; Todo, Mitsugu; Jeon, Insu

    2012-05-01

    Knee joint implants developed by western companies have been imported to Korea and used for Korean patients. However, many clinical problems occur in knee joints of Korean patients after total knee joint replacement owing to the geometric mismatch between the western implants and Korean knee joint structures. To solve these problems, a method to determine the representative dimension parameter values of Korean knee joints is introduced to aid in the design of knee joint implants appropriate for Korean patients. Measurements of the dimension parameters of 88 male Korean knee joint subjects were carried out. The distribution of the subjects versus each measured parameter value was investigated. The measured dimension parameter values of each parameter were grouped by suitable intervals called the "size group," and average values of the size groups were calculated. The knee joint subjects were grouped as the "patient group" based on "size group numbers" of each parameter. From the iterative calculations to decrease the errors between the average dimension parameter values of each "patient group" and the dimension parameter values of the subjects, the average dimension parameter values that give less than the error criterion were determined to be the representative dimension parameter values for designing knee joint implants for Korean patients.

  15. Mid-term outcomes of primary constrained condylar knee arthroplasty for severe knee deformity.

    Science.gov (United States)

    Feng, Xiao-bo; Yang, Cao; Fu, De-hao; Ye, Shu-nan; Liu, Xian-zhe; Chen, Zhe; Rai, Saroj; Yang, Shu-hua

    2016-04-01

    This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy (TKA) with use of NexGen® Legacy® Constrained Condylar Knee (CCK) prosthesis for severe knee deformity. Clinical data of 46 patients (48 knees in total, aged 61 years on average) with severe knee deformity who underwent TKA with NexGen® Legacy® CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months (range 40-90 months). The New Knee Society scoring (NKSS) system and the Hospital for Special Surgery (HSS) score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale (VAS) was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion (ROM) from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus (≥7°) in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior (A

  16. The effect of knee position on blood loss and range of motion following total knee arthroplasty.

    Science.gov (United States)

    Li, Bin; Wen, Yu; Liu, Da; Tian, Lijie

    2012-03-01

    This study prospectively assessed the effects of knee position on blood loss and range of motion after primary total knee arthroplasty (TKA). One hundred and ten consecutive TKA patients were randomized into flexion group and extension group. Both groups had the leg elevated 30° at the hip over an inactive CPM for 72 h postoperatively. The flexion group had the knee flexed to 30° during this period. The extension group had the knee extended fully. Perioperative blood loss, hidden blood loss, knee swelling, ecchymosis, analgesia requirements, range of motion (ROM), fixed flexion deformity (FFD), straight-leg raising action, and postoperative complications within 6 weeks of surgery were measured for evaluation and comparison. The postoperative hidden blood loss, knee swelling, and scope of ecchymosis were significantly lower in the flexion group than in the extension group, and ROM and straight-leg raising action were significantly higher during the early period after operation. No significant difference was observed in perioperative blood loss, the amount of morphine used, or FFD in the early postoperative period or in ROM and FFD at 6 weeks postoperatively. The findings of this study indicate that flexion of the knee to 30° with the leg elevated 30° at the hip after total knee arthroplasty may mitigate knee swelling and provide other beneficial results during the early rehabilitation following TKA. Prospective comparative study, Level I.

  17. Is Lifelong Knee Joint Force from Work, Home, and Sport Related to Knee Osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Charles R. Ratzlaff

    2012-01-01

    Full Text Available Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA. Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation and dose (frequency, intensity, duration were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the “cumulative peak force index”, a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio’s ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined, and occupational force in men and household force in women were risk factors for knee OA.

  18. Osteonecrosis in the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Poeschl, M.

    1981-12-01

    The following forms are discussed: spontaneous osteonecrosis (Ahlbaeck's necrosis), which extends subchondrally into one of the femur condyles. It usually occurs in older patients, especially females. Blunt trauma may cause similar lesions. These often occur with cartilage and bone avulsions (flake fractures), which are often diagnosed much later (arthroscopy). Patellar chondropathy is increasing in frequency due to more intensive participation in sports. Pain localized at the apex of the patella (patellar apex syndrome) can develop from chondropathy, tendon lesions or primary juvenile necrosis of the patellar apex. Gas emboli occur near the knee joint during deep sea diving. Similar cartilage infarctions are seen in many hemoglobinopathies. The incidence of this is increasing due to the increased number of people immigrating from regions where these diseases are common. We have also observed vascular juvenile lesions of the epi- and metaphyses in Klippel-Trenaunay-Weber's syndrome. Their radiological appearance is similar to that of necroses.

  19. Long-term data of gait characteristics and moment-knee angle relations in female total knee arthroplasty patients.

    Science.gov (United States)

    Ullrich, Boris; Stening, Jens; Pelzer, Thiemo; Raab, Jana

    2015-06-01

    Despite the clinical success of total knee arthroplasty, impaired gait patterns and quadriceps and hamstring maximal voluntary force production might persist years post-surgery. Long-term data of gait patterns and quadriceps and hamstring maximal force production are rarely published with total knee arthroplasty patients. This work examined gait characteristics and the moment-knee angle relations of the knee extensors and flexors about 10 years post-total knee arthroplasty. About a decade post-surgery, 10 female total knee arthroplasty patients (64 years, mobile-bearing inlay) and 10 age-matched female controls were examined. Sagittal plane kinematics in the hip and knee joint during treadmill walking at 2 kilometres per hour were recorded using motion analysis. Spatiotemporal gait parameters were analyzed at self-selected walking speeds with a pressure-platform. The unilateral isometric moment-knee angle relations of the knee extensors and flexors and the electromyographic knee angle relation of the quadriceps were studied using dynamometry. Due to group differences for body mass index values, univariate analysis of variance (main effect: group, secondary effect: body mass index) was used for statistical analysis. Total knee arthroplasty patients demonstrated significant (Pgait deficits during constant and self-selected walking speeds and lower average absolute values in the moment-knee angle relations of the knee extensors and flexors. Significant (Pgait characteristics and maximal voluntary force production, especially for the knee extensors, might persist after total knee arthroplasty. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. MRI based knee cartilage assessment

    Science.gov (United States)

    Kroon, Dirk-Jan; Kowalski, Przemyslaw; Tekieli, Wojciech; Reeuwijk, Els; Saris, Daniel; Slump, Cornelis H.

    2012-03-01

    Osteoarthritis is one of the leading causes of pain and disability worldwide and a major health problem in developed countries due to the gradually aging population. Though the symptoms are easily recognized and described by a patient, it is difficult to assess the level of damage or loss of articular cartilage quantitatively. We present a novel method for fully automated knee cartilage thickness measurement and subsequent assessment of the knee joint. First, the point correspondence between a pre-segmented training bone model is obtained with use of Shape Context based non-rigid surface registration. Then, a single Active Shape Model (ASM) is used to segment both Femur and Tibia bone. The surfaces obtained are processed to extract the Bone-Cartilage Interface (BCI) points, where the proper segmentation of cartilage begins. For this purpose, the cartilage ASM is trained with cartilage edge positions expressed in 1D coordinates at the normals in the BCI points. The whole cartilage model is then constructed from the segmentations obtained in the previous step. An absolute thickness of the segmented cartilage is measured and compared to the mean of all training datasets, giving as a result the relative thickness value. The resulting cartilage structure is visualized and related to the segmented bone. In this way the condition of the cartilage is assessed over the surface. The quality of bone and cartilage segmentation is validated and the Dice's coefficients 0.92 and 0.86 for Femur and Tibia bones and 0.45 and 0.34 for respective cartilages are obtained. The clinical diagnostic relevance of the obtained thickness mapping is being evaluated retrospectively. We hope to validate it prospectively for prediction of clinical outcome the methods require improvements in accuracy and robustness.

  1. Can donated media placements reach intended audiences?

    Science.gov (United States)

    Cooper, Crystale Purvis; Gelb, Cynthia A; Chu, Jennifer; Polonec, Lindsey

    2013-09-01

    Donated media placements for public service announcements (PSAs) can be difficult to secure, and may not always reach intended audiences. Strategies used by the Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) to obtain donated media placements include producing a diverse mix of high-quality PSAs, co-branding with state and tribal health agencies, securing celebrity involvement, monitoring media trends to identify new distribution opportunities, and strategically timing the release of PSAs. To investigate open-ended recall of PSAs promoting colorectal cancer screening, CDC conducted 12 focus groups in three U.S. cities with men and women either nearing age 50 years, when screening is recommended to begin, or aged 50-75 years who were not in compliance with screening guidelines. In most focus groups, multiple participants recalled exposure to PSAs promoting colorectal cancer screening, and most of these individuals reported having seen SFL PSAs on television, in transit stations, or on the sides of public buses. Some participants reported exposure to SFL PSAs without prompting from the moderator, as they explained how they learned about the disease. Several participants reported learning key campaign messages from PSAs, including that colorectal cancer screening should begin at age 50 years and screening can find polyps so they can be removed before becoming cancerous. Donated media placements can reach and educate mass audiences, including millions of U.S. adults who have not been screened appropriately for colorectal cancer.

  2. NASA's Astronomy Education Program: Reaching Diverse Audiences

    Science.gov (United States)

    Hasan, Hashima; Smith, Denise Anne; Hertz, Paul; Meinke, Bonnie

    2015-08-01

    An overview will be given of the rich programs developed by NASA to inject the science from it's Astrophysics missions into STEM activities targeted to diverse audiences. For example, Astro4Girls was started as a pilot program during IYA2009. This program partners NASA astrophysics education programs with public libraries to provide NASA-themed hands-on education activities for girls and their families, and has been executed across the country. School curricula and NASA websites have been translated in Spanish; Braille books have been developed for the visually impaired; programs have been developed for the hearing impaired. Special effort has been made to reach underrepresented minorities. Audiences include students, teachers, and the general public through formal and informal education settings, social media and other outlets. NASA Astrophysics education providers include teams embedded in its space flight missions; professionals selected though peer reviewed programs; as well as the Science Mission Directorate Astrophysics Education forum. Representative examples will be presented to demonstrate the reach of NASA education programs, as well as an evaluation of the effectiveness of these programs.

  3. Post-traumatic extensive knee ganglion cyst

    Directory of Open Access Journals (Sweden)

    Mehran Mahvash

    2011-08-01

    Full Text Available A rare case of a posttraumatic extensive ganglion cyst of the anterolateral thigh with connection to the knee joint is presented. A 54- year-old man presented a palpable mass in the anterolateral region of his right thigh with a 15 months existing sense of fullness and tightness. He had an accident with his bicycle 21 months ago. Magnetic resonance imaging (MRI was performed showing a cyst inside the quadriceps femoris muscle between vastus lateralis and intermedius with connection to recessus suprapatellaris and knee joint. In addition MRI detected a traumatic lesion in the quadriceps femoris tendon in the near of the knee joint. The ganglion cyst was 18 cm long and was excised completely. Intraope - ratively, the knee joint connection was confirmed and excised as well. The ganglion cyst was filled with a gelatinous and viscous fluid.

  4. Magnetic Resonance Imaging for Traumatic Knee Injury

    NARCIS (Netherlands)

    E.H.G. Oei (Edwin)

    2009-01-01

    textabstractTraumatic knee lesions are frequently encountered both in general practice and in the hospital setting. These injuries are often caused by sports and other physical activities and may lead to severe pain and disability.

  5. OCCUPATIONAL RISK FACTORS IN KNEE OSTEOARTHRITIS

    National Research Council Canada - National Science Library

    V, Muralidhara

    2015-01-01

    .... RESULTS Prevalence of osteoarthritis common in farmers accounting to 70%. Other occupations at risk of OA of knee were, Teachers 12%, Housewives 08%, Athletes 04%, Policemen 04% and Drivers 02...

  6. Platelet Rich Plasma and Knee Surgery

    Directory of Open Access Journals (Sweden)

    Mikel Sánchez

    2014-01-01

    Full Text Available In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon’s goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

  7. Platelet Rich Plasma and Knee Surgery

    Science.gov (United States)

    Sánchez, Mikel; Sánchez, Pello; Orive, Gorka; Anitua, Eduardo; Padilla, Sabino

    2014-01-01

    In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon's goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs) application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery. PMID:25302310

  8. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  9. Knee tuberculosis masquerading as pigmented villonodular synovitis

    Directory of Open Access Journals (Sweden)

    Sanjay Meena

    2014-01-01

    Full Text Available Tuberculosis (TB, once a disease confined to undeveloped or developing nations is currently in resurgence, which is attributable to pandemic human immunodeficiency virus (HIV infection and immigration from endemic areas. Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and nonspecific imaging findings. TB is also known as the ′great mimicker′. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS. The present report describes a young patient with tuberculous arthritis of knee joint. Accurate diagnosis and appropriate management was delayed due to magnetic resonance imaging (MRI findings, such as, hemosiderin deposits and a nodular mass around the knee joint, suggestive of a diffuse type of PVNS. Our findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion.

  10. Cartilage Injuries in the Adult Knee

    Science.gov (United States)

    Moyad, Thomas F.

    2011-01-01

    Cartilage injuries are frequently recognized as a source of significant morbidity and pain in patients with previous knee injuries. The majority of patients who undergo routine knee arthroscopy have evidence of a chondral defect. These injuries represent a continuum of pathology from small, asymptomatic lesions to large, disabling defects affecting a major portion of one or more compartments within the knee joint. In comparison to patients with osteoarthritis, individuals with isolated chondral surface damage are often younger, significantly more active, and usually less willing to accept limitations in activities that require higher impact. At the present time, a variety of surgical procedures exist, each with their unique indications. This heterogeneity of treatment options frequently leads to uncertainty regarding which techniques, if any, are most appropriate for patients. The purpose of this review is to describe the workup and discuss the management techniques for cartilage injuries within the adult knee. PMID:26069581

  11. MRI EVALUATION OF SPORTS RELATED KNEE INJURIES

    Directory of Open Access Journals (Sweden)

    Aniruddha Basu

    2016-07-01

    Full Text Available PURPOSE To investigate the accuracy of MRI in evaluation of sports related knee injuries. MATERIALS AND METHODS From June 2015 to 1 st week of July 2016. Thirty patients referred for sports related knee pain have been included in this study. Patients were subjected to a dedicated MR knee study (GE HD XT 1.5T MR System and correlated knee arthroscopy and surgery. RESULTS The study included Thirty patients complaining of sports related knee pain, only 5 patients (16.67 % were with normal MRI findings and 25 patients (83.33% were with abnormal MRI findings. Among the 25 patients who had injuries of their knees, 15 patients (60% had ACL injuries, 6 patients (24% had PCL injuries, 10 patients (40% had meniscal injuries, 8 patients (32% had collateral ligament injuries, 5 patients (20% had bone injuries and 2 patients (8% had muscular injuries. Only 5 patients (20% were represented with isolated injury and 20 patients (80% were represented with combined injuries. In correlation with arthroscopies and surgeries, morphological analysis was true-positive in 23 (92% patients of the 25 injured patients, and true-negative in 1 (60% patient of the 2 normal patients. Morphological analysis revealed overall 92% sensitivity and 60% specificity. Regarding the 15 patients who had ACL injuries, 13 patients (86.6% were true-positive and 8 patients (80% of the 10 patients who had meniscal injuries were true-positive. CONCLUSION MRI represents the optimal imaging modalities in the evaluation of the sports related knee injuries, which has been shown to be an accurate and non-invasive method of diagnosing ligament, meniscal, cartilage and muscular knee injuries.

  12. Thompson′s quadricepsplasty for stiff knee

    Directory of Open Access Journals (Sweden)

    Kundu Z

    2007-01-01

    Full Text Available Background : Stiffness of the knee after trauma and/or surgery for femoral fractures is one of the most common complications and is difficult to treat. Stiffness in extension is more common and can be reduced by vigorous physiotherapy. If it does not improve then quadricepsplasty is indicated. The present study was undertaken to evaluate the results of Thompsons quadricepsplasty. Materials and Methods : 22 male patients (age range 20-45 years with posttraumatic knee stiffness following distal femoral fractures underwent Thompson′s quadricepsplasty where knee flexion range was less than 45°. The index injury in these patients was treated with plaster cast (n=5, plates (n=3, intramedullary nailing (n=3 and external fixator for open fractures (n=9. Thompson′s quadricepsplasty was performed in all the patients using anterior approach, with incision extending from upper thigh to tibial tubercle. Release of rectus femoris from underlying vastus intermedius and release of intraarticular adhesions were performed. After surgery the patients needed parentral analgesia for three days and then oral analgesics for three weeks. Active assisted knee mobilization exercises were started on the first post-operative day. Continous passive motion machine was used from the same day. Supervised physiotherapy was continued in hospital for six weeks followed by intensive knee flexion and extension exercise including cycling at home for atleast another six months. Results : Out of 22 patients, 20 had excellent to good results and two patients had poor results using criteria devised by Judet. One poor result was due to peroperative fracture of patella which was then internally fixed and hence the flexion of knee could not be started immediately. There was peroperative avulsion of tibial tuberosity in another patient who finally gained less than 50° knee flexion and hence a poor result. Conclusion : Thompsons quadricepsplasty followed by a strict and rigourous

  13. Strategies for the prevention of knee osteoarthritis

    DEFF Research Database (Denmark)

    Roos, Ewa M.; Arden, Nigel K

    2016-01-01

    , interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements......-the regimes. Now is the time to begin the era of personalized prevention for knee OA....

  14. Synovial Hemangioma in the Knee: MRI Findings

    Directory of Open Access Journals (Sweden)

    Harun Arslan

    2015-01-01

    Full Text Available Synovial hemangiomas are rare benign tumors of vascular origin. A 23-year-old boy presented with knee pain and swelling. The boy had developed symptoms 18-months earlier. He was diagnosed with synovial hemangioma based on magnetic resonnance imaging examination and histopathologic findings of the arthroscopic biopsy tissue. We present the magnetic resonance imaging and histopathologic findings of synovial hemangioma of the knee.

  15. Reach and get capability in a computing environment

    Science.gov (United States)

    Bouchard, Ann M [Albuquerque, NM; Osbourn, Gordon C [Albuquerque, NM

    2012-06-05

    A reach and get technique includes invoking a reach command from a reach location within a computing environment. A user can then navigate to an object within the computing environment and invoke a get command on the object. In response to invoking the get command, the computing environment is automatically navigated back to the reach location and the object copied into the reach location.

  16. Riparian Vegetation Mapping Along the Hanford Reach

    Energy Technology Data Exchange (ETDEWEB)

    FOGWELL, T.W.

    2003-07-11

    During the biological survey and inventory of the Hanford Site conducted in the mid-1990s (1995 and 1996), preliminary surveys of the riparian vegetation were conducted along the Hanford Reach. These preliminary data were reported to The Nature Conservancy (TNC), but were not included in any TNC reports to DOE or stakeholders. During the latter part of FY2001, PNNL contracted with SEE Botanical, the parties that performed the original surveys in the mid 1990s, to complete the data summaries and mapping associated with the earlier survey data. Those data sets were delivered to PNNL and the riparian mapping by vegetation type for the Hanford Reach is being digitized during the first quarter of FY2002. These mapping efforts provide the information necessary to create subsequent spatial data layers to describe the riparian zone according to plant functional types (trees, shrubs, grasses, sedges, forbs). Quantification of the riparian zone by vegetation types is important to a number of DOE'S priority issues including modeling contaminant transport and uptake in the near-riverine environment and the determination of ecological risk. This work included the identification of vegetative zones along the Reach by changes in dominant plant species covering the shoreline from just to the north of the 300 Area to China Bar near Vernita. Dominant and indicator species included Agropyron dasytachyudA. smithii, Apocynum cannabinum, Aristida longiseta, Artemisia campestris ssp. borealis var scouleriana, Artemisa dracunculus, Artemisia lindleyana, Artemisia tridentata, Bromus tectorum, Chrysothamnus nauseosus, Coreopsis atkinsoniana. Eleocharis palustris, Elymus cinereus, Equisetum hyemale, Eriogonum compositum, Juniperus trichocarpa, Phalaris arundinacea, Poa compressa. Salk exigua, Scirpus acutus, Solidago occidentalis, Sporobolus asper,and Sporobolus cryptandrus. This letter report documents the data received, the processing by PNNL staff, and additional data gathered in FY

  17. A MECHANICAL HYPOTHESIS FOR THE EFFECTIVENESS OF KNEE BRACING FOR MEDIAL COMPARTMENT KNEE OSTEOARTHRITIS

    Science.gov (United States)

    Ramsey, Dan K; Briem, Kristin; Axe, Michael J; Snyder-Mackler, Lynn

    2011-01-01

    Background Evidence that knee braces used for the treatment of osteoarthritis mediate pain relief and improve function by unloading the joint (increased joint separation) remains inconclusive. Alternatively, valgus braces may mediate pain relief by mechanically stabilizing the joint and reducing muscle co-contractions and joint compression. This study therefore sought to examine the degree to which unloader knee braces control knee instability and influence muscle co-contractions during gait. Methods Sixteen subjects with radiographic evidence of medial compartment knee osteoarthritis and malalignment were recruited and fitted with a custom Generation II Unloader Brace. Gait analysis was performed with the knee unbraced and with the brace in neutral alignment and 4° valgus. A two week washout period separated brace conditions. Muscle co-contraction indices were derived for agonist and antagonist muscle pairings. Pain, instability and functional status were assessed using self-report questionnaires. Repeated-measures ANOVA’s, correlations and regression analysis were used for statistical analysis. Results The scores for pain, function and stability were worst when the knee was unsupported (baseline and washout). At baseline, 9 of 16 subjects reported knee instability, of which 5 complained it affected activities of daily living. Poor knee stability was significantly correlated with decreased activities of daily living, quality of life, global knee function and higher pain and symptoms. Knee function and stability scored highest with the neutral brace compared to the valgus brace. Vastus lateralis-lateral hamstring and vastus medialis-medial hamstring muscle co-contractions were significantly reduced as a result of bracing. Subjects with greater varus alignment exhibited greater decreases in vastus lateralis-lateral hamstrings co-contraction. Conclusion Neutral alignment performed as well or better than valgus alignment, in reducing pain, disability, muscle co

  18. Comparison of three knee braces in the treatment of medial knee osteoarthritis.

    Science.gov (United States)

    Dessery, Yoann; Belzile, Etienne L; Turmel, Sylvie; Corbeil, Philippe

    2014-12-01

    Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. Knee pain was alleviated with all three braces (pbraces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw∗Ht (pbrace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Focal knee lesions in knee pairs of asymptomatic and symptomatic subjects with OA risk factors—Data from the Osteoarthritis Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Chundru, Renu, E-mail: renu.chundru@ucsf.edu [Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107 (United States); Baum, Thomas, E-mail: thbaum@gmx.de [Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107 (United States); Nardo, Lorenzo, E-mail: lorenzo.nardo@ucsf.edu [Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107 (United States); Nevitt, Michael C., E-mail: MNevitt@psg.ucsf.edu [Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107 (United States); Lynch, John, E-mail: JLynch@psg.ucsf.edu [Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107 (United States); McCulloch, Charles E., E-mail: CMcCulloch@epi.ucsf.edu [Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107 (United States); Link, Thomas M., E-mail: tmlink@radiology.ucsf.edu [Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107 (United States)

    2013-08-15

    Objective: To better understand the relationship between knee pain and bilateral knee lesions, we compared focal knee lesions in knee pairs of subjects with no, unilateral, and bilateral knee pain, and risk factors for knee osteoarthritis (OA), but no radiographic knee OA. Materials and methods: We examined both knees of 120 subjects from the Osteoarthritis Initiative database. We randomly selected 60 subjects aged 45–55 years with OA risk factors, no knee pain (WOMAC pain score = 0) and no radiographic OA (KL-score ≤1) in both knees. We also selected two comparison groups with OA risk factors and no radiographic OA in both knees, but with knee pain (WOMAC pain score ≥5): 30 subjects with right only knee pain and 30 subjects with bilateral knee pain. All subjects underwent 3T MRI of both knees and focal knee lesions were assessed. Results: Statistically significant associations between prevalence of focal lesions in the right and left knee with odds ratios up to 13.5 were found in all three subject groups. Focal knee lesions were generally not associated with pain in analyses comparing knee pairs of subjects with unilateral knee pain (p > 0.05). The prevalence and severity of focal knee lesions were not significantly different in knee pairs of subjects with no knee pain and those with bilateral knee pain (p > 0.05). Conclusion: Focal knee lesions in the right and left knee of subjects with OA risk factors were positively associated with each other independent of knee pain status, and were not statistically significant different between knees in subjects with unilateral knee pain.

  20. Dislocation of the knee: imaging findings.

    Science.gov (United States)

    Shearer, Damon; Lomasney, Laurie; Pierce, Kenneth

    2010-01-01

    Dislocations of the knee are relatively uncommon injuries. However, the incidence of this injury appears to be increasing. Knee dislocations are most often high velocity blunt injuries, with motor vehicle accidents being a frequent etiology. Other causes include falls from height, athletic injuries, farming and industrial accidents, and even low velocity mechanisms such as a misstep into a hole. Likewise, minor trauma in the morbidly obese is increasingly recognized as a mechanism of knee dislocation. Multiple forms of dislocation exist, with the common factor being disruption of the tibiofemoral articulation. Dislocation can occur in a variety of directions depending on the mechanism of injury. The most common dislocation is anterior, which may be seen in hyperextension injuries such as martial arts kicking. The "dashboard injury" of motor vehicle accidents can result in a posterior dislocation of the knee. Lateral and rotary dislocations are less common. Knee dislocation is more commonly diagnosed in men, with a mean age of 23 to 31 years old. This is the very patient population encountered by Special Operations Forces (SOF) healthcare providers. Given the mechanisms of injury noted above, it is reasonable to conclude that knee dislocations may be seen in a young, active SOF patient population, particularly those engaged in parachuting, fast-roping/rappelling, driving at high speeds during military operations, and mixed martial arts.

  1. Knee Injury and Osteoarthritis Outcome Score (KOOS)

    DEFF Research Database (Denmark)

    Collins, N J; Prinsen, C A C; Christensen, R

    2016-01-01

    OBJECTIVE: To conduct a systematic review and meta-analysis to synthesize evidence regarding measurement properties of the Knee injury and Osteoarthritis Outcome Score (KOOS). DESIGN: A comprehensive literature search identified 37 eligible papers evaluating KOOS measurement properties in partici......OBJECTIVE: To conduct a systematic review and meta-analysis to synthesize evidence regarding measurement properties of the Knee injury and Osteoarthritis Outcome Score (KOOS). DESIGN: A comprehensive literature search identified 37 eligible papers evaluating KOOS measurement properties...... in participants with knee injuries and/or osteoarthritis (OA). Methodological quality was evaluated using the COSMIN checklist. Where possible, meta-analysis of extracted data was conducted for all studies and stratified by age and knee condition; otherwise narrative synthesis was performed. RESULTS: KOOS has...... adequate internal consistency, test-retest reliability and construct validity in young and old adults with knee injuries and/or OA. The ADL subscale has better content validity for older patients and Sport/Rec for younger patients with knee injuries, while the Pain subscale is more relevant for painful...

  2. Standing Stability in Knee Osteoarthritis Patients

    Directory of Open Access Journals (Sweden)

    M.T. Karimi

    2016-09-01

    Full Text Available Aims: Being prevalent in the more than 40 years old persons, the knee osteoarthritis is one of the main factors in the function system failure mainly affecting their life. There is a type of instability in the persons with knee osteoarthritis, which is an increase in the domain and frequency of body pressure center. The aim of the present study was to compare the standing stability parameters in persons with knee osteoarthritis and healthy persons. Instrument & Methods: In this case-control, 15 patients with knee osteoarthritis referred to the physiotherapy clinic of the rehabilitation center and Al-Zahra hospital were studied in the muscle-skeletal research center of Isfahan University of Medical Sciences in 2015. The subjects were selected via stratified sampling method. As control group, 15 healthy persons were also studied in Isfahan. Total path length and the domain and frequency of pressure center in different directions were measured to assess the stability. Data was analyzed by SPSS 19 software using descriptive statistics and paired T test. Findings: There were increases in the mean movement domain and the frequency of pressure center in the anterior-posterior and the internal-external directions, as well as in the total path proceeded by the pressure center in the internal-external direction, in the persons with knee osteoarthritis than the healthy persons (p0.05. Conclusion: Standing stability and balance in persons with knee osteoarthritis decreases compared to healthy persons.

  3. Which Antidumping Cases Reach the WTO?

    DEFF Research Database (Denmark)

    Kokko, Ari; Tingvall, Patrik Gustavsson; Videnord, Josefin

    This article examines the distribution of antidumping (AD) disputes across countries and industries, and examines which AD cases reach the dispute settlement system of the WTO. Our general finding is that neither the country nor the industry distribution of AD cases remains constant across...... using AD law to protect their domestic firms. We find that the typical AD notification is submitted by an upper middle-income country, and it focuses on a medium low-technology industry with differentiated products, but low relationship-specificity. The most typical complainant at the WTO is also...... an upper middle-income country, challenging a high-income country (most likely the US) that is allegedly giving unfair protection to an industry producing differentiated goods that are not very relationship-specific, using medium-low technologies. The analysis also reveals that when lower middle...

  4. The generalization of prior uncertainty during reaching.

    Science.gov (United States)

    Fernandes, Hugo L; Stevenson, Ian H; Vilares, Iris; Kording, Konrad P

    2014-08-20

    Bayesian statistics defines how new information, given by a likelihood, should be combined with previously acquired information, given by a prior distribution. Many experiments have shown that humans make use of such priors in cognitive, perceptual, and motor tasks, but where do priors come from? As people never experience the same situation twice, they can only construct priors by generalizing from similar past experiences. Here we examine the generalization of priors over stochastic visuomotor perturbations in reaching experiments. In particular, we look into how the first two moments of the prior--the mean and variance (uncertainty)--generalize. We find that uncertainty appears to generalize differently from the mean of the prior, and an interesting asymmetry arises when the mean and the uncertainty are manipulated simultaneously. Copyright © 2014 the authors 0270-6474/14/3411470-15$15.00/0.

  5. Knee kinematics is altered post-fatigue while performing a crossover task.

    Science.gov (United States)

    Cortes, Nelson; Greska, Eric; Ambegaonkar, Jatin P; Kollock, Roger O; Caswell, Shane V; Onate, James A

    2014-09-01

    To examine the effect of a sequential fatigue protocol on lower extremity biomechanics during a crossover cutting task in female soccer players. Eighteen female collegiate soccer players alternated between a fatigue protocol and two consecutive unanticipated crossover trials until fatigue was reached. Lower extremity biomechanics were evaluated during the crossover using a 3D motion capture system and two force plates. Repeated-measures ANOVAs analysed differences between three sequential stages of fatigue (pre, 50, 100%) for each dependent variable (α = 0.05). Knee flexion angles at initial contact (IC) for pre (-32 ± 9°) and 50% (-29 ± 11°) were significantly higher than at 100% fatigue (-22 ± 9°) (p angles at IC for pre (9 ± 5°) and 50% (8 ± 4°) were significantly higher (p = 0.006 and p = 0.049, respectively) than at 100% fatigue (6 ± 4°). Fatigue altered sagittal and frontal knee kinematics after 50% fatigue whereupon participants had diminished knee control at initial contact. Interventions should attempt to reduce the negative effects of fatigue on lower extremity biomechanics by promoting appropriate frontal plane alignment and increased knee flexion during fatigue status. III.

  6. Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study.

    Science.gov (United States)

    Wise, Barton L; Niu, Jingbo; Felson, David T; Hietpas, Jean; Sadosky, Alesia; Torner, James; Lewis, Cora E; Nevitt, Michael

    2015-08-01

    Debilitating pain associated with knee osteoarthritis (OA) often leads patients to seek and complete total knee arthroplasty (TKA). To date, few studies have evaluated the relation of functional impairment to the risk of TKA, despite the fact that OA is associated with functional impairment. The purpose of our study was to (1) evaluate whether function as measured by WOMAC physical function subscale was associated with undergoing TKA; and (2) whether any such association varied by sex. The National Institutes of Health-funded Multicenter Osteoarthritis Study (MOST) is an observational cohort study of persons aged 50 to 79 years with or at high risk of symptomatic knee OA who were recruited from the community. All eligible subjects with complete data were included in this analysis. Our study population sample consisted of 2946 patients with 5796 knees; 1776 (60%) of patients were women. We performed a repeated-measures analysis using baseline WOMAC physical function score to predict the risk of TKA from baseline to 30 months and WOMAC score at 30 months to predict risk of incident TKA from 30 months to 60 months. We used generalized estimating equations to account for the correlation between two knees within an individual and across the two periods. We calculated relative risk (RR) of TKA over 30 months by WOMAC function using a score of 0 to 5 as the referent in multiple binomial regressions with log link. Those with the greatest functional impairment (WOMAC scores 40-68; 62 TKAs in 462 knee periods) had 15.5 times (95% confidence interval [CI], 7.6-31.8; prisk of undergoing TKA over 30 months compared with the referent group (12 TKAs in 3604 knee periods), adjusting for basic covariates, and 5.9 times (95% CI, 2.8-12.5; prisk after further adjusting for knee pain severity. At every level of functional limitation, the RR for TKA for women was higher than for men, but interaction with sex did not reach significance after adjustment for covariates including

  7. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people

    Science.gov (United States)

    Nakagawa, Kazumasa; Maeda, Misako

    2017-01-01

    [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered. PMID:28356631

  8. Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Troelsen, Anders; Thorborg, Kristian

    2018-01-01

    -surgical treatment to be tried prior to surgical procedures. Patients with knee OA are characterized by decreased muscle strength, particularly in the knee-extensor muscles. Correspondingly, decreased knee-extensor strength is found to be associated with an increased risk of development, progression and severity...... of knee OA symptoms. Recent trials suggest a positive effect of pre-operative exercise on pre- and post-operative outcome; however, the most effective pre-operative knee-extensor strength exercise dosage is not known. The purpose of the present trial is to investigate the efficacy of three different...... exercise dosages of pre-operative, home-based, knee-extensor strength exercise on knee-extensor strength before and shortly after surgery in patients eligible for TKA due to end-stage knee OA. METHODS: In this randomized dose-response trial with a three-arm parallel design, 140 patients with end-stage knee...

  9. Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis.

    Science.gov (United States)

    Fantini Pagani, Cynthia H; Willwacher, Steffen; Benker, Rita; Brüggemann, Gert-Peter

    2014-12-01

    Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Controlled laboratory study, repeated measurements. In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle-foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2013.

  10. RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...

  11. Rapid knee-extensions to increase quadriceps muscle activity in patients with total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...

  12. MR imaging of the flexed knee: comparison to the extended knee in delineation of meniscal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, M.; Itai, Y. [Dept. of Radiology, Institute of Clinical Medicine, University of Tsukuba Tennodai, Tsukuba, Ibaraki (Japan); Endo, H. [Tsukuba Medical Center Hospital, Ibaraki (Japan); Ikeda, K. [Dept. of Orthopedic Surgery, University of Tsukuba Tennodai, Tsukuba (Japan)

    2000-11-01

    The aim of this study was to obtain MR images in the flexed-knee position and to compare the diagnostic value to the extended position in delineation of the menisci. With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semi-flexed position (average 45 of flexion) within a 1.5-T superconducting magnet. Sets of sagittal MR images were obtained for both the extended- and flexed-knee positions. Using the arthroscopic results as gold standards, 97 menisci were evaluated. Two observers interpreted each MR image of the extended and flexed positions independently without knowledge of the arthroscopic results. Flexed-knee MR images revealed 22 of the 27 arthroscopically proven torn menisci and 69 of the 70 intact menisci, for a sensitivity of 81.5 %, a specificity of 98.6 %, and an accuracy of 93.8 %. Extended-knee MR images indicated a sensitivity of 81.5 %, a specificity of 92.9 %, and an accuracy of 89.7 %. No statistically significant difference was found between the two positions. To enhance MR visualization of all the knee components, we recommend examining the knee in a flexed position within the magnet. (orig.)

  13. Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis

    NARCIS (Netherlands)

    Gerbrands, T. A.; Pisters, M. F.|info:eu-repo/dai/nl/317999303; Theeven, P. J R; Verschueren, S.; Vanwanseele, B.

    2017-01-01

    Objective To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics.

  14. Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis

    NARCIS (Netherlands)

    M.F. Pisters; Drs. Ing. Tim Gerbrands; B. Vanwanseele; P.J.R. Theeven; S. Verschueren

    2016-01-01

    Objective: To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip

  15. 49 CFR 572.136 - Knees and knee impact test procedure.

    Science.gov (United States)

    2010-10-01

    .... (a) Knee assembly. The knee assembly (refer to §§ 572.130(a)(1)(v) and (vi)) for the purpose of this... (drawing 880105-651 or 650), and femur load transducer (drawing SA572-S14) or its structural replacement... of the femur. (4) Guide the pendulum so that there is no significant lateral vertical or rotational...

  16. Opinions among Danish knee surgeons about indications to perform total knee replacement showed considerable variation

    DEFF Research Database (Denmark)

    Troelsen, Anders; Schrøder, Henrik; Husted, Henrik

    2012-01-01

    During the past decade, the incidence of primary total knee replacement (TKA) surgery in Denmark has approximately doubled. This increase could be due to weakened indications to perform TKA surgery. We aimed to investigate variation in opinions about indications to perform TKA among Danish knee...

  17. Correlation between subcutaneous knee fat thickness and chondromalacia patellae on magnetic resonance imaging of the knee.

    LENUS (Irish Health Repository)

    Kok, Hong Kuan

    2013-08-01

    Chondromalacia patellae is a common cause of anterior knee pain in young patients and can be detected noninvasively with magnetic resonance imaging (MRI). The purpose of our study was to evaluate the correlation between subcutaneous fat thickness around the knee joint on axial MRIs as a surrogate marker of obesity, with the presence or absence of chondromalacia patellae.

  18. Relationships Between Knee Extension Moments During Weighted and Unweighted Gait and Strength Measures That Predict Knee Moments After ACL Reconstruction.

    Science.gov (United States)

    Hartigan, Erin; Aucoin, Jennifer; Carlson, Rita; Klieber-Kusak, Melanie; Murray, Thomas; Shaw, Bernadette; Lawrence, Michael

    Weighted gait increases internal knee extension moment impulses (KEMI) in the anterior cruciate ligament-reconstructed (ACLR) limb; however, limb differences persist. (1) KEMI during normal gait will influence KEMI during weighted gait and (2) peak knee extension (PKE) torque and time to reach PKE torque will predict KEMI during gait tasks. Descriptive laboratory study. Twenty-four women and 14 men completed 3 gait tasks (unweighted, vest, sled) and strength testing after discharge from rehabilitation and clearance to return to sports. KEMI were calculated during the first 25% of stance. PKE torque and time to reach PKE torque were obtained using a dynamometer. Data on the ACLR limb and symmetry indices (SIs) were analyzed for each sex. Women presented with asymmetrical PKE torques and KEMI across tasks. There were three correlations noted for KEMI: between the walk and vest, walk and sled, and vest and sled tasks. Slower time to PKE torque predicted limb asymmetries across tasks and KEMI in the ACLR limb during the sled task. Men presented with asymmetrical PKE torques and KEMI during the sled task. There was a correlation noted for KEMI between walk and vest tasks only. During the sled task, ACLR limb time to PKE torque predicted KEMI in the ACLR limb and PKE torque SI predicted KEMI SI. Women use asymmetrical KEMI profiles during all gait tasks, and those with worse KEMI during walking have worse KEMI during weighted gait. Men have asymmetrical KEMI when sled towing, and these KEMIs do not correlate with KEMI during walking or vest tasks. PKE torque deficits persist when attempting to return to sports. Only men use gains in PKE torque to improve KEMI profiles. Although quicker PKE torque generation will increase KEMI in women, normalization of KEMI profiles will not occur by increasing rate of force development only. Gait retraining is recommended to correct asymmetrical KEMI profiles used across gait tasks in women.

  19. 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

  20. The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen.

    Science.gov (United States)

    Bottoni, G; Herten, A; Kofler, P; Hasler, M; Nachbauer, W

    2013-12-01

    Proprioception has been defined as the capacity to feel the position of a joint in space as sensed by the central nervous system. Prophylactic knee braces are supposed to help in knee injury prevention not just with a mechanical support of the joint but also improving proprioception. The main aim of this study was to determine the effects of a knee brace and a knee sleeve on knee proprioception. The secondary aim was to determine if different starting angles of the knee and different movement directions influence knee proprioception. We tested a group of twenty healthy male sport students without knee injuries. They were tested with the brace, with the sleeve and without support. The threshold of detection of passive knee movement with a starting knee angle of 30° and 60°, both in flexion and extension was determined. We did not find any statistically significant change in the threshold of detection of passive knee movement wearing the brace or the sleeve compared to the unsupported condition (p=0.462, α=0.05). We found a significantly lower proprioceptive sensitivity starting at the more flexed knee angle (p=0.005, α=0.05) and moving in extension than in the other test situations (p=0.001, α=0.05). Movement direction and starting position appear to influence the threshold of detection of passive knee movement. The results of this study also suggest that knee supports do not influence either positively or negatively knee proprioception of uninjured active subjects. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. New symmetry of intended curved reaches

    Directory of Open Access Journals (Sweden)

    Torres Elizabeth B

    2010-04-01

    Full Text Available Abstract Background Movement regularities are inherently present in automated goal-directed motions of the primate's arm system. They can provide important signatures of intentional behaviours driven by sensory-motor strategies, but it remains unknown if during motor learning new regularities can be uncovered despite high variability in the temporal dynamics of the hand motions. Methods We investigated the conservation and violation of new movement regularity obtained from the hand motions traced by two untrained monkeys as they learned to reach outwardly towards spatial targets while avoiding obstacles in the dark. The regularity pertains to the transformation from postural to hand paths that aim at visual goals. Results In length-minimizing curves the area enclosed between the Euclidean straight line and the curve up to its point of maximum curvature is 1/2 of the total area. Similar trend is found if one examines the perimeter. This new movement regularity remained robust to striking changes in arm dynamics that gave rise to changes in the speed of the reach, to changes in the hand path curvature, and to changes in the arm's postural paths. The area and perimeter ratios characterizing the regularity co-varied across repeats of randomly presented targets whenever the transformation from posture to hand paths was compliant with the intended goals. To interpret this conservation and the cases in which the regularity was violated and recovered, we provide a geometric model that characterizes arm-to-hand and hand-to-arm motion paths as length minimizing curves (geodesics in a non-Euclidean space. Whenever the transformation from one space to the other is distance-metric preserving (isometric the two symmetric ratios co-vary. Otherwise, the symmetric ratios and their co-variation are violated. As predicted by the model we found empirical evidence for the violation of this movement regularity whenever the intended goals mismatched the actions. This

  2. Continental reach: The Westcoast Energy story

    Energy Technology Data Exchange (ETDEWEB)

    Newman, P. C.

    2002-07-01

    A historical account is given of the spectacular success that was Westcoast Energy Inc., a Canadian natural gas giant that charted a wilderness pipeline from natural gas fields in Canada's sub-arctic solitude. The beginning of the company is traced to an event in 1934 when near the bank of the Pouce Coupe River, close to the Alberta-British Columbia border, Frank McMahon, a solitary wildcatter and the eventual founder of the company, first sighted the fiery inferno of a runaway wildcat well, drilled by geologists of the Imperial Oil Company during their original search for the Canadian petroleum basin's motherlode. It was on this occasion in 1934 that McMahon first conceived a geological profile that connected the gas-bearing sandstone of Pouce Coupe with the reservoir rock of the biggest natural gas field of Alberta, and a pipeline from this sandstone storehouse across the rugged heart of British Columbia to Vancouver, and south into the United States. It took the better part of a quarter century to realize the dream of that pipeline which, in due course, turned out to be only the first step towards reaching the top rank of Canadian corporations in operational and financial terms, and becoming one of only a handful in terms of a story that became a Canadian corporate legend. By chronicling the lives and contributions of the company's founder and senior officials over the years, the book traces the company's meteoric rise from a gleam in its founder's eye to a cautious regional utility, and to the aggressive Canadian adventurer that went on to burst the boundaries of its Pacific Coast world, until the continental reach of its operations and interests run from Canada's Pacific shoreline to its Atlantic basins and Mexico's Campeche Bay to Alaska's Prudhoe Bay. The company's independent existence came to an end in 2002 when Westcoast Energy, by then a $15 billion operation, was acquired by Duke Energy Limited of North

  3. 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.

  4. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results.

    Science.gov (United States)

    Laroche, Davy; Morisset, Claire; Fortunet, Clementine; Gremeaux, Vincent; Maillefert, Jean-Francis; Ornetti, Paul

    2014-06-01

    Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. The association between submaximal quadriceps force steadiness and the knee adduction moment during walking in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Sørensen, Tina Juul; Langberg, Henning; Aaboe, Jens

    2011-01-01

    STUDY DESIGN: Cross-sectional study. OBJECTIVES: To investigate the relationship between quadriceps force steadiness and knee adduction moment during walking in patients with knee osteoarthritis (OA). BACKGROUND: Studies have shown that quadriceps force steadiness is impaired in patients with knee......, and knee pain was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale and a visual analog scale. RESULTS: Regression analyses showed that quadriceps force steadiness did not predict the peak knee adduction moment (adjusted R2 = 0.05, P = .41). Inclusion of covariates did...

  6. Determinants of physical functioning in women with knee osteoarthritis.

    Science.gov (United States)

    Nur, Hakan; Sertkaya, Bilge Saruhan; Tuncer, Tiraje

    2017-06-12

    Knee osteoarthritis (OA) is an important health problem with its high prevalence and association with pain and functional disability in physical tasks and activities especially in women. To explore the impacts of widely seen demographic, pathological, psychological, and impairment factors on physical functioning in women with knee OA using the performance-based and self-reported measures. One hundred and ten women with knee OA participated in this study. Performance-based measures included the 10-m walk test, timed up and go (TUG) test, and a stair test. Self-reported physical functioning was measured using the Western Ontario and McMasters Universities OA Index. Knee muscle strength, pain intensity, flexion range of motion (ROM), body mass index (BMI), radiographic severity, and anxious and depressive symptoms were measured. Age, disease duration, and comorbidities were recorded. Correlation and linear regression analyses were used to assess the associations. In the linear regression models, knee muscle weakness, limited knee flexion ROM, pain intensity, and older age contributed to 65% of variance in physical performance measures mostly explained by knee muscle weakness. Knee pain intensity, BMI, anxiety, and knee muscle weakness contributed to 60% of variance in WOMAC physical function score mostly explained by pain. Radiologic severity, depression, comorbidities, and disease duration did not have a significant association (P knee OA, knee muscle strength was the main determinant of performance-based physical functioning together with knee flexion ROM, knee pain, and age. Knee pain was the main determinant of self-reported physical functioning. BMI, anxiety, and knee muscle strength had some contributions as well. Performance-based and self-reported measures had moderate relations and evaluate different aspects of physical functioning. In the management of women with knee OA strengthening of weak knee muscles, improving limited flexion ROM, pain management

  7. Using New Media to Reach Broad Audiences

    Science.gov (United States)

    Gay, P. L.

    2008-06-01

    The International Year of Astronomy New Media Working Group (IYA NMWG) has a singular mission: To flood the Internet with ways to learn about astronomy, interact with astronomers and astronomy content, and socially network with astronomy. Within each of these areas, we seek to build lasting programs and partnerships that will continue beyond 2009. Our weapon of choice is New Media. It is often easiest to define New Media by what it is not. Television, radio, print and their online redistribution of content are not New Media. Many forms of New Media start as user provided content and content infrastructures that answer that individual's creative whim in a way that is adopted by a broader audience. Classic examples include Blogs and Podcasts. This media is typically distributed through content specific websites and RSS feeds, which allow syndication. RSS aggregators (iTunes has audio and video aggregation abilities) allow subscribers to have content delivered to their computers automatically when they connect to the Internet. RSS technology is also being used in such creative ways as allowing automatically updating Google-maps that show the location of someone with an intelligent GPS system, and in sharing 100 word microblogs from anyone (Twitters) through a single feed. In this poster, we outline how the IYA NMWG plans to use New Media to reach target primary audiences of astronomy enthusiasts, image lovers, and amateur astronomers, as well as secondary audiences, including: science fiction fans, online gamers, and skeptics.

  8. Media perspective - new opportunities for reaching audiences

    Science.gov (United States)

    Haswell, Katy

    2007-08-01

    The world of media is experiencing a period of extreme and rapid change with the rise of internet television and the download generation. Many young people no longer watch standard TV. Instead, they go on-line, talking to friends and downloading pictures, videos, music clips to put on their own websites and watch/ listen to on their laptops and mobile phones. Gone are the days when TV controllers determined what you watched and when you watched it. Now the buzzword is IPTV, Internet Protocol Television, with companies such as JOOST offering hundreds of channels on a wide range of subjects, all of which you can choose to watch when and where you wish, on your high-def widescreen with stereo surround sound at home or on your mobile phone on the train. This media revolution is changing the way organisations get their message out. And it is encouraging companies such as advertising agencies to be creative about new ways of accessing audiences. The good news is that we have fresh opportunities to reach young people through internet-based media and material downloaded through tools such as games machines, as well as through the traditional media. And it is important for Europlanet to make the most of these new and exciting developments.

  9. Important ATLAS Forward Calorimeter Milestone Reached

    CERN Document Server

    Loch, P.

    The ATLAS Forward Calorimeter working group has reached an important milestone in the production of their detectors. The mechanical assembly of the first electromagnetic module (FCal1C) has been completed at the University of Arizona on February 25, 2002, only ten days after the originally scheduled date. The photo shows the University of Arizona FCal group in the clean room, together with the assembled FCal1C module. The module consists of a stack of 18 round copper plates, each about one inch thick. Each plate is about 90 cm in diameter, and has 12260 precision-drilled holes in it, to accommodate the tube/rod electrode assembly. The machining of the plates, which was done at the Science Technology Center (STC) at Carleton University, Ottawa, Canada, required high precision to allow for easy insertion of the electrode copper tube. The plates have been carefully cleaned at the University of Arizona, to remove any machining residue and metal flakes. This process alone took about eleven weeks. Exactly 122...

  10. Has Athletic Performance Reached its Peak?

    Science.gov (United States)

    Berthelot, Geoffroy; Sedeaud, Adrien; Marck, Adrien; Antero-Jacquemin, Juliana; Schipman, Julien; Saulière, Guillaume; Marc, Andy; Desgorces, François-Denis; Toussaint, Jean-François

    2015-09-01

    Limits to athletic performance have long been a topic of myth and debate. However, sport performance appears to have reached a state of stagnation in recent years, suggesting that the physical capabilities of humans and other athletic species, such as greyhounds and thoroughbreds, cannot progress indefinitely. Although the ultimate capabilities may be predictable, the exact path for the absolute maximal performance values remains difficult to assess and relies on technical innovations, sport regulation, and other parameters that depend on current societal and economic conditions. The aim of this literature review was to assess the possible plateau of top physical capabilities in various events and detail the historical backgrounds and sociocultural, anthropometrical, and physiological factors influencing the progress and regression of athletic performance. Time series of performances in Olympic disciplines, such as track and field and swimming events, from 1896 to 2012 reveal a major decrease in performance development. Such a saturation effect is simultaneous in greyhound, thoroughbred, and frog performances. The genetic condition, exhaustion of phenotypic pools, economic context, and the depletion of optimal morphological traits contribute to the observed limitation of physical capabilities. Present conditions prevailing, we approach absolute physical limits and endure a continued period of world record scarcity. Optional scenarios for further improvements will mostly depend on sport technology and modification competition rules.

  11. LEP Dismantling Reaches Half-Way Stage

    CERN Multimedia

    2001-01-01

    LEP's last superconducting module leaves its home port... Just seven months into the operation, LEP dismantling is forging ahead. Two of the eight arcs which form the tunnel have already been emptied and the last of the accelerator's radiofrequency (RF) cavities has just been raised to the surface. The 160 people working on LEP dismantling have reason to feel pleased with their progress. All of the accelerator's 72 superconducting RF modules have already been brought to the surface, with the last one being extracted on 2nd May. This represents an important step in the dismantling process, as head of the project, John Poole, explains. 'This was the most delicate part of the project, because the modules are very big and they could only come out at one place', he says. The shaft at point 1.8 through which the RF cavity modules pass is 18 metres in diameter, while each module is 11.5 metres long. Some modules had to travel more than 10 kilometres to reach the shaft. ... is lifted up the PM 1.8 shaft, after a m...

  12. CAST reaches milestone but keeps on searching

    CERN Multimedia

    CERN Courier (september 2011 issue)

    2011-01-01

    After eight years of searching for the emission of a dark matter candidate particle, the axion, from the Sun, the CERN Axion Solar Telescope (CAST) has fulfilled its original physics programme.   Members of the CAST collaboration in July, together with dipole-based helioscope. CAST, the world’s most sensitive axion helioscope, points a recycled prototype LHC dipole magnet at the Sun at dawn and dusk, looking for the conversion of axions to X-rays. It incorporates four state-of-the-art X-ray detectors: three Micromegas detectors and a pn-CCD imaging camera attached to a focusing X-ray telescope that was recovered from the German space programme (see CERN Courier April 2010).  Over the years, CAST has operated with the magnet bores - the location of the axion conversion - in different conditions: first in vacuum, covering axion masses up to 20 meV/c2, and then with a buffer gas (4He and later 3He) at various densities, finally reaching the goal of 1.17 eV/c2 on 22 ...

  13. Parallel explicit and implicit control of reaching.

    Science.gov (United States)

    Mazzoni, Pietro; Wexler, Nancy S

    2009-10-22

    Human movement can be guided automatically (implicit control) or attentively (explicit control). Explicit control may be engaged when learning a new movement, while implicit control enables simultaneous execution of multiple actions. Explicit and implicit control can often be assigned arbitrarily: we can simultaneously drive a car and tune the radio, seamlessly allocating implicit or explicit control to either action. This flexibility suggests that sensorimotor signals, including those that encode spatially overlapping perception and behavior, can be accurately segregated to explicit and implicit control processes. We tested human subjects' ability to segregate sensorimotor signals to parallel control processes by requiring dual (explicit and implicit) control of the same reaching movement and testing for interference between these processes. Healthy control subjects were able to engage dual explicit and implicit motor control without degradation of performance compared to explicit or implicit control alone. We then asked whether segregation of explicit and implicit motor control can be selectively disrupted by studying dual-control performance in subjects with no clinically manifest neurologic deficits in the presymptomatic stage of Huntington's disease (HD). These subjects performed successfully under either explicit or implicit control alone, but were impaired in the dual-control condition. The human nervous system can exert dual control on a single action, and is therefore able to accurately segregate sensorimotor signals to explicit and implicit control. The impairment observed in the presymptomatic stage of HD points to a possible crucial contribution of the striatum to the segregation of sensorimotor signals to multiple control processes.

  14. Parallel explicit and implicit control of reaching.

    Directory of Open Access Journals (Sweden)

    Pietro Mazzoni

    2009-10-01

    Full Text Available Human movement can be guided automatically (implicit control or attentively (explicit control. Explicit control may be engaged when learning a new movement, while implicit control enables simultaneous execution of multiple actions. Explicit and implicit control can often be assigned arbitrarily: we can simultaneously drive a car and tune the radio, seamlessly allocating implicit or explicit control to either action. This flexibility suggests that sensorimotor signals, including those that encode spatially overlapping perception and behavior, can be accurately segregated to explicit and implicit control processes.We tested human subjects' ability to segregate sensorimotor signals to parallel control processes by requiring dual (explicit and implicit control of the same reaching movement and testing for interference between these processes. Healthy control subjects were able to engage dual explicit and implicit motor control without degradation of performance compared to explicit or implicit control alone. We then asked whether segregation of explicit and implicit motor control can be selectively disrupted by studying dual-control performance in subjects with no clinically manifest neurologic deficits in the presymptomatic stage of Huntington's disease (HD. These subjects performed successfully under either explicit or implicit control alone, but were impaired in the dual-control condition.The human nervous system can exert dual control on a single action, and is therefore able to accurately segregate sensorimotor signals to explicit and implicit control. The impairment observed in the presymptomatic stage of HD points to a possible crucial contribution of the striatum to the segregation of sensorimotor signals to multiple control processes.

  15. Planning of the Extended Reach well Dieksand 2; Planung der Extended Reach Bohrung Dieksand 2

    Energy Technology Data Exchange (ETDEWEB)

    Frank, U.; Berners, H. [RWE-DEA AG, Hamburg (Germany). Drilling Team Mittelplate und Dieksand; Hadow, A.; Klop, G.; Sickinger, W. [Wintershall AG Erdoelwerke, Barnstdorf (Germany); Sudron, K.

    1998-12-31

    The Mittelplate oil field is located 7 km offshore the town of Friedrichskoog. Reserves are estimated at 30 million tonnes of oil. At a production rate of 2,500 t/d, it will last about 33 years. The transport capacity of the offshore platform is limited, so that attempts were made to enhance production by constructing the extended reach borehole Dieksand 2. Details are presented. (orig.) [Deutsch] Das Erdoelfeld Mittelplate liegt am suedlichen Rand des Nationalparks Schleswig Holsteinisches Wattenmeer, ca. 7000 m westlich der Ortschaft Friedrichskoog. Die gewinnbaren Reserven betragen ca. 30 Millionen t Oel. Bei einer Foerderkapazitaet von 2.500 t/Tag betraegt die Foerderdauer ca. 33 Jahre. Aufgrund der begrenzten Transportkapazitaeten von der Insel, laesst sich durch zusaetzliche Bohrungen von der kuenstlichen Insel Mittelplate keine entscheidende Erhoehung der Foerderkapazitaet erzielen. Ab Sommer 1996 wurde erstmals die Moeglichkeit der Lagerstaettenerschliessung von Land untersucht. Ein im Mai 1997 in Hamburg etabliertes Drilling Team wurde mit der Aufgabe betraut, die Extended Reach Bohrung Dieksand 2 zu planen und abzuteufen. Die Planungsphasen fuer die Extended Reach Bohrung Dieksand 2 wurden aufgezeigt. Die fuer den Erfolg einer Extended Reach Bohrung wichtigen Planungsparameter wurden erlaeutert. Es wurden Wege gezeigt, wie bei diesem Projekt technische und geologische Risiken in der Planung mit beruecksichtigt und nach Beginn der Bohrung weiter bearbeitet werden koennen. (orig.)

  16. Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke.

    Science.gov (United States)

    Duff, Margaret; Chen, Yinpeng; Cheng, Long; Liu, Sheng-Min; Blake, Paul; Wolf, Steven L; Rikakis, Thanassis

    2013-05-01

    Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. We describe the first proof-of-concept study to compare outcomes of AMRR and traditional upper-extremity physical therapy. Two groups of participants with chronic stroke received either a month of AMRR therapy (n = 11) or matched dosing of traditional repetitive task therapy (n = 10). Participants were right handed, between 35 and 85 years old, and could independently reach to and at least partially grasp an object in front of them. Upper-extremity clinical scale scores and kinematic performances were measured before and after treatment. Both groups showed increased function after therapy, demonstrated by statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment (FMA) scores, with the traditional therapy group improving significantly more on the FMA. However, only participants who received AMRR therapy showed a consistent improvement in kinematic measurements, both for the trained task of reaching to grasp a cone and the untrained task of reaching to push a lighted button. AMRR may be useful in improving both functionality and the kinematics of reaching. Further study is needed to determine if AMRR therapy induces long-term changes in movement quality that foster better functional recovery.

  17. Does an unloader brace reduce knee loading in normally aligned knees?

    Science.gov (United States)

    Ebert, Jay R; Hambly, Karen; Joss, Brendan; Ackland, Timothy R; Donnelly, Cyril J

    2014-03-01

    Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking. The purpose of this study was to investigate the effect of varus and valgus adjustments to one commercially available unloader knee brace on tibiofemoral joint loading and knee muscle activation in populations with normal knee alignment. The gait of 20 healthy participants (mean age 28.3 years; body mass index 22.9 kg/m(2)) was analyzed with varus and valgus knee brace conditions and without a brace. Spatiotemporal variables were calculated as were knee adduction moments and muscle activation during stance. A directed cocontraction ratio was also calculated to investigate the relative change in the activation of muscles with medial (versus lateral) moment arms about the knee. Group differences were investigated using analysis of variance. The numbers available would have provided 85% power to detect a 0.05 increase or decrease in the knee adduction moment (Nm/kg*m) in the braced condition compared with the no brace condition. With the numbers available, there were no differences between the braced and nonbraced conditions in kinetic or muscle activity parameters. Both varus (directed cocontraction ratio 0.29, SD 0.21, effect size 0.95, p = 0.315) and valgus (directed cocontraction ratio 0.28, SD 0.24, effect size 0.93, p = 0.315) bracing conditions increased the relative activation of muscles with lateral moment arms compared with no brace (directed cocontraction ratio 0.49, SD 0.21). Results revealed inconsistencies in knee kinetics and muscle activation strategies after varus and valgus bracing conditions. Although in this pilot study the results were not statistically significant, the magnitudes of the observed effect sizes were moderate to large and represent suitable pilot data for future work. Varus bracing increased knee

  18. Columbia River Estuary Ecosystem Classification Hydrogeomorphic Reach

    Science.gov (United States)

    Cannon, Charles M.; Ramirez, Mary F.; Heatwole, Danelle W.; Burke, Jennifer L.; Simenstad, Charles A.; O'Connor, Jim E.; Marcoe, Keith

    2012-01-01

    Estuarine ecosystems are controlled by a variety of processes that operate at multiple spatial and temporal scales. Understanding the hierarchical nature of these processes will aid in prioritization of restoration efforts. This hierarchical Columbia River Estuary Ecosystem Classification (henceforth "Classification") of the Columbia River estuary is a spatial database of the tidally-influenced reaches of the lower Columbia River, the tidally affected parts of its tributaries, and the landforms that make up their floodplains for the 230 kilometers between the Pacific Ocean and Bonneville Dam. This work is a collaborative effort between University of Washington School of Aquatic and Fishery Sciences (henceforth "UW"), U.S. Geological Survey (henceforth "USGS"), and the Lower Columbia Estuary Partnership (henceforth "EP"). Consideration of geomorphologic processes will improve the understanding of controlling physical factors that drive ecosystem evolution along the tidal Columbia River. The Classification is organized around six hierarchical levels, progressing from the coarsest, regional scale to the finest, localized scale: (1) Ecosystem Province; (2) Ecoregion; (3) Hydrogeomorphic Reach; (4) Ecosystem Complex; (5) Geomorphic Catena; and (6) Primary Cover Class. For Levels 4 and 5, we mapped landforms within the Holocene floodplain primarily by visual interpretation of Light Detection and Ranging (LiDAR) topography supplemented with aerial photographs, Natural Resources Conservation Service (NRCS) soils data, and historical maps. Mapped landforms are classified as to their current geomorphic function, the inferred process regime that formed them, and anthropogenic modification. Channels were classified primarily by a set of depth-based rules and geometric relationships. Classification Level 5 floodplain landforms ("geomorphic catenae") were further classified based on multivariate analysis of land-cover within the mapped landform area and attributed as "sub

  19. Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Richard Henry

    2012-01-01

    Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.

  20. 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.

  1. Fuzzy Modelling of Knee Joint with Genetic Optimization

    National Research Council Canada - National Science Library

    B. S. K. K. Ibrahim; M. O. Tokhi; M. S. Huq; R. Jailani; S. C. Gharooni

    2011-01-01

    .... The objective of this study is to develop a knee joint model capable of relating electrical parameters to dynamic joint torque as well as knee angle for functional electrical stimulation application...

  2. Prevalence of knee instability in relation to sports activity

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders; Hansen, Thorsten Ingemann

    2001-01-01

    The objective was to estimate the prevalence of knee instability among active athletes and to investigate potential associations to type, amount and duration of sports participation. Based on a questionnaire, 339 athletes provided information about different features of occupation, sports activity...... and knee instability. The 12-month period prevalence of knee instability and constant or recurrent knee instability, and absence from sport and absence from work due to knee instability, was 22%, 14%, 5% and 1%, respectively. Knee instability as such, and constant or recurrent knee instability were found...... to be positively associated with female gender and different features of occupational work. In conclusion, knee instability is a commonly reported phenomenon among active athletes. It was found to be independent of the type and the amount of sports activity but highly dependent on female gender, type and amount...

  3. Taking Opioids Before Knee Surgery Could Raise Pain Later

    Science.gov (United States)

    ... the procedure. Knee replacement is used to treat knee osteoarthritis. But patients spend an average of 13 years before surgery using non-surgical treatments such as physical therapy, injections and painkillers, the ...

  4. variability of the lateral ligamentous complex of the knee

    African Journals Online (AJOL)

    ligaments on the lateral aspect of the knee namely lateral collateral ligament, anterolateral and triradiate collateral ... lateral knee stability and prevention of excessive internal ... anterior cruciate ligaments were repaired. It therefore becomes ...

  5. MRI in assessment of sports related knee injuries

    Directory of Open Access Journals (Sweden)

    Waleed Hetta

    2014-12-01

    Conclusion: MRI represents the optimal imaging tool in the evaluation of the sports related knee injuries, which has been shown to be an accurate and non invasive method of diagnosing ligament, meniscal, cartilage and muscular knee injuries.

  6. Successful total knee arthroplasty in the presence of sporotrichal arthritis.

    NARCIS (Netherlands)

    Koeter, S.; Jackson, R.W.

    2006-01-01

    Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of

  7. Hip or knee replacement - in the hospital after

    Science.gov (United States)

    Hip replacement surgery - after - self-care; Knee replacement surgery - after - self-care ... taking walks in the hallways with help. After knee replacement, some surgeons recommend using a continuous passive ...

  8. Outcomes of Bicompartmental Knee Arthroplasty: A Review

    Directory of Open Access Journals (Sweden)

    Luigi Sabatini

    2014-10-01

    Full Text Available Introduction: Total knee arthroplasty (TKA offers high survival and high functional scores when arthritis is affecting the three compartments of the knee; however, TKA does not preserve the bone stock and the ligaments and these points can represent theoretical disadvantages, particularly for young patients with higher demand and higher risk for potential revision. Bicompartmental knee arthroplasty (BKA is a type of resurfacing surgery where two of the three compartments of the knee joint (medial tibiofemoral, lateral tibiofemoral or patellofemoral are replaced with preservation of the third. Smaller implant sizes, less operative trauma, preservation of both cruciate ligaments and bone stock, and a more ‘‘physiological’’ knee are reported advantages over TKA. BKA has been proposed to bridge the gap between UKA and TKA. Methods: A systematic literature search was conducted during May and June 2014. The electronic databases searched were: PUBMED/MEDLINE and Cochrane Library. No language or data restrictions were used. The search keyword was bicompartmental knee artroplasty, BKA, unicompartmental knee arthroplasty AND patellofemoral arthroplasty, unicompartmental knee arthroplasty AND patellofemoral joint, UKA AND PFJ, which appeared in the title, abstract or keyword fields. Initially, 129 articles were found: based on abstract and after removal of duplicates, 102 articles remained. The full text of each of these articles was read and another 13 articles were considered non-relevant and removed. The final number of articles included in this review was 89. Results: Functional and radiological results, complication, survivorship, kinematics and advantages of BKA versus TKA were analyzed. Discussion and Conclusion: Advantages of a bonesparing, ligament-sparing, such as BKA, are clearly evident. It seems intuitive that a knee reconstruction that maintains the proprioceptive and kinematic benefits of retaining the cruciate ligaments would be

  9. Can coronal hole spicules reach coronal temperatures?

    Science.gov (United States)

    Madjarska, M. S.; Vanninathan, K.; Doyle, J. G.

    2011-08-01

    Aims: The present study aims to provide observational evidence of whether coronal hole spicules reach coronal temperatures. Methods: We combine multi-instrument co-observations obtained with the SUMER/SoHO and with the EIS/SOT/XRT/Hinode. Results: The analysed three large spicules were found to be comprised of numerous thin spicules that rise, rotate, and descend simultaneously forming a bush-like feature. Their rotation resembles the untwisting of a large flux rope. They show velocities ranging from 50 to 250 kms-1. We clearly associated the red- and blue-shifted emissions in transition region lines not only with rotating but also with rising and descending plasmas. Our main result is that these spicules although very large and dynamic, are not present in the spectral lines formed at temperatures above 300 000 K. Conclusions: In this paper we present the analysis of three Ca ii H large spicules that are composed of numerous dynamic thin spicules but appear as macrospicules in lower resolution EUV images. We found no coronal counterpart of these and smaller spicules. We believe that the identification of phenomena that have very different origins as macrospicules is due to the interpretation of the transition region emission, and especially the He ii emission, wherein both chromospheric large spicules and coronal X-ray jets are present. We suggest that the recent observation of spicules in the coronal AIA/SDO 171 Å and 211 Å channels probably comes from the existence of transition region emission there. Movie is available in electronic form at http://www.aanda.org

  10. Safe Care to Knee Injuries in Athletes

    Directory of Open Access Journals (Sweden)

    Gerardo Águila Tejeda

    2013-04-01

    Full Text Available Background: the guarantee of sporting success lies in the appropriate functioning of the musculoskeletal system, given that its vulnerability hinders the performance of each athlete. Being timely is critical to provide safe care to the affections of knee; late diagnosis in this system may lead to the development of complications and hinder sport practice. Objective: to characterize knee injuries in athletes of the sport system in the province of Cienfuegos.Methods: an observational, quantitative and qualitative, longitudinal and retrospective study was conducted. It included 104 athletes who attended the Traumatology Consultation from 2009 to 2011, presenting different types of knee injuries in various stages of training. Variables such as age, sex, sport, site of injury, stage of training, kilocalories consumed, type of training, quality of equipment and diagnosis were analyzed. The procedure used consists of a comprehensive review of case notes and medical records of all patients that attended consultation during the period analyzed, from which the necessary data was collected. Interviews with coaches and technical staff were carried out as well. Results: knee injuries occur in all ages of athletes, with a slight predominance of males. Highest frequencies are those of the ligament and meniscus, with the highest incidence in athletics, volleyball and judo. Conservative treatment predominated.Conclusions: knee injuries require a timely treatment in order to achieve athlete's success and safety.

  11. Timing Sequence of Multi-Planar Knee Kinematics Revealed by Physiologic Cadaveric Simulation of Landing: Implications for ACL Injury Mechanism

    Science.gov (United States)

    Kiapour, Ata M.; Quatman, Carmen E.; Goel, Vijay K.; Wordeman, Samuel C.; Hewett, Timothy E.; Demetropoulos, Constantine K.

    2013-01-01

    Background Challenges in accurate, in vivo quantification of multi-planar knee kinematics and relevant timing sequence during high-risk injurious tasks pose challenges in understanding the relative contributions of joint loads in non-contact injury mechanisms. Biomechanical testing on human cadaveric tissue, if properly designed, offers a practical means to evaluate joint biomechanics and injury mechanisms. This study seeks to investigate detailed interactions between tibiofemoral joint multi-planar kinematics and anterior cruciate ligament strain in a cadaveric model of landing using a validated physiologic drop-stand apparatus. Methods Sixteen instrumented cadaveric legs, 45(SD 7) years (8 female and 8 male) were tested. Event timing sequence, change in tibiofemoral kinematics (position, angular velocity and linear acceleration) and change in anterior cruciate ligament strain were quantified. Findings The proposed cadaveric model demonstrated similar tibiofemoral kinematics/kinetics as reported measurements obtained from in vivo studies. While knee flexion, anterior tibial translation, knee abduction and increased anterior cruciate ligament strain initiated and reached maximum values almost simultaneously, internal tibial rotation initiated and peaked (p<0.015 for all comparisons) significantly later. Further, internal tibial rotation reached 1.8(SD 2.5)°, almost 63% of its maximum value, at the time that peak anterior cruciate ligament strain occurred, while both anterior tibial translation and knee abduction had already reached their peaks. Interpretation Together, these findings indicate that although internal tibial rotation contributes to increased anterior cruciate ligament strain, it is secondary to knee abduction and anterior tibial translation in its effect on anterior cruciate ligament strain and potential risk of injury. PMID:24238957

  12. Computer-aided diagnosis of early knee osteoarthritis based on MRI T2 mapping.

    Science.gov (United States)

    Wu, Yixiao; Yang, Ran; Jia, Sen; Li, Zhanjun; Zhou, Zhiyang; Lou, Ting

    2014-01-01

    This work was aimed at studying the method of computer-aided diagnosis of early knee OA (OA: osteoarthritis). Based on the technique of MRI (MRI: Magnetic Resonance Imaging) T2 Mapping, through computer image processing, feature extraction, calculation and analysis via constructing a classifier, an effective computer-aided diagnosis method for knee OA was created to assist doctors in their accurate, timely and convenient detection of potential risk of OA. In order to evaluate this method, a total of 1380 data from the MRI images of 46 samples of knee joints were collected. These data were then modeled through linear regression on an offline general platform by the use of the ImageJ software, and a map of the physical parameter T2 was reconstructed. After the image processing, the T2 values of ten regions in the WORMS (WORMS: Whole-organ Magnetic Resonance Imaging Score) areas of the articular cartilage were extracted to be used as the eigenvalues in data mining. Then,a RBF (RBF: Radical Basis Function) network classifier was built to classify and identify the collected data. The classifier exhibited a final identification accuracy of 75%, indicating a good result of assisting diagnosis. Since the knee OA classifier constituted by a weights-directly-determined RBF neural network didn't require any iteration, our results demonstrated that the optimal weights, appropriate center and variance could be yielded through simple procedures. Furthermore, the accuracy for both the training samples and the testing samples from the normal group could reach 100%. Finally, the classifier was superior both in time efficiency and classification performance to the frequently used classifiers based on iterative learning. Thus it was suitable to be used as an aid to computer-aided diagnosis of early knee OA.

  13. Knee Fusion or Above-The-Knee Amputation after Failed Two-Stage Reimplantation Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2015-10-01

    Full Text Available Prosthetic joint infection (PJI is a serious complication of total knee arthroplasty (TKA. Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA or a the-knee (KF. The purpose of this review is to determine which treatment method (AKA or KF yields better function and ambulatory status for patients after a failed two-stage reimplantation. A PubMed search related to the resolution of infection by means of an above-the-knee amputation (AKA or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article. KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA. Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure.

  14. Early Progressive Strength Training to Enhance Recovery After Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Kehlet, Henrik; Husted, Henrik

    2014-01-01

    OBJECTIVE: To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. METHODS: In total, 82 patients with a unilateral primary TKA were randomized to 2...... different interventions: 7 weeks of supervised physical rehabilitation with PST (PST group) and without PST (CON group) commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower extremity strength and power...... meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome knee extension strength did not reach the level recorded before surgery in both groups. CONCLUSION: Seven weeks of supervised physical rehabilitation with PST...

  15. Congenital bony fusion (absence) of the knee: a case report.

    Science.gov (United States)

    Madadi, F; Kahlaee, A H; Sarmadi, A; Madadi, Fi; Sadeghian, R; Emami, T M M; Abbasian, M R

    2010-12-01

    Congenital knee ankylosis is a rare condition which might be accompanied with other abnormalities or not. To our knowledge, there is no report on true bony ankylosis of the knee. The only ones in the literature include fibrous knee ankylosis. Thus this seems to be the first presentation of true congenital bony fusion of the knee joint. Copyright © 2009 Elsevier B.V. All rights reserved.

  16. Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis.

    Science.gov (United States)

    Gerbrands, T A; Pisters, M F; Theeven, P J R; Verschueren, S; Vanwanseele, B

    2017-01-01

    To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Abnormal loading of the major joints in knee osteoarthritis and the response to knee replacement.

    Science.gov (United States)

    Metcalfe, Andrew; Stewart, Caroline; Postans, Neil; Barlow, David; Dodds, Alexander; Holt, Cathy; Whatling, Gemma; Roberts, Andrew

    2013-01-01

    Knee osteoarthritis is common and patients frequently complain that they are 'overloading' the joints of the opposite leg when they walk. However, it is unknown whether moments or co-contractions are abnormal in the unaffected joints of patients with single joint knee osteoarthritis, or how they change following treatment of the affected knee. Twenty patients with single joint medial compartment knee osteoarthritis were compared to 20 asymptomatic control subjects. Gait analysis was performed for normal level gait and surface EMG recordings of the medial and lateral quadriceps and hamstrings were used to investigate co-contraction. Patients were followed up 12 months post-operatively and the analysis was repeated. Results are presented for the first 14 patients who have attended follow-up. Pre-operatively, adduction moment impulses were elevated at both knees and the contra-lateral hip compared to controls. Co-contraction of hamstrings and quadriceps was elevated bilaterally. Post-operatively, moment waveforms returned to near-normal levels at the affected knee and co-contraction fell in the majority of patients. However, abnormalities persisted in the contra-lateral limb with partial or no recovery of both moment waveforms and co-contraction in the majority. Patients with knee osteoarthritis do experience abnormal loads of their major weight bearing joints bilaterally, and abnormalities persist despite treatment of the affected limb. Further treatment may be required if we are to protect the other major joints following joint arthroplasty. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Dynamic knee alignment and collateral knee laxity and its variations in normal humans

    Directory of Open Access Journals (Sweden)

    Kamal eDeep

    2015-11-01

    Full Text Available Alignment of normal, arthritic and replaced human knees is a much debated subject as is the collateral ligamentous laxity. Traditional quantitative values have been challenged. Methods used to measure these are also not without flaws. Authors review the recent literature and a novel method of measurement of these values has been included. This method includes use of computer navigation technique in clinic setting for assessment of the normal or affected knee before the surgery. Computer navigation has been known for achievement of alignment accuracy during knee surgery. Now its use in clinic setting has added to the inventory of measurement methods. Authors dispel the common myth of straight mechanical axis in normal knees and also look at quantification of amount of collateral knee laxity. Based on the scientific studies it has been shown that the mean alignment is in varus in normal knees. It changes from lying non weight bearing position to standing weight bearing position in both coronal and the sagittal planes. It also varies with gender and race. The collateral laxity is also different for males and females. Further studies are needed to define the ideal alignment and collateral laxity which the surgeon should aim for individual knees.

  19. Dynamic knee stability and ballistic knee movement after ACL reconstruction: an application on instep soccer kick.

    Science.gov (United States)

    Cordeiro, Nuno; Cortes, Nelson; Fernandes, Orlando; Diniz, Ana; Pezarat-Correia, Pedro

    2015-04-01

    The instep soccer kick is a pre-programmed ballistic movement with a typical agonist-antagonist coordination pattern. The coordination pattern of the kick can provide insight into deficient neuromuscular control. The purpose of this study was to investigate knee kinematics and hamstrings/quadriceps coordination pattern during the knee ballistic extension phase of the instep kick in soccer players after anterior cruciate ligament reconstruction (ACL reconstruction). Seventeen players from the Portuguese Soccer League participated in this study. Eight ACL-reconstructed athletes (experimental group) and 9 healthy individuals (control group) performed three instep kicks. Knee kinematics (flexion and extension angles at football contact and maximum velocity instants) were calculated during the kicks. Rectus femoris (RF), vastus lateralis, vastus medialis, biceps femoralis, and semitendinosus muscle activations were quantified during the knee extension phase. The ACL-reconstructed group had significantly lower knee extension angle (-1.2 ± 1.6, p angle and RF muscle activation while performing an instep kick. These findings are in accordance with the knee stability recovery process after ACL reconstruction. No differences were observed in the ballistic control movement pattern between normal and ACL-reconstructed subjects. Performing open kinetic chain exercises using ballistic movements can be beneficial when recovering from ACL reconstruction. The exercises should focus on achieving multi-joint coordination and full knee extension (range of motion). III.

  20. Reproducibility of the measurements of knee joint proprioception in patients with osteoarthritis of the knee and healthy subject

    NARCIS (Netherlands)

    Hurkmans, E.; van der Esch, M.; Ostelo, R.W.J.G.; Knol, D.L.; Dekker, J; Steultjens, M

    2007-01-01

    Objective. To estimate the inter- and intrarater reliability and agreement of instrumented knee joint proprioception measurement in subjects with knee osteoarthritis (OA) and healthy subjects; to assess the effect of variations in the measurement procedure on agreement parameters. Methods.

  1. Reaching remote areas in Latin America.

    Science.gov (United States)

    Jaimes, R

    1994-01-01

    Poor communities in remote and inaccessible areas tend to not only be cut off from family planning education and services, but they are also deprived of basic primary health care services. Efforts to bring family planning to such communities and populations should therefore be linked with other services. The author presents three examples of programs to bring effective family planning services to remote communities in Central and South America. Outside of the municipal center in the Tuxtlas region of Mexico, education and health levels are low and people live according to ancient customs. Ten years ago with the help of MEXFAM, the IPPF affiliate in Mexico, two social promoters established themselves in the town of Catemaco to develop a community program of family planning and health care offering education and prevention to improve the quality of people's lives. Through their health brigades taking health services to towns without an established health center, the program has influenced an estimated 100,000 people in 50 villages and towns. The program also has a clinic. In Guatemala, the Family Welfare Association (APROFAM) gave bicycles to 240 volunteer health care workers to facilitate their outreach work in rural areas. APROFAM since 1988 has operated an integrated program to treat intestinal parasites and promote family planning in San Lucas de Toliman, an Indian town close to Lake Atitlan. Providing health care to more than 10,000 people, the volunteer staff has covered the entire department of Solola, reaching each family in the area. Field educators travel on motorcycles through the rural areas of Guatemala coordinating with the health volunteers the distribution of contraceptives at the community level. The Integrated Project's Clinic was founded in 1992 and currently carries out pregnancy and Pap tests, as well as general lab tests. Finally, Puna is an island in the middle of the Gulf of Guayaquil, Ecuador. Women on the island typically have 10

  2. OCCURRENCE OF EARLY KNEE ARTHROSIS FOLLOWING TOTAL MENISCECTOMIES IN YOUTH

    Directory of Open Access Journals (Sweden)

    Sasa Milenkovic

    2006-01-01

    Full Text Available The occurrence of early knee arthrosis following early total meniscectomy is a significant orthopedic, social and economical problem. Arthroscopic surgery shows the role and significance of the menisci for normal knee functioning. The outcome of 19 knee arthroscopies are presented; patients are of male sex, average age 39 (from 34 to 45. All patients underwent knee arthrotomy and total medial and lateral meniscectomy before the age of 25. All patients were active sportsmen. 12 arthroscopies of the right knee and 7 arthroscopies of the left one were done. In 13 patients, medial knee arthrosis following medial meniscectomy was found. One patient had lateral knee arthrosis and degeneration of the medial meniscus following lateral meniscectomy . The same patient had the total rupture of LCA. The remaining 5 patients had lateral knee arthrosis following lateral meniscectomy. One or more loose bodies of cartilaginous origin were found in 8 patients. All the operated patients had evident early signs of initial or progressive knee arthrosis confirmed or diagnosed arthroscopically. Knee arthroscopy in early arthroses following knee meniscectomies in youth can relieve the pain and slow down disease progression. A permanent solution to the problem is possible only with unicompartmental knee arthroplasty.

  3. Biomechanical and functional efficacy of knee sleeves: A literature review.

    Science.gov (United States)

    Mohd Sharif, Nahdatul Aishah; Goh, Siew-Li; Usman, Juliana; Wan Safwani, Wan Kamarul Zaman

    2017-11-01

    Knee sleeves are widely used for the symptomatic relief and subjective improvements of knee problems. To date, however, their biomechanical effects have not been well understood. To determine whether knee sleeves can significantly improve the biomechanical variables for knee problems. Systematic literature search was conducted on four online databases - PubMed, Web of Science, ScienceDirect and Springer Link - to find peer-reviewed and relevant scientific papers on knee sleeves published from January 2005 to January 2015. Study quality was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES). Twenty studies on knee sleeves usage identified from the search were included in the review because of their heterogeneous scope of coverage. Twelve studies found significant improvement in gait parameters (3) and functional parameters (9), while eight studies did not find any significant effects of knee sleeves usage. Most improvements were observed in: proprioception for healthy knees, gait and balance for osteoarthritic knees, and functional improvement of injured knees. This review suggests that knee sleeves can effect functional improvements to knee problems. However, further work is needed to confirm this hypothesis, due to the lack of homogeneity and rigor of existing studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Lateral Knee Braces in Football: Do They Prevent Injury?

    Science.gov (United States)

    Paulos, Lonnie E.; And Others

    1986-01-01

    The results of three recently presented clinical studies and a biomechanical study of the use of lateral knee braces to prevent knee injuries are reviewed. The results raise serious doubts about the efficacy of the preventive knee braces which are currently available. (Author/MT)

  5. 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

  6. Early and late synovectomy of the knee in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Jensen, C M; Poulsen, S; Ostergren, M

    1991-01-01

    The results after open knee synovectomy in the treatment of rheumatoid arthritis were investigated in a retrospective study including 44 patients with 55 knees. Median observation time was 73 months. Early synovectomy showed significant pain-relief and improvement of knee function, effusion...

  7. In vitro laxity-testers for knee joints of mice

    NARCIS (Netherlands)

    Blankevoort, L.; van Osch, G. J.; Janssen, B.; Hekman, E. E.

    1996-01-01

    The knee joints of mice can be used as a model for studying the effects of interventions on knee laxity. The goal of this study was to quantify knee joint laxity in vitro. Three devices were developed: a positioning- and cementing device, an anterior-posterior (AP) laxity tester and a varus-valgus

  8. Complicated Congenital Dislocation of the Knee: A Case Report

    Directory of Open Access Journals (Sweden)

    Firooz Madadi

    2016-10-01

    Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.

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

    African Journals Online (AJOL)

    earlier studies, as to the exact definition of anterior knee pain. Anterior knee pain ... sport participation. Exclusion criteria were: previously diagnosed ligamentous, meniscal, tendon, fat pad or bursae involvement; previous surgery; history of patella dislocation or subluxation; ..... Sports-related knee injuries in female athletes.

  10. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...... migration can be used as a predictor of implant loosening....

  11. Wearable Vector Electrical Bioimpedance System to Assess Knee Joint Health.

    Science.gov (United States)

    Hersek, Sinan; Toreyin, Hakan; Teague, Caitlin N; Millard-Stafford, Mindy L; Jeong, Hyeon-Ki; Bavare, Miheer M; Wolkoff, Paul; Sawka, Michael N; Inan, Omer T

    2017-10-01

    We designed and validated a portable electrical bioimpedance (EBI) system to quantify knee joint health. Five separate experiments were performed to demonstrate the: 1) ability of the EBI system to assess knee injury and recovery; 2) interday variability of knee EBI measurements; 3) sensitivity of the system to small changes in interstitial fluid volume; 4) reducing the error of EBI measurements using acceleration signals; and 5) use of the system with dry electrodes integrated to a wearable knee wrap. 1) The absolute difference in resistance ( R) and reactance (X) from the left to the right knee was able to distinguish injured and healthy knees (p knee R was 2.5 Ω and for X was 1.2 Ω. 3) Local heating/cooling resulted in a significant decrease/increase in knee R (p knee R and X measured using the wet electrodes and the designed wearable knee wrap were highly correlated ( R 2 = 0.8 and 0.9, respectively). This study demonstrates the use of wearable EBI measurements in monitoring knee joint health. The proposed wearable system has the potential for assessing knee joint health outside the clinic/lab and help guide rehabilitation.

  12. Nontraumatic Knee Complaints in Adults in General Practice

    NARCIS (Netherlands)

    J.N. Belo (Janneke)

    2009-01-01

    textabstractIn general practice, knee complaints (traumatic and nontraumatic) take second place after back pain in the prevalence of musculoskeletal disorders (19/1000 patients per year), mostly presented as knee pain or functional loss of the knee joint. Of these complaints, approximately 20% are

  13. Obesity and disability in the symptomatic Irish knee osteoarthritis population.

    LENUS (Irish Health Repository)

    Ambrose, N L

    2010-06-01

    Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity.

  14. Congenital fibrous hamartoma of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Arioni, Cesare; Bellini, Carlo; Risso, Francesco Maria; Scopesi, Fabio; Serra, Giovanni [University of Genoa, Neonatal Pathology Service, Department of Paediatrics, Institute G. Gaslini, Genoa (Italy); Oddone, Mauro; Toma, Paolo [Institute G. Gaslini, Radiology Service, Genoa (Italy); Nozza, Paolo [Institute G. Gaslini, U. O. di Anatomia Patologica, Genoa (Italy)

    2006-05-15

    A full-term male infant presented at birth with a hard swelling of the left knee. The lemon-sized lesion was fixed to the underlying knee muscles, while the overlying skin was stretched and shiny; there was no bruit. Radiography, sonography and MRI suggested a soft-tissue tumour. After surgical excision, histology showed the presence of fibrous and mesenchymal tissue, with mature adipose tissue. Fibrous hamartoma of infancy was diagnosed. Among soft-tissue tumours, fibrous hamartoma of infancy is a rare and benign lesion, occurring in the first 2 years of life. The tumour mainly affects the trunk, axilla, and upper extremities. This infant had unique involvement of the knee. The treatment of choice is local excision. (orig.)

  15. Pedobarographic findings in patients with knee osteoarthritis.

    Science.gov (United States)

    Kul-Panza, Evren; Berker, Nadire

    2006-03-01

    The aim of this study was to evaluate pedobarographic findings and balance in knee osteoarthritis. A total of 48 patients with knee osteoarthritis and 30 controls were included in this study. Pedobarographic measures were obtained from all patients and controls. Pain intensity of patients was measured using the Visual Analog Scale. The percentage of pressure on forefoot and hindfoot was measured using static pedobarography, and the peak pressures at forefoot, midfoot, and hindfoot were measured using dynamic pedobarography. The center-of-pressure sway length and width were measured for evaluation of balance. The percentage of right hindfoot pressure (P pressure of the right forefoot during walking were lower in the osteoarthritic group than in the controls (P Visual Analog Scale score at rest was negatively correlated with peak pressures of both right and left hindfeet in the osteoarthritic group (P pressures that change because of disturbed weightbearing and balance problems in knee osteoarthritis.

  16. Multicentric giant cell tumor around the knee

    Directory of Open Access Journals (Sweden)

    Salgia Anil

    2007-01-01

    Full Text Available A case of multicentric giant cell tumor with synchronous occurrence in all three bones around the knee is reported here in view of its rarity. A 33-year-old average built male reported with complaints of severe pain, gradually increasing swelling around the right knee. A 3 x 2 cm swelling was present on the lateral aspect of the distal end of the right femur and a 3 x 3 cm swelling on the proximal part of the right tibia. Plain X-ray of right knee showed subarticular eccentrically located expansile lytic lesion in the lateral tibia condyle, lateral condyle of femur and patella. Fine needle aspiration cytology and subsequent histology ascertained the diagnosis of giant cell tumor of the bone. The patient was treated successfully with curettage, bone grafting and methyl methacrylate cementing (Sandwich technique.

  17. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  18. [Osteoarthritis of the knee: lose weight first?].

    Science.gov (United States)

    Poolman, Rudolf W; van Wagensveld, Bart A

    2013-01-01

    Being heavy and having knee pain often co-exists. To date, the optimal treatment for patients with osteoarthritis of the knee and obesity remains the subject of debate, since patients with a high BMI (> 30 kg/m2) have a higher risk of complications following total knee arthroplasty (TKA). Kerkhoffs and colleagues suggest that these patients should first be submitted to a weight-loss programme prior to their TKA to reduce the risk of complications. This commentary addresses various questions arising from the Dutch meta-analysis by Kerkhoffs. For instance, should patients who fail to lose weight still undergo TKA or have bariatric surgery, or are there other options? Finally, suggestions are made for future research that might shed light upon this critical issue.

  19. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...... of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...

  20. Transfemoral Amputation After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-01-01

    BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...

  1. Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis.

    Science.gov (United States)

    Mayorga-Vega, Daniel; Merino-Marban, Rafael; Viciana, Jesús

    2014-01-01

    tests have a moderate mean criterion-related validity for estimating hamstring extensibility, but they have a low mean validity for estimating lumbar extensibility.Among all the sit-and-reach test protocols, the Classic sit-and-reach test seems to be the best option to estimate hamstring extensibility.End scores (e.g., the Classic sit-and-reach test) are a better indicator of hamstring extensibility than the modifications that incorporate fingers-to-box distance (e.g., the Modified sit-and-reach test).When angular tests such as straight leg raise or knee extension tests cannot be used, sit-and-reach tests seem to be a useful field test alternative to estimate hamstring extensibility, but not to estimate lumbar extensibility.

  2. Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis

    Science.gov (United States)

    Mayorga-Vega, Daniel; Merino-Marban, Rafael; Viciana, Jesús

    2014-01-01

    tests have a moderate mean criterion-related validity for estimating hamstring extensibility, but they have a low mean validity for estimating lumbar extensibility. Among all the sit-and-reach test protocols, the Classic sit-and-reach test seems to be the best option to estimate hamstring extensibility. End scores (e.g., the Classic sit-and-reach test) are a better indicator of hamstring extensibility than the modifications that incorporate fingers-to-box distance (e.g., the Modified sit-and-reach test). When angular tests such as straight leg raise or knee extension tests cannot be used, sit-and-reach tests seem to be a useful field test alternative to estimate hamstring extensibility, but not to estimate lumbar extensibility. PMID:24570599

  3. Total condylar prosthesis placement in knee arthroplasty. Biomechanic analysis of human knee preparations.

    Science.gov (United States)

    Møller, J T; Boe, S; Vang, P S

    1983-10-01

    Knee replacement using the Total Condylar Prosthesis was carried out on six large cadaveric knees. Tibiofemoral articulation was studied radiographically with the tibial component placed anteriorly as well as posteriorly on the tibial plateau. It is concluded that, in this model, when using the Total Condylar Prosthesis for big-sized knees, a tall, posteriorly placed tibial component gave the best placement of the femoral component and the most central tibio-femoral articulation, entailing optimal distribution of the load on the trabecular bone beneath the tibial component.

  4. Brace yourself: an unusual case of knee pain, an extradigital glomangioma of the knee

    Directory of Open Access Journals (Sweden)

    Victoria V. Villescas, MD

    2017-06-01

    Full Text Available The differential diagnosis for knee pain is extensive. Glomus tumors comprise approximately 1.6% of soft-tissue tumors in the extremities. Classic subungual tumors occur more frequently in women, whereas ectopic locations are more common in men. Unusual locations include the stomach; lungs; trachea; bones; intestines; fallopian tubes; and intraneural, neuromal, and intravenous locations. We present the case of a 50-year-old man with a 12-year history of enlarging right knee mass found to be a glomangioma. This case report discusses the incidence, presentation, imaging characteristics, histology, and management of glomus tumors of the knee.

  5. Changes in knee shape and geometry resulting from total knee arthroplasty.

    Science.gov (United States)

    Akbari Shandiz, Mohsen; Boulos, Paul; Saevarsson, Stefan Karl; Ramm, Heiko; Fu, Chun Kit Jack; Miller, Stephen; Zachow, Stefan; Anglin, Carolyn

    2018-01-01

    Changes in knee shape and geometry resulting from total knee arthroplasty can affect patients in numerous important ways: pain, function, stability, range of motion, and kinematics. Quantitative data concerning these changes have not been previously available, to our knowledge, yet are essential to understand individual experiences of total knee arthroplasty and thereby improve outcomes for all patients. The limiting factor has been the challenge of accurately measuring these changes. Our study objective was to develop a conceptual framework and analysis method to investigate changes in knee shape and geometry, and prospectively apply it to a sample total knee arthroplasty population. Using clinically available computed tomography and radiography imaging systems, the three-dimensional knee shape and geometry of nine patients (eight varus and one valgus) were compared before and after total knee arthroplasty. All patients had largely good outcomes after their total knee arthroplasty. Knee shape changed both visually and numerically. On average, the distal condyles were slightly higher medially and lower laterally (range: +4.5 mm to -4.4 mm), the posterior condyles extended farther out medially but not laterally (range: +1.8 to -6.4 mm), patellofemoral distance increased throughout flexion by 1.8-3.5 mm, and patellar thickness alone increased by 2.9 mm (range: 0.7-5.2 mm). External femoral rotation differed preop and postop. Joint line distance, taking cartilage into account, changed by +0.7 to -1.5 mm on average throughout flexion. Important differences in shape and geometry were seen between pre-total knee arthroplasty and post-total knee arthroplasty knees. While this is qualitatively known, this is the first study to report it quantitatively, an important precursor to identifying the reasons for the poor outcome of some patients. Using the developed protocol and visualization techniques to compare patients with good versus poor clinical outcomes could

  6. Functional outcomes of uni-knee arthroplasty for medial compartment knee arthropathy in asian patients

    Directory of Open Access Journals (Sweden)

    To Wong

    2014-12-01

    Full Text Available Background: Uni-knee arthroplasty (UKA has shown better knee kinematics and motion that may better suit the activities of daily living in Eastern countries. The purpose of this study was to evaluate the functional outcomes of UKA for medial compartment knee arthropathy in Asian patients. Methods: The study cohort consisted of 48 patients with 51 UK A knees. Only one type of prosthesis was used and all components were cemented. Postoperative management included ambulation with weight bearing, range of motion, and muscle strengthening exercises as tolerated until full recovery. The average follow-up was 52.0 ± 24.0 (range 12-92 months. The evaluation included functional assessment, the Knee Society knee and functional scores, the International Knee Document Committee (IKDC subjective and objective scores, and radiographs of the knee. Results: The overall clinical outcomes of the knee showed the functional outcome of the knee to be normal in 51%, nearly normal in 37%, abnormal in 8%, and severely abnormal in 4%. The functional activities included stair climbing in 96%, squatting in 76%, jogging in 71% and kneeling in 47%. Three-quarters of the patients were able to kneel for daily activities. Approximately 98% of the patients were satisfied with the operation. The survivorship of the prosthesis was 98% with one revision pending. Radiographic evaluations revealed the components were centered in 82% and off-centered in 18%. Osteoarthritis was 22% preoperative and 27% postoperative for the patellofemoral compartment, and 0% before and 4% after surgery for the lateral compartment. The functional outcomes showed no difference between patients with and without patellofemoral arthritis. The complications included one component malposition and one knee pain of undetermined origin. Conclusions: UKA provides excellent pain relief and restoration of knee function including kneeling, squatting, and sit-to-stand activities that perfectly fit the oriental

  7. Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age.

    Science.gov (United States)

    Turkiewicz, Aleksandra; Timpka, Simon; Thorlund, Jonas Bloch; Ageberg, Eva; Englund, Martin

    2017-10-01

    To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using multivariable-adjusted Cox proportional regression model. To assess the influence of adult knee injury and occupation, we performed a formal mediation analysis. The mean (SD) knee extensor strength was 234 (47) Nm, the mean (SD) weight was 66 (9.3) kg. During 24 years (median) of follow-up starting at the age of 35 years, 2049 persons were diagnosed with knee OA. The adjusted HR (95% CI) of incident knee OA was 1.12 (1.06 to 1.18) for each SD of knee extensor strength and 1.18 (1.15 to 1.21) per 5 kg of body weight. Fifteen per cent of the increase in OA risk due to higher knee extensor strength could be attributed to knee injury and adult occupation. Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor for knee OA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Impact of flexion versus extension of knee position on outcomes after total knee arthroplasty: a meta-analysis

    OpenAIRE

    Jiang, Chao; Lou, Jieqiong; QIAN, WENWEI; Ye, Canhua; Zhu, Shibai

    2016-01-01

    Introduction Controversy still exists regarding positioning of the knee in flexion or in extension after total knee arthroplasty (TKA) impacts treatment outcomes. In this meta-analysis, we evaluated if a postoperative knee position regime could positively affect the rehabilitation. Methods A comprehensive search for randomized controlled trials (RCTs) assessing the effect of knee positioning after TKA was conducted. The outcomes of interest were blood loss and range of motion (ROM); total cal...

  9. Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty.

    Science.gov (United States)

    Naili, Josefine E; Wretenberg, Per; Lindgren, Viktor; Iversen, Maura D; Hedström, Margareta; Broström, Eva W

    2017-03-21

    It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty. Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A "good outcome" was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a "poor outcome" was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test. Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups. Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after

  10. Functional reach and lateral reach tests adapted for aquatic physical therapy

    Directory of Open Access Journals (Sweden)

    Ana Angélica Ribeiro de Lima

    Full Text Available Abstract Introduction: Functional reach (FR and lateral reach (LR tests are widely used in scientific research and clinical practice. Assessment tools are useful in assessing subjects with greater accuracy and are usually adapted according to the limitations of each condition. Objective: To adapt FR and LR tests for use in an aquatic environment and assess the performance of healthy young adults. Methods: We collected anthropometric data and information on whether the participant exercised regularly or not. The FR and LR tests were adapted for use in an aquatic environment and administered to 47 healthy subjects aged 20-30 years. Each test was repeated three times. Results: Forty-one females and six males were assessed. The mean FR test score for men was 24.06 cm, whereas the mean value for right lateral reach (RLR was 10.94 cm and for left lateral reach (LLR was 9.78 cm. For females, the mean FR score was 17.57 cm, while the mean values for RLR was 8.84cm and for LLR was 7.76 cm. Men performed better in the FR (p < 0.001 and RLR tests than women (p = 0.037. Individuals who exercised regularly showed no differences in performance level when compared with their counterparts. Conclusion: The FR and LR tests were adapted for use in an aquatic environment. Males performed better on the FR and RLR tests, when compared to females. There was no correlation between the FR and LR tests and weight, height, Body Mass Index (BMI, foot length or length of the dominant upper limb.

  11. Introduction of total knee arthroplasty in Lithuania

    Science.gov (United States)

    Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790

  12. Immediate effects of a knee brace with a constraint to knee extension on knee kinematics and ground reaction forces in a stop-jump task.

    Science.gov (United States)

    Yu, Bing; Herman, Daniel; Preston, Jennifer; Lu, William; Kirkendall, Donald T; Garrett, William E

    2004-01-01

    A small knee flexion angle in landing tasks was identified as a possible risk factor for noncontact anterior cruciate ligament injuries that are common in sports. A specially designed knee brace with a constraint to knee extension would significantly increase the knee flexion angle at the landing of athletic tasks preceded with horizontal movement components, such as stop-jump tasks. Repeated measure design for brace effects. Three-dimensional videographic and force plate data were collected for 10 male and 10 female recreational athletes performing a stop-jump task with and without the specially designed brace. Knee flexion angle at landing, maximum knee flexion angle, and peak ground reaction forces during the stance phase of the stop-jump task were determined for each subject with and without the knee brace. The knee brace decreased the knee flexion angle at the landing by 5 degrees for both genders but did not significantly affect the peak ground reaction forces during the landing. The specially designed knee brace may be a useful device in the prevention and rehabilitation of noncontact anterior cruciate ligament injuries in sports. Copyright 2004 American Orthopaedic Society for Sports Medicine

  13. 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 (pbrace and allocated brace for the four-week study (pbraces produced immediate improvements in knee 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.

  14. Tantalum Cones in Revision Total Knee Arthroplasty.

    Science.gov (United States)

    Kim, Eric G; Patel, Nirav K; Chughtai, Morad; Elmallah, Randa D K; Delanois, Ronald E; Harwin, Steven F; Mont, Michael A

    2016-11-01

    The best strategy to address large bony defects in revision total knee arthroplasty has yet to be determined. The relatively recent development of porous tantalum cones and their use to address massive bone loss in knee arthroplasty has shown promising short- and intermediate-term results. The purpose of this review is to present the current literature on: (1) basic science of porous tantalum, (2) classification and treatment for bone loss, (3) clinical results, and (4) evolution of newer generation cones. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Knee and Ankle Arthroplasty in Hemophilia.

    Science.gov (United States)

    Solimeno, Luigi Piero; Pasta, Gianluigi

    2017-11-22

    Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the "gold standard", while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia. In this review, the role of replacement surgery in the treatment of chronic hemophilic arthropathy will be described.

  16. MRI of Native Knee Cartilage Delamination Injuries.

    Science.gov (United States)

    White, Candace L; Chauvin, Nancy A; Waryasz, Gregory R; March, Bradford T; Francavilla, Michael L

    2017-11-01

    The purpose of this article is to describe the normal imaging appearance of cartilage and the pathophysiologic findings, imaging appearance, and surgical management of cartilage delamination. Delamination injuries of knee cartilage signify surgical lesions that can lead to significant morbidity without treatment. These injuries may present with clinical symptoms identical to those associated with meniscal injury, and arthroscopic identification can be difficult, thereby creating a role for imaging diagnosis. A low sensitivity of imaging identification of delamination injury of the knee is reported in the available literature, although vast improvements in MRI of cartilage have since been introduced.

  17. Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

    Science.gov (United States)

    Danoff, Jonathan R.; Geller, Jeffrey A.

    2013-01-01

    The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success. PMID:24151549

  18. Knee and Ankle Arthroplasty in Hemophilia

    Directory of Open Access Journals (Sweden)

    Luigi Piero Solimeno

    2017-11-01

    Full Text Available Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the “gold standard”, while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia. In this review, the role of replacement surgery in the treatment of chronic hemophilic arthropathy will be described.

  19. Imaging of postoperative knee extensor mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Motamedi, Kambiz [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-59, Los Angeles, CA 90095 (United States); Seeger, Leanne L. [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-57, Los Angeles, CA 90095 (United States); Hame, Sharon L. [David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Box 956902, 76-143 CHS, Los Angeles, CA 90095 (United States)

    2005-05-01

    Disorders of the anterior knee are common and include patellofemoral syndrome, patella instability, patella fracture, and patellar and quadriceps tendon ruptures. Depending on the operative procedure performed, the post-operative imaging appearance of these knees may be confusing. It is crucial for the radiologist to be familiar with the procedures performed in order to recognize the postoperative findings. Radiologists must be able to interpret hardware (anchors, screw and wires) and disruptions in soft tissue planes that may persist with these types of procedures.

  20. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  1. Secondary knee instability caused by fracture of the stabilizing insert in a dual-articular total knee

    DEFF Research Database (Denmark)

    Boesen, Morten P; Jensen, Tim Toftgaard; Husted, Henrik

    2004-01-01

    A case of a fractured polyethylene stabilizing insert causing secondary knee instability in a Dual-articular total knee arthroplasty (TKA) is presented. A 65-year-old woman who underwent surgery with a Dual-articular TKA 4 years earlier had a well-functioning prosthesis until a fall, after which......-articular knee....

  2. An investigation to examine the inter-tester and intra-tester reliability of the Rolimeter ® knee tester, and its sensitivity in identifying knee joint laxity

    National Research Council Canada - National Science Library

    Hatcher, Alison; Hatcher, Julian; Arbuthnot, Jamie; McNicholas, Mike

    2005-01-01

    The purpose of this study is to evaluate the Rolimeter knee tester (Aircast, Europe) as reliable and clinically sensitive tool for identifying and quantifying knee joint laxity utilising a sample of both known ACLD and normal knees...

  3. Complicated Congenital Dislocation of the Knee: A Case Report.

    Science.gov (United States)

    Madadi, Firooz; Tahririan, Mohammad A; Karami, Mohsen; Madadi, Firoozeh

    2016-10-01

    Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid. Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.

  4. 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...... a standing position). The purpose of this study is to evaluate the construct validity, responsiveness, and interpretability of the DAP for knee osteoarthritis (OA). METHODS: One-hundred participants with knee OA were tested twice each with the DAP, the Knee injury and Osteoarthritis Outcome Score (KOOS), six...

  5. Forward lunge knee biomechanics before and after partial meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Nielsen, Jonas Høberg; Holsgaard-Larsen, Anders

    2015-01-01

    partial meniscectomy (APM) on knee joint mechanics. The purpose of this study was to evaluate changes in knee joint biomechanics during a forward lunge in patients with a suspected degenerative meniscal tear from before to three months after APM. METHODS: Twenty-two patients (35-55years old......) with a suspected degenerative medial meniscal tear participated in this study. Three dimensional knee biomechanics were assessed on the injured and contralateral leg before and three months after APM. The visual analogue scale was used to assess knee pain and the Knee Injury Osteoarthritis Outcome Score was used...

  6. Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Viktoria; Bandholm, Thomas Q; Zilmer, Camilla K

    2017-01-01

    Background and purpose - Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss......-group differences were similar for knee circumference, TUG test, and pain scores. MP reduced the inflammatory response (CRP) at 24 hours postoperatively; group MP 33 (IQR 21-50) mg/L vs. group C 72 (IQR 58-92) mg/L (p ...-265) mg/L (p reduce the pronounced loss of knee-extension strength or other functional outcomes at discharge after fast-track TKA despite a reduced systemic inflammatory response....

  7. Knee awareness and functionality after simultaneous bilateral vs unilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Latifi, Roshan; Thomsen, Morten Grove; Kallemose, Thomas

    2016-01-01

    AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty (TKA). METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA (UTKA) and 65 patients who had undergone......-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- and postoperative...... overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1...

  8. Physiotherapist-designed aquatic exercise programme for community-dwelling elders with osteoarthritis of the knee: a Hong Kong pilot study.

    Science.gov (United States)

    Lau, Mary C K; Lam, Joseph K S; Siu, Eva; Fung, Carmen S W; Li, Kevin T Y; Lam, Margaret W F

    2014-02-01

    OBJECTIVES. To examine the effectiveness and feasibility of a community-based aquatic exercise programme for elders with osteoarthritis of the knee. DESIGN. Prospective intervention study, with a before-and-after design. SETTING. Community elders. PARTICIPANTS. Twenty elders aged 65 years or above (mean, 72 years) attending four Elderly Health Centres of the Department of Health who had suffered from osteoarthritis of the knee for at least 3 years and with mild-to-severe knee pain. INTERVENTION. A 10-week aquatic exercise programme designed and led by physiotherapists. MAIN OUTCOME MEASURES. Range of motion and power of extension of the knees, functional reach test, repeated sit-to-stand test, and the Chinese Arthritis Impact Measurement Scales 2. RESULTS. There was an improvement in the median range of knee flexion from 115° to 125° (Paquatic exercise has definite benefits in terms of physical and psychosocial functioning, and should be promoted as one of the strategies to enhance long-term self-management of community elders with knee osteoarthritis.

  9. Change in Knee Cartilage Volume in Individuals Completing a Therapeutic Exercise Program for Knee Osteoarthritis

    Science.gov (United States)

    Woollard, Jason D.; Gil, Alexandra B.; Sparto, Patrick; Kwoh, C. Kent; Piva, Sara R.; Farrokhi, Shawn; Powers, Christopher M.; Fitzgerald, G. Kelley

    2012-01-01

    STUDY DESIGN Prospective cohort study OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis (KOA) who have completed a therapeutic exercise program. BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA, no studies have reported the volume of cartilage change, or individual factors that may impact volume of cartilage change, in those completing an exercise program for KOA. METHODS 13 individuals with KOA underwent magnetic resonance imaging (MR) to quantify cartilage volume change for the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up. Measurements of body structure and function and activity levels/limitations such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Physical Activity Scale for the Elderly (PASE) were performed prior to the therapeutic exercise program. At 6 months from baseline follow-up clinical measurements of knee strength and motion were performed. At 1-year from baseline, imaging of the knee cartilage, knee alignment, and the WOMAC and PASE questionnaires were completed. RESULTS The central region of the medial femoral condyle (cMF) had a median volume of cartilage loss of 3.8%. The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change. Individuals were dichotomized into progressors (n=6) and non-progressors (n=7) based on the standard error of measurement (SEM) of cartilage volume change for the cMF. Progressors were younger, had a larger body mass index, had a higher Kellgren-Lawrence grade in the medial compartment of the knee, and had a greater increase in knee varus alignment from baseline to 1-year follow-up. The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increase medial knee joint loading. CONCLUSION The loss of c

  10. Knee disorders in primary care: design and patient selection of the HONEUR knee cohort

    OpenAIRE

    Koes Bart W; Berger Marjolein Y; Heintjes Edith M; Bierma-Zeinstra Sita M

    2005-01-01

    Abstract Background Knee complaints are a frequent reason for consultation in general practice. These patients constitute a specific population compared to secondary care patients. However, information to base treatment decisions on is generally derived from specialistic settings. Our cohort study is aimed at collecting knowledge about prognosis and prognostic factors of knee complaints presented in a primary care setting. This paper describes the methods used for data collection, and discuss...

  11. 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.

  12. The SIGN nail for knee fusion: technique and clinical results

    Directory of Open Access Journals (Sweden)

    Anderson Duane Ray

    2016-01-01

    Full Text Available Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males with an average age of 30.5 years (range, 18–50 years underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months. Diagnoses included tuberculosis (two knees, congenital knee dislocation in two knees (one patient, bacterial septic arthritis (one knee, malunited spontaneous fusion (one knee, and severe gout with 90° flexion contracture (one knee. The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

  13. [Biomechanics of the tibiofemoral joint and knee braces].

    Science.gov (United States)

    Thomsen, M; Mannel, H; Spiering, S; Dathe, H; Kubein-Meesenburg, D; Nägerl, H

    2002-09-01

    We investigated whether the kinematics of modern knee braces reflect the natural movement of the knee, especially with regard to the roll-glide ratio. Seven commercially available modern knee braces were analyzed in a new measuring unit with a 6-D positional registration system, which had been developed for this study. The results were compared to the theoretically postulated joint movements. All knee braces produced a roll-glide ratio different from the natural movement of the knee. Only the Townsend brace protected the anterior cruciate ligament at the beginning of the movement.Biomechanically, none of the knee braces tested provided efficient protection for the knee movement. We propose a new functional external joint, which allows restoration of the natural roll-glide mechanism of the articulating surfaces.

  14. The effect of the squat exercise on knee stability.

    Science.gov (United States)

    Chandler, T J; Wilson, G D; Stone, M H

    1989-06-01

    Past studies have produced conflicting results as to the effect of squat exercises on knee stability. One hundred male and female college students were measured using a knee ligament arthrometer on nine tests of knee stability. Over an 8-wk training program, full or half squats did not consistently affect knee stability compared to non-squatting controls. To measure the effect of long-term squat training 27 male powerlifters (14 Elite or Master Class) and 28 male weightlifters (8 Elite or Master Class) were measured on the same tests. Powerlifters were significantly tighter than controls on the anterior drawer at 90 degrees of knee flexion. Both powerlifters and weightlifters were significantly tighter than controls on the quadriceps active drawer at 90 degrees of knee flexion. Data on powerlifters and weightlifters were also analyzed by years of experience and skill level. No effect of squat training on knee stability was demonstrated in any of the groups tested.

  15. Early recovery after fast-track Oxford unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Dalsgaard, Jesper; Bjerggaard, Karin

    2012-01-01

    trauma. We investigated changes in leg-extension power (LEP) in the first month after MIS Oxford UKA and its relation to pain, knee motion, functional performance, and knee function. Patients and methods In 35 consecutive Oxford UKA patients, LEP was measured 1 week before and 1 month after surgery...... together with knee motion, knee swelling, the 30-second chair-stand test, and Oxford knee score. Assessment of knee pain at rest and walking was done using a visual analog scale. Results 30 patients were discharged on the day after surgery, and 5 on the second day after surgery. LEP and functional...... supervision in the first month after discharge. Interpretation Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used....

  16. Functional Outcomes of Revision Total Knee Arthroplasty Following Failed Unicompartmental Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Chris Ironside

    2014-12-01

    Full Text Available Introduction: Unicompartmental knee arthroplasty (UKA can be used to treat medial compartment osteoarthritis of the knee. Some of these knees will eventually fail, and need to be revised. There is controversy about using UKA in younger patients as a definitive procedure or as a means to delay total knee arthroplasty (TKA because the outcomes of subsequent revision surgery may be inferior to a primary TKA. Methods: We retrospectively reviewed a series of 46 revision TKA patients following failed UKA (UKA revisions using functional outcomes questionnaires and compared the results with a cohort of age and gender matched primary TKA patients. Our hypothesis was that UKA revision surgery would be inferior to primary TKA surgery. Results: Data was collected on 33 knees after a mean follow-up period of five years. There was no significant difference in the Oxford Knee Score (33.7 vs 37.1, p = 0.09 or the Western Ontario and MacMasters Universities Arthritis Index (WOMAC (24.8 vs. 19.1, p = 0.22. A subgroup analysis demonstrated that UKAs, which fail early, are more likely to produce an inferior outcome following revision surgery than those that survive more than five years. Discussion: We conclude that UKA can be used effectively in appropriately selected patients, as the functional outcome of their subsequent revision to TKA is not significantly inferior to a primary TKA.

  17. The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases

    Directory of Open Access Journals (Sweden)

    Omar Dahmani

    2014-01-01

    Full Text Available Context: Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature. Aims: We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee. Materials and Methods: We report a retrospective series of nine patients with extraarticular floating knee. Results: There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser′s classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlstrφm criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days. Conclusions: The intramedullary nailing using a single knee incision has shown in this series better results.

  18. Effects of strength exercise on the knee and ankle proprioception of individuals with knee osteoarthritis.

    Science.gov (United States)

    Lai, Zhangqi; Zhang, Yu; Lee, Seullee; Wang, Lin

    2018-01-24

    This study aims to investigate the effects of 8-week strength exercise on knee and ankle proprioception of individuals with knee osteoarthritis (KOA). Forty participants were randomly divided into control and strength exercise groups. Strength exercise group underwent squat training of three times a week for 8 weeks, while control group received an education programme. Threshold for detection of passive movement of knee and ankle joint was tested using an electrically driven movable frame. Between- and within-group differences were evaluated through repeated-measurement analysis of variance. After intervention, passive motion sense in knee flexion of participants in strength exercise group significantly improved (p = 0.033, 95% confidence interval of mean difference: 0.019-1.478) with significant difference between groups. No significant differences of passive motion senses were found in knee extension and ankle between strength exercise and control groups. Eight-week squat training significantly improves the motion sense of knee flexion in patients with KOA.

  19. 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.

  20. 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...... bias that might arise from non-responses in the study. Results: With education, the RIIs for FKP and knee OA were 0.71 [95% confidence interval (CI) 0.61–0.84] and 0.56 (95% CI 0.34–0.93), respectively. With occupation, the corresponding figures were 0.70 (95% CI 0.60–0.82) and 0.59 (95% CI 0...

  1. Self-reported knee joint instability is related to passive mechanical stiffness in medial knee osteoarthritis

    Science.gov (United States)

    2013-01-01

    Background Self-reported knee joint instability compromises function in individuals with medial knee osteoarthritis and may be related to impaired joint mechanics. The purpose of this study was to evaluate the relationship between self-reported instability and the passive varus-valgus mechanical behaviour of the medial osteoarthritis knee. Methods Passive varus-valgus angular laxity and stiffness were assessed using a modified isokinetic dynamometer in 73 participants with medial tibiofemoral osteoarthritis. All participants self-reported the absence or presence of knee instability symptoms and the degree to which instability affected daily activity on a 6-point likert scale. Results Forward linear regression modelling identified a significant inverse relationship between passive mid-range knee stiffness and symptoms of knee instability (r = 0.27; P  0.05). Conclusions Conceivably, a stiffer passive system may contribute toward greater joint stability during functional activities. Importantly however, net joint stiffness is influenced by both active and passive stiffness, and thus the active neuromuscular system may compensate for reduced passive stiffness in order to maintain joint stability. Future work is merited to examine the role of active stiffness in symptomatic joint stability. PMID:24252592

  2. 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...... 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...

  3. Computerized biofeedback knee goniometer: acceptance and effect on exercise behavior in post-total knee arthroplasty rehabilitation.

    Science.gov (United States)

    Kuiken, Todd A; Amir, Hagay; Scheidt, Robert A

    2004-06-01

    To assess device accuracy, patient acceptance, and effect of a computerized biofeedback knee goniometer (CBG), on patients' compliance with active range of motion (AROM) exercises after total knee arthroplasty (TKA). Two-stage study: measurement validation on asymptomatic controls and an unblinded, multiple crossover trial. Inpatient rehabilitation. Asymptomatic controls (n=14) and post-TKA inpatients (n=11). For measurement validation, CBG-angle measurements were compared with manual, clinician-obtained angles. To assess motivational effect, the CBG was worn after TKA; on alternating days, it either monitored AROM silently (no feedback) or provided audiovisual feedback about reaching preset range of motion (ROM) goals and prompted the patients to exercise when idle. To assess accuracy, the device's readings were compared with manual measurements. Patient satisfaction was determined by a self-report questionnaire; exercise compliance was assessed by calculating activity rate and stratified interactivity intervals. CBG readings reproduced clinician measurements reliably between 0 degrees and 100 degrees (eta(2)=98.5%). Auditory feedback was more helpful than visual feedback for motivating exercise. During feedback-on days, the mean total activity rate +/- standard deviation was 15.1+/-10.9 activity counts per hour, and the interactivity interval was 6.7+/-5.7 minutes. The activity rate was higher on feedback-off days-22.5+/-11.1 counts/hour (P=.11)-and the mean interactivity interval was 3.6+/-2.7 minutes (P=.07). The CBG provided reliable, unbiased estimates of clinician measurements of joint angle within the range of 0 degrees to 100 degrees. The CBG was accepted well by most patients. Surprisingly, slightly more ROM activity was noted during feedback-off days than feedback-on days.

  4. Periprosthetic Fractures Following Total Knee Arthroplasty

    Science.gov (United States)

    Kim, Nam Ki

    2015-01-01

    Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888

  5. Ultrasonography research of knee joint injury

    OpenAIRE

    RUSTAMOVA UMIDA MUKHTAROVNA

    2016-01-01

    Ultrasonographic studies were conducted in 468 patients with complaints of pain in the knee joint between the ages of 35 to 58 years (mean age 48 years). Traumatic injuries are identified as fractures joint, tendon ruptures quadriceps, gap lateral ligaments and the patellar tendon, meniscus damage, as well as changes that may be accompanied at these injuries. Semiotics joint damage elements are described.

  6. Value and limits of knee arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Fischedick, O.

    1981-09-01

    In the view of modern knowledges of biomechanic of the knee and the introduce of arthroscopy, the possibilities of arthrography will be discussed. The value of arthrography is not reduced, especially for the cruciate ligaments. Arthroscopy should follow arthrography in uncertain cases.

  7. Magnetic resonance tomography of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Puig, Stefan; Kuruvilla, Yojena Chittazhathu Kurian; Ebner, Lukas [University Hospital, University of Berne, Department of Interventional, Pediatric and Diagnostic Radiology Inselspital, Berne (Switzerland); Endel, Gottfried [Main Association of Austrian Social Insurance Institutions, Vienna (Austria)

    2015-10-15

    To compare the diagnostic performance of magnetic resonance imaging (MRI) in terms of sensitivity and specificity using a field strength of <1.0 T (T) versus ≥1.5 T for diagnosing or ruling out knee injuries or knee pathologies. The systematic literature research revealed more than 10,000 references, of which 1598 abstracts were reviewed and 87 full-text articles were retrieved. The further selection process resulted in the inclusion of four systematic reviews and six primary studies. No differences could be identified in the diagnostic performance of low- versus high-field MRI for the detection or exclusion of meniscal or cruciate ligament tears. Regarding the detection or grading of cartilage defects and osteoarthritis of the knee, the existing evidence suggests that high-field MRI is tolerably specific but not very sensitive, while there is literally no evidence for low-field MRI because only a few studies with small sample sizes and equivocal findings have been performed. We can recommend the use of low-field strength MRI systems in suspected meniscal or cruciate ligament injuries. This does, however, not apply to the diagnosis and grading of knee cartilage defects and osteoarthritis because of insufficient evidence. (orig.)

  8. Bipedal walking gait with variable stiffness knees

    NARCIS (Netherlands)

    Roozing, W.; Carloni, Raffaella

    The Segmented Spring-Loaded Inverted Pendulum model is analysed, and it is shown that it exhibits walking gait. We propose a control architecture that exploits control of the knee stiffness to provide robustness of the system with respect to changes in gait. This controller is extended for a

  9. Battling Obesity : efforts in preventing knee osteoarthritis

    NARCIS (Netherlands)

    B.C. de Vos (Bastiaan)

    2017-01-01

    markdownabstractThis thesis describes the results of the first preventive randomized controlled trial worldwide in the field of knee osteoarthritis. The preventive effectiveness of a tailor-made lifestyle intervention, consisting of diet and exercise, is described in detail. Short-term results

  10. Obesity and symptomatic osteoarthritis of the knee.

    Science.gov (United States)

    Sridhar, M S; Jarrett, C D; Xerogeanes, J W; Labib, S A

    2012-04-01

    Given the growing prevalence of obesity around the world and its association with osteoarthritis of the knee, orthopaedic surgeons need to be familiar with the management of the obese patient with degenerative knee pain. The precise mechanism by which obesity leads to osteoarthritis remains unknown, but is likely to be due to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient and seems to be a logical way of relieving joint pain associated with degenerative arthritis. There are a variety of ways in which this may be done including diet and exercise, and treatment with drugs and bariatric surgery. Whether substantial weight loss can delay or even reverse the symptoms associated with osteoarthritis remains to be seen. Surgery for osteoarthritis in the obese patient can be technically more challenging and carries a risk of additional complications. Substantial weight loss before undertaking total knee replacement is advisable. More prospective studies that evaluate the effect of significant weight loss on the evolution of symptomatic osteoarthritis of the knee are needed so that orthopaedic surgeons can treat this patient group appropriately.

  11. 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...

  12. Prevalence and pattern of knee osteoarthritis in

    African Journals Online (AJOL)

    Muiruri

    among homemakers than other occupational groups. Northeastern Nigerian rural community is 16.3% for because homemakers are generally women, adults aged 230 years and 20.6% for those 240 years. Almost 25% of the participants with. Prevalence is higher in females, increases with age. Symptomatic knee OA ...

  13. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  14. Reconstructive vascular surgery below the knee

    DEFF Research Database (Denmark)

    Rasmussen, L B; Jelnes, R; Sager, P

    1986-01-01

    In a series of 38 consecutive patients with advanced peripheral vascular disease (i.e. rest pain) reconstructive vascular surgery was performed with the distal anastomosis below the knee. Ankle/arm pressure index (AAI) was 0.28 (0.11-0.47) preoperatively; accumulated graft patency rate was 0.47 (SD...

  15. The Danish Knee Ligament Reconstruction Registry

    Directory of Open Access Journals (Sweden)

    Rahr-Wagner L

    2016-10-01

    Full Text Available Lene Rahr-Wagner, Martin Lind Department of Orthopaedic Surgery, Division of Sports Surgery, Aarhus University Hospital, Aarhus, Denmark Abstract: The Danish Knee Ligament Reconstruction Registry was established in 2005 as a web-based nationwide clinical database with the purpose of improving the monitoring and quality of both primary and revision knee ligament reconstructions in Denmark. All primary and revision anterior and posterior cruciate ligament reconstructions as well as collateral ligament and multiligament reconstructions are recorded. Main variables include sex, age, cause of injury, objective ligament instability, and surgical data, such as affected ligament, graft- and implant choice, operation technique among other things. The operating surgeon prospectively collects the data. Hence, detailed preoperative, intraoperative, and 1-year follow-up data are recorded by the operating surgeon using a standardized form and a secured Internet portal. The number of procedures registered in the database each year is ~2,500 and the first 9 years, in total, 22,775 procedures have been registered. Since the beginning of the database multiple papers have been published in international peer-reviewed journals, improving the knowledge of patients treated with knee ligament reconstruction surgery. This paper reviews the content, organization, and published research from the Danish Knee Ligament Reconstruction Registry. Keywords: ligament reconstruction, anterior cruciate ligament, operation technique, database, graft choice, femoral tunnel drilling, patient-reported outcome measure

  16. Segmental Trunk Control Acquisition and Reaching in Typically Developing Infants

    Science.gov (United States)

    Rachwani, Jaya; Santamaria, Victor; Saavedra, Sandra L.; Wood, Stacy; Porter, Francine; Woollacott, Marjorie H.

    2013-01-01

    This study explored the influence of an external support at the thoracic and pelvic level of the trunk on the success of reaching, postural stability and reaching kinematics while infants reached for a toy. Seventeen infants (4–6 months) were clustered into two groups according to their trunk control assessed with the Segmental Assessment of Trunk Control (SATCo). Major differences were seen between groups with pelvic support, whereas with thoracic support, all infants showed similar quality reaching behaviours. With the external pelvic support, infants who had acquired trunk control in the lumbar region were more accurate in their reaching movements (less movement time, improved straightness of reach, less movement units and path length per movement unit) and were more stable (decreased trunk and head displacement) during a reach than infants that had only acquired trunk control in the thoracic region. These results support the hypothesis that trunk control influences the quality of reaching behaviour. PMID:23681292

  17. Risk factors of knee osteoarthritis, WHO-ILAR-COPCORD study

    Directory of Open Access Journals (Sweden)

    Barghamdi M

    2009-01-01

    Full Text Available "nBackground: To evaluate the association between age, sex, BMI, waist/hip ratio, smoking, religion, ethnicity, education and knee osteoarthritis. "nMethods: Eligible subjects were randomly included from participants of Tehran COPCORD study, of whom 480 subjects with knee osteoarthritis were compared to 490 subjects without (case-control study. Using a questionnaire developed by COPCORD group (Asia & Oceania, we enquired about the risk factors of knee osteoarthritis i.e. age, sex, BMI, Waist/Hip ratio, religion, ethnicity, education and smoking. Knee osteoarthritis was defined using ACR criteria. Each knee was unit of analysis using GEE technique to evaluate these associations. "nResults: Age (OR; 1.096; CI95%: 1.091-1.1; P: 0.00 and sex (OR; 2.85; CI95%: 2.49-3.28; P: 0.00 showed significant association with knee osteoarthritis. Overweight (OR; 1.81; CI95%: 1.28-2.55; P: 0.00 and obesity (OR; 3.3; CI95%: 2.34-4.66; P: 0.00 both showed higher risk for knee osteoarthritis. The association between waist/hip ratio and knee osteoarthritis showed an OR of 5.28, CI95%: 0.89-31.44; P: 0.07. However, this association was only borderline significant. People with different religion or ethnicity and smokers had no extra risks for knee osteoarthritis. Higher education is a protective factor for knee osteoarthritis as people who had university education compared to people with no/primary education showed a lower risk for knee osteoarthritis (OR; 0.54; CI95%: 0.38-0.78; P: 0.00. "nConclusions: Our study confirmed that elderly, females, overweight and obese people are at higher risk to develop knee osteoarthritis as found in western societies. Higher education is a protective factor against knee osteoarthritis. Ethnicity, religion and smoking showed no extra risk of knee osteoarthritis.

  18. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Zhi-Xin Zhao

    2015-01-01

    Full Text Available Background: The goal of total knee arthroplasty (TKA is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0-135° flexion. Results: Both the output data trends and the measured values derived from the normal knee′s kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, "rollback" compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis.

  19. The Effects of Sex, Limb Dominance, and Soccer Participation on Knee Proprioception and Dynamic Postural Control.

    Science.gov (United States)

    Cug, Mutlu; Wikstrom, Erik A; Golshaei, Bahman; Kirazci, Sadettin

    2016-02-01

    Both female athletes' participation in soccer and associated injuries have greatly increased in recent years. One issue is the 2-9 times greater incidence of noncontact anterior cruciate ligament (ACL) injuries in female athletes relative to male athletes in comparable sports. Several factors such as limb dominance and sporting history have been proposed to play a role in ACL incidence rates between male and female athletes. However, evidence about the effects of these factors and how they interact with sex is mixed, and thus no consensus exists. To quantify the effects of sports participation, limb dominance, and sex on dynamic postural control and knee-joint proprioception. Cross-sectional study. University research laboratory. 19 male soccer players, 17 female soccer players, 19 sedentary men, and 18 sedentary women. Joint-position sense was tested using reproduction of passive positioning on a Biodex isokinetic dynamometer (30°, 45°, and 60° from 90° of knee flexion). Three Star Excursion Balance Test directions were used to assess dynamic postural control. Normalized reach distance (% of leg length) in the anterior, posteromedial, and posterolateral directions on each leg quantified dynamic postural control. Average absolute error and constant error for both limbs quantified joint-position sense. Posteromedial reach distance was significantly better in soccer players than sedentary individuals (P = .006). Anterior reach distance was significantly better (P = .04) in sedentary individuals than soccer players. No limb-dominance or sex differences were identified for dynamic postural control, and no differences in absolute- or constant-error scores were identified. Sporting history has a direction-specific impact on dynamic postural control. Sporting history, sex, and limb dominance do not influence knee-joint proprioception when tested in an open kinetic chain using passive repositioning.

  20. Prevention of infection after knee arthroplasty.

    Science.gov (United States)

    Gorenoi, Vitali; Schönermark, Matthias P; Hagen, Anja

    2010-07-15

    Man-made joints (joint endoprostheses), including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty) is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis) are used. The benefits of these interventions are not clear yet. The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT), systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of expert opinions. The evidence of the effectiveness of intravenous

  1. Prevention of infection after knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2010-01-01

    Full Text Available Scientific background: Man-made joints (joint endoprostheses, including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis are used. The benefits of these interventions are not clear yet. Research questions: The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. Methods: A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT, systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. Results: The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of

  2. Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age

    DEFF Research Database (Denmark)

    Turkiewicz, Aleksandra; Timpka, Simon; Thorlund, Jonas Bloch

    2017-01-01

    OBJECTIVES: To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. METHODS: We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isome......OBJECTIVES: To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. METHODS: We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data...... on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using...... be attributed to knee injury and adult occupation. CONCLUSION: Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor...

  3. Power at hip, knee and ankle joints are compromised in women with mild and moderate knee osteoarthritis.

    Science.gov (United States)

    Resende, Renan Alves; Fonseca, Sérgio Teixeira; Silva, Paula Lanna; Magalhães, Claudio Marcos Bedran; Kirkwood, Renata Noce

    2012-12-01

    Analyses of the biomechanical characteristics of gait of women with mild and moderate knee osteoarthritis may identify parameters that could be targeted by physical therapy interventions. Therefore, the purpose of the present study was to compare the joint power profiles during gait between a group of elderly women with mild and moderate levels of knee osteoarthritis and a group of age-matched asymptomatic women. Thirty-nine women diagnosed with osteoarthritis at the medial compartment of the knee and 39 healthy women with no diagnosis of knee osteoarthritis participated in the study. Joint power profiles of the hip, knee and ankle joints in the sagittal plane during gait were performed using video and force data obtained using Qualisys ProReflex System synchronized with two force plates. Principal component analysis was applied to extract features from the joint power waveforms characterizing their main modes of temporal variation. The extracted features were compared between groups. Women with knee osteoarthritis absorbed and generated less energy at the hip and ankle joints, and absorbed less energy at the knee when compared to the asymptomatic group. The observed power pattern in women with knee osteoarthritis may be related to their reduced gait speed, a suboptimal strategy possibly used to reduce reaction forces at the knee. Clinical studies should investigate whether interventions designed to improve muscular resources, as a means to control the flow of forces at the knee, would optimize power patterns and gait performance in women with knee osteoarthritis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Association Between Anatomical Characteristics, Knee Laxity, Muscle Strength, and Peak Knee Valgus During Vertical Drop-Jump Landings.

    Science.gov (United States)

    Nilstad, Agnethe; Krosshaug, Tron; Mok, Kam-Ming; Bahr, Roald; Andersen, Thor Einar

    2015-12-01

    Controlled laboratory study; cross-sectional. To investigate the relationship among anatomical variables, knee laxity, muscle strength, and peak knee valgus angles during a vertical drop-jump landing task. Excessive knee valgus has been associated with anterior cruciate ligament injury in females; however, the influence of anatomical characteristics, knee laxity, and muscle strength on frontal plane knee motion is not completely understood. Norwegian elite female soccer players (n = 279; mean ± SD age, 21 ± 4 years; height, 167 ± 6 cm; body mass, 63 ± 7 kg) were evaluated from 2009 through 2012. The evaluation included 3-D motion analysis of a vertical drop jump, anatomical measures (height, static knee valgus, leg length, and static foot posture), knee laxity, and muscle strength (quadriceps, hamstrings, and hip abductors). Multiple linear regression analyses were used to investigate the relationships among anatomical characteristics, knee laxity, muscle strength, and peak knee valgus angles. Anatomical characteristics explained 11% of the variance in peak knee valgus angles (Pangles during a vertical drop-jump landing task. However, these variables only explained 11% of the variance in peak knee valgus.

  5. Guaranteed performance in reaching mode of sliding mode ...

    Indian Academy of Sciences (India)

    The choice of the controller parameters based on the time to reach a desirable level of output tracking error (OTE), rather than on the reaching time is proposed. Using the Lyapunov theory, it is shown that parameter selections, based on the reaching time criterion, may need substantially larger time to achieve the OTE.

  6. Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis

    Science.gov (United States)

    Ju, Sung-Bum; Park, Gi Duck; Kim, Sang-Soo

    2015-01-01

    [Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis. PMID:26357422

  7. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Chih-Yen Chiang

    2017-02-01

    Full Text Available Total knee arthroplasty (TKA is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements.

  8. Effects of fatigue on knee proprioception.

    Science.gov (United States)

    Lattanzio, P J; Petrella, R J; Sproule, J R; Fowler, P J

    1997-01-01

    To investigate the effects of muscular fatigue on knee joint proprioception. Prospective study. Exercise physiology laboratory. Sixteen (eight men and eight women) healthy volunteers ages 19-27 years, with no history of neuromuscular disorders, vestibular disorders, or lower limb injuries (e.g., ligament/meniscus tear). Three separate fatigue protocols [ramp test (RT), continuous test (CT), and interval test (IT)] were performed. All tests consisted of lower limb cycling on a computer-driven cycle ergometer (Lode). The RT was used to calculate the maximal aerobic power (VO2max) and determine the work rates for the CT and IT. Work rate for the RT increased 20/25 W/min to maximal exhaustion. The CT consisted of cycling at 80% VO2max until maximal exhaustion. The IT consisted of cycling alternately at 120% VO2max and at 40% VO2max for 30 s each to the point of maximal exhaustion. In the standing position, subjects were instructed to perform a two-legged squat to specific knee flexion angles. The absolute angular error (AAE) was measured for each test angle using an electrogoniometer (Penny & Giles, Blackwood, Gwent, U.K.) placed laterally across the dominant knee joint. AAE was defined as the absolute difference between test angle and subject perceived angle of knee flexion. A statistically significant increase in AAE after the RT (1.0 +/- 0.66 degree, p 0.5) after the RT protocol. These findings suggest that exercising to fatigue may produce a change in subjects' reproduction ability of knee joint angles. This may represent a decline in proprioceptive function after heavy exercise bouts. Whether this suggested proprioceptive decline is at the clinical significance level (e.g., significantly altering joint stability and motion) cannot be determined from the present findings.

  9. Trunk-rotation differences at maximal reach of the star excursion balance test in participants with chronic ankle instability.

    Science.gov (United States)

    de la Motte, Sarah; Arnold, Brent L; Ross, Scott E

    2015-04-01

    Functional reach on the Star Excursion Balance Test is decreased in participants with chronic ankle instability (CAI). However, comprehensive 3-dimensional kinematics associated with these deficits have not been reported. To determine if lower extremity kinematics differed in CAI participants during anteromedial, medial, and posteromedial reach on the Star Excursion Balance Test. Case-control study. Sports medicine research laboratory. Twenty CAI participants (age = 24.15 ± 3.84 years, height = 168.95 ± 11.57 cm, mass = 68.95 ± 16.29 kg) and 20 uninjured participants (age = 25.65 ± 5.58 years, height = 170.14 ± 8.75 cm, mass = 69.89 ± 10.51 kg) with no history of ankle sprain. We operationally defined CAI as repeated episodes of ankle "giving way" or "rolling over" or both, regardless of neuromuscular deficits or pathologic laxity. All CAI participants scored ≤26 on the Cumberland Ankle Instability Tool. Star Excursion Balance Test reaches in the anteromedial, medial, and posteromedial directions. The CAI participants used the unstable side as the stance leg. Control participants were sex, height, mass, and side matched to the CAI group. The 3-dimensional kinematics were assessed with a motion-capture system. Group differences on normalized reach distance, trunk, pelvis, and hip-, knee-, and ankle-joint angles at maximum Star Excursion Balance Test reach. No reach-distance differences were detected between CAI and uninjured participants in any of the 3 reach directions. With anteromedial reach, trunk rotation (t(1,38) = 3.06, P = .004), pelvic rotation (t(1,38) = 3.17, P = .003), and hip flexion (t(1,38) = 2.40, P = .002) were greater in CAI participants. With medial reach, trunk flexion (t(1,38) = 6.39, P = .05) was greater than for uninjured participants. No differences were seen with posteromedial reach. We did not detect reach-distance differences in any direction. However, participants with CAI rotated the trunk and pelvis more toward the stance leg

  10. Speed-related spinal excitation from ankle dorsiflexors to knee extensors during human walking

    DEFF Research Database (Denmark)

    Iglesias, Caroline; Nielsen, Jens Bo; Marchand-Pauvert, Véronique

    2008-01-01

    Automatic adjustments of muscle activity throughout the body are required for the maintenance of balance during human walking. One mechanism that is likely to contribute to this control is the heteronymous spinal excitation between human ankle dorsiflexors and knee extensors (CPQ-reflex). Here, we....../h, then increased with walking speeds about 3-4 km/h, and reached a plateau without any further change at walking speeds from 4 to 6 km/h. The reflex showed no modulation when the stride cycle was varied at constant speed (4 km/h; short steps versus long steps). These changes were unlikely to be only caused...

  11. Gait and clinical improvements with a novel knee brace for knee OA.

    Science.gov (United States)

    Johnson, Aaron J; Starr, Roland; Kapadia, Bhaveen H; Bhave, Anil; Mont, Michael A

    2013-06-01

    Knee osteoarthritis causes debilitating pain, and results in characteristic gait changes. Some authors believe that a system of neuromuscular retraining may improve these parameters. We therefore evaluated a novel brace that combines pneumatic joint unloading and active swing-assist to assess: (1) differences in pain levels or medication usage; (2) reductions in additional interventions; (3) changes in quadriceps muscle strength; and (4) improvements in specific gait measurements after 3 months. A prospective pilot series of 10 knee osteoarthritis patients who had exhausted other nonoperative treatment measures were enrolled. These patients were compared with the previous 15 knee osteoarthritis patients who met similar criteria, but were not braced. Quadriceps muscle strength was measured, as were pain levels, and additional interventions such as injections or total knee arthroplasty procedures. Gait parameters measured included: walking speed, total range-of-motion, knee flexion at foot-strike, and knee adduction moment. All but one of the compliant patients reported a decrease of at least two pain points after 3 months of use. There was one additional intervention in the brace cohort versus a statistical increase of 10 in the nonbrace cohort. All patients who were compliant with the brace showed an increase in thigh girth measurements, compared with none in the nonbrace cohort. Braced patients experienced retained improvements in at least one gait parameter including improved walking speed, total range of motion, and improved knee-angle at heel strike. The mean improvement in knee adduction moment was a decrease of 0.2255 Nm/kg (range, 0.56 to 0.564 Nm/kg), showing a mean improvement of 48% (range, 16 to 76% of original peak moment). The use of a brace that has features including a combination of unloader characteristics along with active swing-assist, provided neuromuscular retraining benefits for patients who have knee osteoarthritis. In summary, although quite

  12. Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury

    Science.gov (United States)

    Grindem, Hege; Eitzen, Ingrid; Engebretsen, Lars; Snyder-Mackler, Lynn; Risberg, May Arna

    2014-01-01

    Background: While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment. Methods: This prospective cohort study included 143 patients with an ACL injury. Isokinetic knee extension and flexion strength and patient-reported knee function as recorded on the International Knee Documentation Committee (IKDC) 2000 form were collected at baseline, six weeks, and two years. Sports participation was reported monthly for two years with use of an online activity survey. Knee reinjuries were reported at the follow-up evaluations and in a monthly online survey. Repeated analysis of variance (ANOVA), generalized estimating equation (GEE) models, and Cox regression analysis were used to analyze group differences in functional outcomes, sports participation, and knee reinjuries, respectively. Results: The surgically treated patients (n = 100) were significantly younger, more likely to participate in level-I sports, and less likely to participate in level-II sports prior to injury than the nonsurgically treated patients (n = 43). There were no significant group-by-time effects on functional outcome. The crude analysis showed that surgically treated patients were more likely to sustain a knee reinjury and to participate in level-I sports in the second year of the follow-up period. After propensity score adjustment, these differences were nonsignificant; however, the nonsurgically treated patients were significantly more likely to participate in level-II sports during the first year of the follow-up period and in level-III sports over the two years. After two years, 30% of all patients had an extensor strength deficit, 31% had a flexor strength deficit, 20% had patient-reported knee function below the normal range, and

  13. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis.

    Science.gov (United States)

    Øiestad, B E; Juhl, C B; Eitzen, I; Thorlund, J B

    2015-02-01

    The objective of this study was to perform a systematic review and meta-analysis on the association between knee extensor muscle weakness and the risk of developing knee osteoarthritis. A systematic review and meta-analysis was conducted with literature searches in Medline, SPORTDiscus, EMBASE, CINAHL, and AMED. Eligible studies had to include participants with no radiographic or symptomatic knee osteoarthritis at baseline; have a follow-up time of a minimum of 2 years, and include a measure of knee extensor muscle strength. Hierarchies for extracting data on knee osteoarthritis and knee extensor muscle strength were defined prior to data extraction. Meta-analysis was applied on the basis of the odds ratios (ORs) of developing symptomatic knee osteoarthritis or radiographic knee osteoarthritis in subjects with knee extensor muscle weakness. ORs for knee osteoarthritis and 95% confidence intervals (CI) were estimated and combined using a random effects model. Twelve studies were eligible for inclusion in the meta-analysis after the initial searches. Five cohort studies with a follow-up time between 2.5 and 14 years, and a total number of 5707 participants (3553 males and 2154 females), were finally included. The meta-analysis showed an overall increased risk of developing symptomatic knee osteoarthritis in participants with knee extensor muscle weakness (OR 1.65 95% CI 1.23, 2.21; I(2) = 50.5%). This systematic review and meta-analysis showed that knee extensor muscle weakness was associated with an increased risk of developing knee osteoarthritis in both men and women. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  14. Spiking and LFP activity in PRR during symbolically instructed reaches.

    Science.gov (United States)

    Hwang, Eun Jung; Andersen, Richard A

    2012-02-01

    The spiking activity in the parietal reach region (PRR) represents the spatial goal of an impending reach when the reach is directed toward or away from a visual object. The local field potentials (LFPs) in this region also represent the reach goal when the reach is directed to a visual object. Thus PRR is a candidate area for reading out a patient's intended reach goals for neural prosthetic applications. For natural behaviors, reach goals are not always based on the location of a visual object, e.g., playing the piano following sheet music or moving following verbal directions. So far it has not been directly tested whether and how PRR represents reach goals in such cognitive, nonlocational conditions, and knowing the encoding properties in various task conditions would help in designing a reach goal decoder for prosthetic applications. To address this issue, we examined the macaque PRR under two reach conditions: reach goal determined by the stimulus location (direct) or shape (symbolic). For the same goal, the spiking activity near reach onset was indistinguishable between the two tasks, and thus a reach goal decoder trained with spiking activity in one task performed perfectly in the other. In contrast, the LFP activity at 20-40 Hz showed small but significantly enhanced reach goal tuning in the symbolic task, but its spatial preference remained the same. Consequently, a decoder trained with LFP activity performed worse in the other task than in the same task. These results suggest that LFP decoders in PRR should take into account the task context (e.g., locational vs. nonlocational) to be accurate, while spike decoders can robustly provide reach goal information regardless of the task context in various prosthetic applications.

  15. Effects of Real-World Versus Virtual Environments on Joint Excursions in Full-Body Reaching Tasks

    Science.gov (United States)

    France, Christopher R.; Leitkam, Samuel T.; Applegate, Megan E.; Pidcoe, Peter E.; Walkowski, Stevan

    2016-01-01

    Starting from an upright standing posture and reaching for a target that requires some forward bending of the trunk can involve many different configurations of the trunk and limb segments. We sought to determine if configurations of the limb and trunk segments during our standardized full-body reaching tasks were influenced by the visual environment. This paper examined movement patterns of healthy participants (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$n=17$ \\end{document}, eight female and nine male) performing full body reaching tasks to: 1) real-world targets; 2) virtual targets presented on a 3-D television; and 3) virtual targets presented using a head-mounted display. For reaches performed in the virtual world, the avatar was presented from a third-person perspective for the 3-D television and from a first-person perspective for the head-mounted display. Reaches to virtual targets resulted in significantly greater excursions of the ankle, knee, hip, spine, and shoulder compared with reaches made to real-world targets. This resulted in significant differences in the forward and downward displacements of the whole-body center of mass between the visual environments. Visual environment clearly influences how subjects perform full-body reaching tasks to static targets. Because a primary goal of virtual reality within rehabilitation is often to restore movement following orthopedic or neurologic injury, it is important to understand how visual environment will affect motor behavior. The present findings suggest that the existing game systems that track and present avatars from a third-person perspective elicit significantly different motor behavior when compared with the same tasks being presented from a first-person perspective. PMID:27957404

  16. Effects of Real-World Versus Virtual Environments on Joint Excursions in Full-Body Reaching Tasks.

    Science.gov (United States)

    Thomas, James S; France, Christopher R; Leitkam, Samuel T; Applegate, Megan E; Pidcoe, Peter E; Walkowski, Stevan

    2016-01-01

    Starting from an upright standing posture and reaching for a target that requires some forward bending of the trunk can involve many different configurations of the trunk and limb segments. We sought to determine if configurations of the limb and trunk segments during our standardized full-body reaching tasks were influenced by the visual environment. This paper examined movement patterns of healthy participants ([Formula: see text], eight female and nine male) performing full body reaching tasks to: 1) real-world targets; 2) virtual targets presented on a 3-D television; and 3) virtual targets presented using a head-mounted display. For reaches performed in the virtual world, the avatar was presented from a third-person perspective for the 3-D television and from a first-person perspective for the head-mounted display. Reaches to virtual targets resulted in significantly greater excursions of the ankle, knee, hip, spine, and shoulder compared with reaches made to real-world targets. This resulted in significant differences in the forward and downward displacements of the whole-body center of mass between the visual environments. Visual environment clearly influences how subjects perform full-body reaching tasks to static targets. Because a primary goal of virtual reality within rehabilitation is often to restore movement following orthopedic or neurologic injury, it is important to understand how visual environment will affect motor behavior. The present findings suggest that the existing game systems that track and present avatars from a third-person perspective elicit significantly different motor behavior when compared with the same tasks being presented from a first-person perspective.

  17. Does muscle inhibition after knee injury increase the risk of osteoarthritis?

    Science.gov (United States)

    Suter, E; Herzog, W

    2000-01-01

    Knee pathologies are commonly associated with muscle inhibition, an inability to fully activate the knee extensors during voluntary contractions. This inhibition results in knee extensor weakness, and is thought to limit the functional recovery of the knee joint structures. The possible contribution of persistent knee extensor inhibition to osteoarthritis is discussed.

  18. Multimodal imaging of the human knee down to the cellular level

    Science.gov (United States)

    Schulz, G.; Götz, C.; Müller-Gerbl, M.; Zanette, I.; Zdora, M.-C.; Khimchenko, A.; Deyhle, H.; Thalmann, P.; Müller, B.

    2017-06-01

    Computed tomography reaches the best spatial resolution for the three-dimensional visualization of human tissues among the available nondestructive clinical imaging techniques. Nowadays, sub-millimeter voxel sizes are regularly obtained. Regarding investigations on true micrometer level, lab-based micro-CT (μCT) has become gold standard. The aim of the present study is firstly the hierarchical investigation of a human knee post mortem using hard X-ray μCT and secondly a multimodal imaging using absorption and phase contrast modes in order to investigate hard (bone) and soft (cartilage) tissues on the cellular level. After the visualization of the entire knee using a clinical CT, a hierarchical imaging study was performed using the lab-system nanotom® m. First, the entire knee was measured with a pixel length of 65 μm. The highest resolution with a pixel length of 3 μm could be achieved after extracting cylindrically shaped plugs from the femoral bones. For the visualization of the cartilage, grating-based phase contrast μCT (I13-2, Diamond Light Source) was performed. With an effective voxel size of 2.3 μm it was possible to visualize individual chondrocytes within the cartilage.

  19. Functional Strength Training Effects on Knee Flexors and Extensors Power Output in Football Players

    Directory of Open Access Journals (Sweden)

    Izet Radjo

    2016-06-01

    Full Text Available Study aim was to compare and reevaluate effects of additional strength training program in football players after eight week application. Program was design to increase power and strength of knee extensors and flexors using neuromuscular adaptation. In overall, 18 senior level football players completed intervention in preparation period executing program as part of warm up 2-3 times per week. Using t-test for dependent samples statistical significance of the possible change was evaluated in peak torque, total and average work changes measured using Biodex isokinetic dynamometer. All measuring procedures were done for both limbs. Results are suggesting that statistically significant change observed in both limbs for the peak power output and average work load in flexion and extension, respectively. Other research papers are suggesting that increase of power and strength of knee muscles can help in preventing of injurie occurrence. LCA injurie can be prevention when femoral biceps strength is increase. This training modality based on neuromuscular adaptation is noninvasive with good effects in performance increase. Using training loads with body weight intensity is a good way to establish prevention to possible knee injurie with simultaneous power increase, with minimum of chance to reach unwanted overtraining.

  20. The EIUS unicompartmental knee design: early failure in elderly patients.

    Science.gov (United States)

    Barnes, C Lowry; Lincoln, Daniel; Wilson, Becky

    2013-10-01

    This report presents the results of 34 unicompartmental knee replacements in 28 elderly patients. The mean age of patients at the time of index surgery was 78.7 years. All cases were performed by a single surgeon over a 16-month period. In all cases, the EIUS Unicompartmental Knee System (Stryker, Mahwah, NJ) was used. The surgeon was technically experienced at implanting EIUS knee prostheses prior to the start of this study.Knees were evaluated by Knee Society Score through 5 years, and patients were followed up by phone interviews for a minimum period of 8 years. With revision as the end point, the 5-year failure rate was 14.7% (n = 5), and the mean time to failure was 25.6 months (range: 4 to 44 months).At 8 years follow-up, 3 patients (4 knees) died for reasons unrelated to the knee implant, and 2 patients (4 knees) were lost to follow-up. Three knees in 3 patients were revised at 5.75 years, 7.0 years, and 8.0 years, respectively. The majority of knees that did not experience early failure remained pain and symptom free at minimum 8 years follow-up.We suspect the early failures were more likely due to a combination of the design characteristics and instrumentation of the EIUS prosthesis than surgical technique. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. Primary knee osteoarthritis increases the risk of falling.

    Science.gov (United States)

    Tasci Bozbas, Gulnur; Sendur, Omer Faruk; Aydemir, Ali Hakan

    2017-01-01

    The aim of this study was to investigate the effect of primary knee osteoarthritis on the risk of falling. One hundred participants (50 with knee osteoarthritis and 50 healthy controls) were included in this study. Primary knee osteoarthritis was diagnosed according to the American College of Rheumatology (ACR) criteria. Patients who were grade 2 or 3 by Kellgren-Lawrence criteria according to weight-bearing knee radiographs were included in this study. The risk of falling was evaluated by the interactive balance and coordination device both in the osteoarthritis and control groups. The functional status and pain were evaluated with respectively Lequesne Index and Visual Analogue Scale. No statistically significant differences were found between the group of primary knee osteoarthritis and control in terms of age, BMI, and gender. The median falling index was 52 in the group with knee OA, whereas it was 31 in the control group. It was determined that primary knee osteoarthritis increased the risk of falling significantly and grade 3 primary knee osteoarthritis was statistically significantly higher than grade 2 (p 0.05). Falling is among the important causes of mortality and morbidity in advanced age. Therefore, assessment of risk factors for falling and the strategies to prevent it are important. Primary knee osteoarthritis is one of the risk factors associated with falling. Therefore, medical approaches, proprioception training, balance-gait training, muscle strengthening exercises, and arrangements to prevent domestic injurious falling should be planned to reduce the risk of falling in the presence of primary knee osteoarthritis.

  2. An Approach to Developing Customized Total Knee Replacement Implants

    Directory of Open Access Journals (Sweden)

    Xinyu Li

    2017-01-01

    Full Text Available Total knee replacement (TKR has been performed for patients with end-stage knee joint arthritis to relieve pain and gain functions. Most knee replacement patients can gain satisfactory knee functions; however, the range of motion of the implanted knee is variable. There are many designs of TKR implants; it has been suggested by some researchers that customized implants could offer a better option for patients. Currently, the 3-dimensional knee model of a patient can be created from magnetic resonance imaging (MRI or computed tomography (CT data using image processing techniques. The knee models can be used for patient-specific implant design, biomechanical analysis, and creating bone cutting guide blocks. Researchers have developed patient-specific musculoskeletal lower limb model with total knee replacement, and the models can be used to predict muscle forces, joint forces on knee condyles, and wear of tibial polyethylene insert. These available techniques make it feasible to create customized implants for individual patients. Methods and a workflow of creating a customized total knee replacement implant for improving TKR kinematics and functions are discussed and presented in this paper.

  3. Wearable Vector Electrical Bioimpedance System to Assess Knee Joint Health

    Science.gov (United States)

    Hersek, Sinan; Töreyin, Hakan; Teague, Caitlin N.; Millard-Stafford, Mindy L.; Jeong, Hyeon-Ki; Bavare, Miheer M.; Wolkoff, Paul; Sawka, Michael N.; Inan, Omer T.

    2017-01-01

    Objective We designed and validated a portable electrical bioimpedance (EBI) system to quantify knee joint health. Methods Five separate experiments were performed to demonstrate the: (1) ability of the EBI system to assess knee injury and recovery; (2) inter-day variability of knee EBI measurements; (3) sensitivity of the system to small changes in interstitial fluid volume; (4) reducing the error of EBI measurements using acceleration signals; (5) use of the system with dry electrodes integrated to a wearable knee wrap. Results (1) The absolute difference in resistance (R) and reactance (X) from the left to the right knee was able to distinguish injured and healthy knees (pmeasurements. (5) Linear regression between the knee R and X measured using the wet electrodes and the designed wearable knee wrap were highly correlated (r2 = 0.8 and 0.9, respectively). Conclusion This work demonstrates the use of wearable EBI measurements in monitoring knee joint health. Significance The proposed wearable system has the potential for assessing knee joint health outside the clinic/lab and help guide rehabilitation. PMID:28026745

  4. The Oxford unicompartmental knee fails at a high rate in a high-volume knee practice.

    Science.gov (United States)

    Schroer, William C; Barnes, C Lowry; Diesfeld, Paul; LeMarr, Angela; Ingrassia, Rachel; Morton, Diane J; Reedy, Mary

    2013-11-01

    The Oxford knee is a unicompartmental implant featuring a mobile-bearing polyethylene component with excellent long-term survivorship results reported by the implant developers and early adopters. By contrast, other studies have reported higher revision rates in large academic practices and in national registries. Registry data have shown increased failure with this implant especially by lower-volume surgeons and institutions. In the setting of a high-volume knee arthroplasty practice, we sought to determine (1) the failure rate of the Oxford unicompartmental knee implant using a failure definition for aseptic loosening that combined clinical features, plain radiographs, and scintigraphy, and (2) whether increased experience with this implant would decrease failure rate, if there is a learning curve effect. Eighty-three Oxford knee prostheses were implanted between September 2005 and July 2008 by the principal investigator. Radiographic and clinical data were available for review for all cases. A failed knee was defined as having recurrent pain after an earlier period of recovery from surgery, progressive radiolucent lines compared with initial postoperative radiographs, and a bone scan showing an isolated area of uptake limited to the area of the replaced compartment. Eleven knees in this series failed (13%); Kaplan-Meier survivorship was 86.5% (95% CI, 78.0%-95.0%) at 5 years. Failure occurrences were distributed evenly over the course of the study period. No learning curve effect was identified. Based on these findings, including a high failure rate of the Oxford knee implant and the absence of any discernible learning curve effect, the principal investigator no longer uses this implant.

  5. Correlation between subcutaneous knee fat thickness and chondromalacia patellae on magnetic resonance imaging of the knee.

    Science.gov (United States)

    Kok, Hong Kuan; Donnellan, John; Ryan, Davinia; Torreggiani, William C

    2013-08-01

    Chondromalacia patellae is a common cause of anterior knee pain in young patients and can be detected noninvasively with magnetic resonance imaging (MRI). The purpose of our study was to evaluate the correlation between subcutaneous fat thickness around the knee joint on axial MRIs as a surrogate marker of obesity, with the presence or absence of chondromalacia patellae. A retrospective review was conducted of knee MRIs in 170 patients who satisfied the inclusion criteria. Imaging was performed over a 12-month period on a 1.5T MRI system with a dedicated extremity coil. Two radiologists experienced in musculoskeletal imaging assessed each examination in consensus for the presence or absence of chondromalacia patellae and graded positive studies from 0 (absent) to 3 (full cartilage thickness defect). Measurement of subcutaneous knee fat thickness was obtained on the medial aspect of the knee. MRI findings of chondromalacia patellae were present in 33 patients (19.4%), of which, there were 11 grade 1 lesions (33.3%), 9 grade 2 lesions (27.3%), and 13 grade 3 lesions (39.4%). The mean subcutaneous knee fat thickness was significantly higher in the chondromalacia patellae group for all grades compared with the normal group (P chondromalacia patellae (R = 0.48 [95% confidence interval, 0.38-0.68]; P chondromalacia patellae. Subcutaneous knee fat thickness as a surrogate marker of obesity was positively associated with the presence and severity of chondromalacia patellae on MRI. Copyright © 2013 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  6. Charcot arthropathy of the knee. A case-based review.

    Science.gov (United States)

    Kucera, Tomas; Urban, Karel; Sponer, Pavel

    2011-03-01

    The diagnosis of Charcot arthropathy in the knee is rare. However, there is an increasing number of diabetic patients, and they are living longer due to improvements in treatment. Because neuropathic arthropathy is a late effect of peripheral neuropathy, we can expect an increasing incidence of neuropathic arthropathy. Total knee arthroplasty is the preferred choice of treatment by patients, although it may also be associated with a high incidence of serious complications. This case report presents a young female with diabetes mellitus and Charcot arthropathy of the knee managed by total knee arthroplasty and a literature review. The report encompasses a 5-year follow-up of the patient, from the first contact after knee distortion through diagnosis of Charcot arthropathy and the performance of total knee arthroplasty with outpatient controls. The diagnosis was established on the basis of the rapid destruction of the medial tibial condyle after knee distortion in a patient with neuropathy. Neuropathic arthropathy was confirmed by histology. The patient refused knee fusion and total knee arthroplasty was performed. The patient quickly achieved a painless, stable knee with a 130-degree range of motion. However, a radiolucent line appeared under the tibial component due to premature weight-bearing. The patient was ordered to refrain from weight-bearing for the next 3 months, and the knee was healed. While the management of Charcot arthropathy in the knee remains controversial, total knee arthroplasty is not a contraindication. Early diagnosis, appropriate choice of implant and operative technique, and long-term weight protection are essential.

  7. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.

    Science.gov (United States)

    Levine, W N; Ozuna, R M; Scott, R D; Thornhill, T S

    1996-10-01

    Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.

  8. [Clinical application of biomechanic and functional anatomical findings of the knee joint].

    Science.gov (United States)

    Friederich, N F; Müller, W; O'Brien, W R

    1992-02-01

    In order to study the functional anatomy of the knee joint, careful anatomical dissections were conducted on over 130 fresh-frozen cadaveric knee specimens. We found no evidence to support the two-bundle and three-bundle theories of cruciate ligament fiber patterns. The longest fibers in the anterior cruciate ligaments (ACL) measured 37 mm, and the longest in the posterior cruciate ligament (PCL), 41 mm. Cruciate ligament insertions follow a transition line on tibia and femur. Usually not all the fibers of the cruciate ligaments are taut at the same time. They are progressively recruited according to the biomechanical demands placed on them. Fibre recruitment in the ACL is from knee flexion to extension and in the PCL from extension to flexion. The concept of fiber recruitment was recently evaluated mathematically. As a working hypothesis, the knee joint can be looked upon as a biological realization of the crossed four-bar linkage, even in three dimensions. In vitro measurements have shown that correct graft placement in cruciate reconstructions is critical for knee biomechanics. Incorrect placement of grafts may lead to decreased range of motion and/or increased laxity. Distance changes of 3 mm between femoral origin and tibial insertion of a graft may lead to a 400% increase of graft preload and will thus easily reach published pull-out forces for some of the graft fixation methods (button = 248 N). Precise drill guides and isometers may be helpful in any operative technique (open, arthroscopic). Using the IKDC evaluation form and the KT-1000 arthrometer, our studies on 25 patients demonstrated a direct correlation between intraoperative graft tracking and the clinical outcome 2 years after operation. Biomechanical studies to investigate in vivo strain patterns of the anterior cruciate ligament and in vitro strain patterns of isometrically placed cruciate graft reconstructions showed that they did not reach critical fixation failure or graft rupture loads. The

  9. 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: panterior cruciate ligament reconstruction, participants with knee osteoarthritis had significantly worse knee confidence (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, panterior cruciate ligament reconstruction, compared to those without. Future studies should further investigate the psychological impairments associated with knee osteoarthritis after anterior cruciate

  10. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

    Science.gov (United States)

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W.; Arokoski, Jari P.; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; Saarakkala, Simo

    2016-01-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level. PMID:26926836

  11. Knee Pain and Patellofemoral Symptoms in Patients With Cerebral Palsy.

    Science.gov (United States)

    Rethlefsen, Susan A; Nguyen, Danny T; Wren, Tishya A L; Milewski, Matthew D; Kay, Robert M

    2015-01-01

    Knee pain in cerebral palsy (CP) is associated with increased patellofemoral forces present when walking with flexed knees. In typically developing children, knee pain and patellofemoral dysfunction are associated with obesity, genu valgum, femoral anteversion, and external tibial torsion. These problems are also common in CP, and may contribute to knee problems in this population. The purposes of this study were to define the prevalence of knee pain and patellofemoral dysfunction in children with CP, and to identify physical and gait characteristics (using 3-dimensional gait analysis data) that predispose them to such problems. Retrospective review of 121 children with CP, Gross Motor Function Classification System level I to IV, who underwent computerized gait analysis testing. Demographics, range of motion, body mass index and hip, knee, and ankle kinematics were compared between subjects with and without knee pain. Twenty-five of 121 subjects (21%) reported knee pain at the time of testing. Three of 121 subjects (2%) had a history of patellar subluxation/dislocation. Age and sex were significantly related to presence of knee pain. The likelihood of knee pain was almost 5 times higher in females (odds ratio=4.9, [95% confidence interval, 1.8-13.3], P=0.002), with a prevalence of 40% (17/42) in females versus 10% (8/79) in males. The likelihood of knee pain increased with age by approximately 13% per year (odds ratio=1.13, [95% confidence interval, 1.00-1.28], P=0.058). Malignant malalignment syndrome showed a potential relationship to more severe knee pain (P=0.05), which warrants further investigation. Body mass index, pes valgus, and degree of stance knee flexion showed no statistically significant relationships to knee pain (P>0.16). The prevalence of knee pain in ambulatory patients with CP is approximately 21%. Patellar subluxation (2%) and dislocation are rare in these patients. Knee pain is not always related to crouch, femoral anteversion, external

  12. Gender difference in outcome after total knee replacement.

    Science.gov (United States)

    Lim, Jason Beng Teck; Chi, Chong Hwei; Lo, Lup Ean; Lo, Woon Theng; Chia, Shi-Lu; Yeo, Seng Jin; Chin, Pak Lin; Tay, Keng Jin Darren; Lo, Ngai Nung

    2015-08-01

    To compare the outcome after primary total knee replacement (TKR) for end-stage knee osteoarthritis (OA) in men versus women. Records of 214 men and 1040 women who underwent primary TKR for end-stage knee OA and were followed up for a minimum of 2 years were reviewed. Knee flexion, Oxford Knee Score, Knee Society Score (KSS), and 8 subscores of Short Form 36 (SF-36) were recorded preoperatively and at postoperative 6 months and 2 years. Men and women were comparable only in age (67.9 vs. 67.3 years, p=0.244); men had a lower mean body mass index (27.0 vs. 28.3 kg/m(2), p<0.001). Preoperatively, men had better knee flexion (117º vs. 114.8º, p=0.05), Oxford Knee Score (33.5 vs. 36.8, p<0.001), KSS knee score (44.3 vs. 40.3, p=0.001), KSS function score (52.5 vs. 47.1, p<0.001), and all 8 subscores of SF-36 (p=0.005 to p<0.001). Compared with men, women achieved greater improvement at 6 months in Oxford Knee score (13.2 vs. 15.1, p=0.009) and KSS knee score (36.9 vs. 41.6, p=0.016), and at 2 years in Oxford Knee Score (15.0 vs. 17.9, p<0.001), KSS knee score (39.8 vs. 43.9, p=0.009), and SF-36 subscores of social functioning (23.6 vs. 35.1, p<0.001) and mental health (3.9 vs. 8.2, p=0.003). Compared with men, women had poorer preoperative knee flexion, Oxford Knee Score, KSS, and 8 subscores of SF-36, but achieved greater improvement in the Oxford Knee Score and KSS knee score at 6 months and 2 years, as well as in SF-36 subscores of social functioning and mental health at 2 years.

  13. Risk Factors for Knee Injury in Golf: A Systematic Review.

    Science.gov (United States)

    Baker, Matthew L; Epari, Devakar R; Lorenzetti, Silvio; Sayers, Mark; Boutellier, Urs; Taylor, William R

    2017-12-01

    Golf is commonly considered a low-impact sport that carries little risk of injury to the knee and is generally allowed following total knee arthroplasty (TKA). Kinematic and kinetic studies of the golf swing have reported results relevant to the knee, but consensus as to the loads experienced during a swing and how the biomechanics of an individual's technique may expose the knee to risk of injury is lacking. Our objective was to establish (1) the prevalence of knee injury resulting from participation in golf and (2) the risk factors for knee injury from a biomechanical perspective, based on an improved understanding of the internal loading conditions and kinematics that occur in the knee from the time of addressing the ball to the end of the follow-through. A systematic literature search was conducted to determine the injury rate, kinematic patterns, loading, and muscle activity of the knee during golf. A knee injury prevalence of 3-18% was established among both professional and amateur players, with no clear dependence on skill level or sex; however, older players appear at greater risk of injury. Studies reporting kinematics indicate that the lead knee is exposed to a complex series of motions involving rapid extension and large magnitudes of tibial internal rotation, conditions that may pose risks to the structures of a natural knee or TKA. To date, the loads experienced by the lead knee during a golf swing have been reported inconsistently in the literature. Compressive loads ranging from 100 to 440% bodyweight have been calculated and measured using methods including inverse dynamics analysis and instrumented knee implants. Additionally, the magnitude of loading appears to be independent of the club used. This review is the first to highlight the lack of consensus regarding knee loading during the golf swing and the associated risks of injury. Results from the literature suggest the lead knee is subject to a higher magnitude of stress and more demanding

  14. Mechanical contributors to sex differences in idiopathic knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Nicolella Daniel P

    2012-12-01

    Full Text Available Abstract The occurrence of knee osteoarthritis (OA increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and obesity on sex differences in knee OA. Observational data suggest that limb alignment can predict the development of radiographic signs of knee OA, potentially due to increased stresses and strains within the joint. However, these data do not indicate how limb alignment could contribute to sex differences in either the development or worsening of knee OA. Similarly, the strength of the knee extensor muscles is compromised in women who develop radiographic and symptomatic signs of knee OA, but the extent to which the decline in muscle function precedes the development of the disease is uncertain. Even less is known about how changes in muscle function might contribute to the worsening of knee OA. Conversely, obesity is a stronger predictor of developing knee OA symptoms in women than in men. The influence of obesity on developing knee OA symptoms is not associated with deviation in limb alignment, but BMI predicts the worsening of the symptoms only in individuals with neutral and valgus (knock-kneed knees. It is more likely, however, that obesity modulates OA through a combination of systemic effects, particularly an increase in inflammatory cytokines, and mechanical factors within the joint. The absence of strong associations of these surrogate measures of the mechanical environment in the knee joint with sex

  15. An inverse kinematics model for post-operative knee. Ligament parameters estimation from knee motion.

    Science.gov (United States)

    Chen, Elvis C S; Ellis, Randy E

    2006-01-01

    A motion-based Inverse Kinematics Knee (IKK) model was developed for Total Knee Replacement (TKR) joints. By tracking a sequence of passive knee motion, the IKK model estimated ligament properties such as insertion locations. The formulation of the IKK model embedded a Forward Kinematics Knee (FKK) model in a numerical optimization algorithm known as the Unscented Kalman Filter. Simulation results performed on a semi-constrained TKR design suggested that ligament insertions could be accurately estimated in the medial-lateral (ML) and the proximal-distal (PD) directions, but less reliably in the anterior-posterior (AP) direction for the tibial component. However, the forward kinematics produced by both the true and estimated ligament properties were nearly identical, suggesting that the IKK model recovered a kinematically equivalent set of ligament properties. These results imply that it may not be necessary to use a patient-specific CT or MRI scan to locate ligaments, which considerably widens potential applications of kinematic-based total knee replacement.

  16. Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial.

    Science.gov (United States)

    van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; Emans, P J; Mastbergen, S C; Lafeber, F P J G

    2017-01-01

    Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two. The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness. In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003). In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD. Cite this article: Bone Joint J 2017;99-B:51-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

  17. 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

    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 unkn......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...

  18. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs.

    Science.gov (United States)

    Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Mizusaki Imoto, Aline; Toupin-April, Karine; Westby, Marie; Álvarez Gallardo, Inmaculada C; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

    2017-05-01

    To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

  19. Total knee arthroplasty in patients with a previous patellectomy.

    Science.gov (United States)

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.

  20. 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...

  1. Total knee arthroplasty with asymmetric femoral condyles and tibial tray.

    Science.gov (United States)

    Crockarell, John R; Hicks, John M; Schroeder, R Jason; Guyton, James L; Harkess, James W; Lavelle, David G

    2010-01-01

    Total knee arthroplasties with an asymmetric tibial tray and posterior femoral condyles were implanted in 224 knees. Follow-up averaged 6.3 years. All components were cemented, all patellae were resurfaced, and all femoral components were cruciate-substituting. Postoperative alignment averaged 3.3 degrees valgus. Radiolucencies were absent around 116 knees (66%). No components were radiographically loose. Knee Society scores averaged 85 postoperatively and modified Western Ontario and McMaster Universities Index scores averaged 82. Postoperative flexion averaged 114 degrees. Ten knees required manipulation for arthrofibrosis. Lateral release was necessary in 62 knees (28%). No revisions were required for aseptic loosening. Survivorship free of additional surgical procedures was 97% at 5 years. Compared with other series by designing surgeons, similar excellent survivorship was seen but with a higher lateral release rate. 2010 Elsevier Inc. All rights reserved.

  2. The anterolateral complex of the knee: a pictorial essay.

    Science.gov (United States)

    Herbst, Elmar; Albers, Marcio; Burnham, Jeremy M; Shaikh, Humza S; Naendrup, Jan-Hendrik; Fu, Freddie H; Musahl, Volker

    2017-04-01

    Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.

  3. The Great Mimic Again? A Case of Tuberculosis Knee

    Directory of Open Access Journals (Sweden)

    Teo SH

    2011-11-01

    Full Text Available Tuberculosis (TB, once a disease confined to undeveloped or developing nations is currently in resurgence due to pandemic human immunodeficiency virus infection and immigration from endemic areas. TB is also known as the ‘great mimicker’. Extra-pulmonary tuberculosis affecting the knee is rare in all forms of TB (0.1-0.3%. Here, we report a case of isolated highly erosive TB knee in a previously fit Burmese migrant worker. He presented with after a history of fall into a drain. The patient also reported pain and swelling over his left knee for the previous three years. He had been treated for a bacterial infection of the knee in another hospital but defaulted due to financial constraints. Arthrotomy of the knee was performed including washout. Diagnosis of TB of the knee was made based on the synovial fluid and tissue culture. Treatment with anti- tuberculosis drugs was then initiated.

  4. MR imaging of the posterolateral aspect of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Hideho; Wada, Mitsuyoshi; Yoshizako, Takeshi [Tsukuba Medical Center Hospital, Ibaraki (Japan); Niitsu, Mamoru; Itai, Yuji

    1999-11-01

    The structures of the posterolateral aspect of the knee were evaluated with axial MR images. One hundred twelve knees of clinical cases without posterolateral injury were retrospectively reviewed, and 30 knees of 15 volunteers with no history of knee injury or pain were evaluated. The amount of joint effusion and visualization of the lateral collateral ligament (LCL) and popliteal tendon were classified according to three grades. The LCL and popliteal tendon were identified in 111 clinical cases (99%) and 28 volunteer knees (93%). Visualization of the LCL and popliteal tendon was facilitated in the presence of both joint effusion and fluid collection between the LCL and popliteal tendon. Fluid collection posterior to the femoral attachment of the popliteal tendon was seen in 79 clinical cases (71%) and 20 volunteer knees (67%). Based on cadaveric study, this was considered to be a potential fluid space for communication to the joint space. (author)

  5. Anterior cruciate ligament reconstruction and knee osteoarthritis.

    Science.gov (United States)

    Paschos, Nikolaos K

    2017-03-18

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not.

  6. Inherited knee disorders in the Medici family.

    Science.gov (United States)

    Lippi, Donatella; Matucci-Cerinic, Marco; Alburyc, W R; Weisz, George M

    2014-01-01

    Reconstructing a medical condition which was existent centuries ago is limited by the lack of contemporaneous evidence-based descriptions in the accounts given by physicians and other observers. Despite these limitations modern paleopathological evidence, supplemented by techniques of historical investigation, have led to the conclusion that males in the Medici family typically suffered from a complex clinical entity with a triple pathology of stenotic spinal ankylosis, recurrent peripheral joint disease and erythematous skin disease; the Medici Syndrome. Examination of the knee joint is illustrative of recurrent joint disease both in the primary and secondary lines of the family. Pictorial and sculptural representations, if used cautiously, can assist in this retrospective process. The six cases presented here illustrate the involvement of the knee joint where the joint destruction ultimately led to an ankylosis. Copyright © 2013. Published by Elsevier B.V.

  7. OCCUPATIONAL RISK FACTORS IN KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Muralidhara

    2015-12-01

    Full Text Available INTRODUCTION Osteoarthritis (OA, also often called “osteoarthrosis” or “degenerative joint disease” is the most common form of arthritis. MATERIALS AND METHODS Present retrospective statistical study was conducted at the Department of orthopaedics in a tertiary care hospital (Catering to a largely agricultural population over a period of 2 years from January 2012 to December 2014. RESULTS Prevalence of osteoarthritis common in farmers accounting to 70%. Other occupations at risk of OA of knee were, Teachers 12%, Housewives 08%, Athletes 04%, Policemen 04% and Drivers 02%. It is in conformity with most previous studies reviewed. CONCLUSION Osteoarthritis of Knee is a major health issue and important cause of disability in elderly population. Occupational risk factors are important in development of osteoarthritis.

  8. Bilateral pigmented villonodular synovitis of the knee

    Directory of Open Access Journals (Sweden)

    Samir H. Shah

    2015-12-01

    Full Text Available Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation.

  9. Below-knee amputee running gait.

    Science.gov (United States)

    Enoka, R M; Miller, D I; Burgess, E M

    1982-04-01

    The running ability of ten unilateral below-knee amputees was examined by analyzing the temporal and length characteristics of their running strides and the angular displacement patterns of their intact and prosthetic limbs. Six of the individuals tested were able to run and in several cases their locomotor patterns were similar to those of non-amputees. The running gait of three of the amputee runners, however, did contain one particular undesirable element namely an excessively straight residual knee during at least a portion of support on the prosthesis. Although several explanations could be postulated to account for this tendency, we believe that it could be eliminated with training and possible prosthetic modification. Results of the study, while attesting to the fact that many lower extremity amputees can run, also suggested directions in which research efforts can and are being focused to facilitate their running performance.

  10. Using auriculotherapy for osteoarthritic knee among elders: a double-blinded randomised feasibility study

    National Research Council Canada - National Science Library

    Suen, Lorna K P; Yeh, Chao Hsing; Yeung, Simon K W

    2016-01-01

    Osteoarthritic knee (OA knee) is a common condition in the elderly. Exploration of non-invasive complementary therapies for OA knee is warranted given the limitations of pharmacologic therapies. Auriculotherapy...

  11. Mathematical modeling of the human knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Ricafort, Juliet [Univ. of Southern California, Los Angeles, CA (United States). Dept. of Biomedical Engineering

    1996-05-01

    A model was developed to determine the forces exerted by several flexor and extensor muscles of the human knee under static conditions. The following muscles were studied: the gastrocnemius, biceps femoris, semitendinosus, semimembranosus, and the set of quadricep muscles. The tibia and fibula were each modeled as rigid bodies; muscles were modeled by their functional lines of action in space. Assumptions based on previous data were used to resolve the indeterminacy.

  12. Dynamic control of knee axial deformities

    OpenAIRE

    E. E. Malyshev; Pavlov, D. V.; S. V. Blinov

    2013-01-01

    The authors have evaluated the clinical examination of the patients with axial malalignments in the knee by the original method and device which was named varovalgometer. The measurements were conducted by tension of the cord through the spina iliaca anterior superior and the middle of the lower pole of patella. The deviation of the center of the ankle estimated by metal ruler which was positioned perpendicular to the lower leg axis on the level of the ankle joint line. The results of compari...

  13. Clearing a blind spot in knee arthroscopy: popliteal bursa.

    Science.gov (United States)

    Ahn, Jin-Hwan; Lee, Dong-Hoon; Lee, Yong-Seuk; Wang, Joon-Ho; Ha, Hae-Chan

    2008-06-01

    Each arthroscopic portal to the knee has a blind area that cannot be inspected directly. In particular, visualization of the posterior compartment is difficult to access. Although arthroscopic procedures for the posterior compartment of the knee joint have been developed through posteromedial, posterolateral and posterior trans-septal portal, the popliteal bursa remains as an area that is difficult to access and manipulate. We report a surgical procedure that can examine one of the blind spots in knee arthroscopy, popliteal bursa.

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

    OpenAIRE

    van den Ende, Els

    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. Inclusion criteria were symptoms of knee osteoarthritis as defined by the American College of Rheumatology. Exclusion criteria included allergy to tape, or history of joint replacement, symptoms or sig...

  15. Lifestyle and biomechanical determinants of knee joint structure and symptoms

    OpenAIRE

    Teichtahl, Andrew

    2017-01-01

    Osteoarthritis (OA) is the most common form of arthritis and commonly affects weight-bearing joints, such as the knee. With the growing obesity endemic and aging population, the prevalence of knee OA will increase over the coming decades. Since the advent of Magnetic resonance imaging (MRI), OA is now considered a whole-organ disease, affecting multiple articular structures. No cure exists for knee OA and the only definitive management is joint replacement surgery, indicated for painful end-s...

  16. Factors Related to Standing Balance in Patients With Knee Osteoarthritis

    OpenAIRE

    Park, Hye Jeong; Ko, Saebyuk; Hong, Hyeon Mi; Ok, Eunjae; Lee, Jong In

    2013-01-01

    Objective To assess factors related to standing balance in patients with knee osteoarthritis (OA). Methods In total, 37 female patients with painful knee OA were included. Pain, knee alignment, and Kellgren and Lawrence grade were evaluated accordingly. Static standing balance was measured with a force-platform system under two different conditions: static standing with eyes open (EO) and eyes closed (EC) for 30 seconds. The mean speed (mm/s) of movement of the center of pressure in the anter...

  17. Gender differences in gait kinematics for patients with knee osteoarthritis

    OpenAIRE

    Phinyomark, Angkoon; Sean T Osis; Blayne A Hettinga; Kobsar, Dylan; Ferber, Reed

    2016-01-01

    Background Females have a two-fold risk of developing knee osteoarthritis (OA) as compared to their male counterparts and atypical walking gait biomechanics are also considered a factor in the aetiology of knee OA. However, few studies have investigated sex-related differences in walking mechanics for patients with knee OA and of those, conflicting results have been reported. Therefore, this study was designed to examine the differences in gait kinematics (1) between male and female subjects ...

  18. Knee osteoarthritis in a chestnut farmer – Case Report

    OpenAIRE

    Stefano Mattioli; Francesca Graziosi; Stefania Curti; Roberta Bonfiglioli; Antonio Argentino; Francesco Saverio Violante

    2017-01-01

    Introduction Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA – also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature. Case report We report the case of a 70-year-old Caucasian male who h...

  19. Causes of knee joint injuries in professional women volleyball

    OpenAIRE

    Nejmanová, Aneta

    2012-01-01

    CAUSES OF KNEE JOINT INJURIES IN PROFESSIONAL WOMEN VOLLEYBALL OBJECTIVES: Objective of this thesis is to identify factors that may cause knee joint injuries and may be neglected in professional women volleyball. METHODS: Two methods of data collection were used: questionnaire with "open" and "closed" questions and semistructured interview. RESULTS: We have discovered more than one factor that we identified as a potential cause of injury of knee joint in every case - every volleyball player t...

  20. Changes in Knee Kinematics Reflect the Articular Geometry after Arthroplasty

    OpenAIRE

    Bull, AMJ; Kessler, O.; Alam, M; Amis, AA

    2008-01-01

    We hypothesized changes in rotations and translations after TKA with a fixed-bearing anterior cruciate ligament (ACL)-sacrificing but posterior cruciate ligament (PCL)-retaining design with equal-sized, circular femoral condyles would reflect the changes of articular geometry. Using 8 cadaveric knees, we compared the kinematics of normal knees and TKA in a standardized navigated position with defined loads. The quadriceps was tensed and moments and drawer forces applied during knee flexion-ex...

  1. Knee Injuries in American Football: An Epidemiological Review.

    Science.gov (United States)

    Rothenberg, Paul; Grau, Luis; Kaplan, Lee; Baraga, Michael G

    Football has the highest injury rate amongst popular American sports. Of those injuries that end seasons or careers, the knee is the most common culprit. This is of particular concern because knee injuries are most common in football. This article reviews 4 of the most common knee injuries in American football, with emphasis on epidemiology, risk factors, and treatment outcomes. The injuries reviewed are tears of the anterior cruciate ligament, medial collateral ligament, medial patellofemoral ligament, and posterior cruciate ligament.

  2. Unusual lesions that distend the knee joint: pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Luana T. Barros de, E-mail: luanatbl@hotmail.com [Universidade Federal de Alagoas (HUPAA/UFAL), Maceio (Brazil). Hospital Universitario; Albuquerque Filho, Eolo Santana de; Batista, Laecio Leitao [Universidade Federal de Pernambuco (UFPE), Recife (Brazil). Hospital das Clinicas; Moraes, Talita Peixoto de [Clinica Derbimagem, Recife, PE (Brazil); Pereira, Bruno Perez Guedes [Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE (Brazil)

    2016-09-15

    The high number of knee imaging exams at radiology clinics, together with the wide variety of knee disorders, calls for expanding the knowledge about the less common lesions seen in routine diagnostic practice. The purpose of this pictorial essay was to illustrate unusual lesions that distend the knee joint, selected by relevance and evaluated with multiple imaging modalities, including X-ray, computed tomography, and magnetic resonance imaging, as well as to perform a brief review of the literature. (author)

  3. Prevention and Therapy of the knee injuries in Football

    OpenAIRE

    BENEŠOVÁ, Michaela

    2010-01-01

    My Bachelor Thesis deals with the problem of knee-joint injuries. The chosen theme ``Prevention and Therapy of the knee injuries in Football{\\crqq} introduces a large variety of possible injuries. The Thesis includes an analysis of the complicated anatomical structure and biomechanics of the knee. The part devoted to injuries describes the injury mechanism that gives the ground for the following examination, diagnosis determination and proposal of the subsequent therapy. Another important cha...

  4. Unusual lesions that distend the knee joint: pictorial essay.

    Science.gov (United States)

    de Lima, Luana T Barros; de Albuquerque Filho, Eolo Santana; Batista, Laecio Leitão; de Moraes, Talita Peixoto; Pereira, Bruno Perez Guedes

    2016-01-01

    The high number of knee imaging exams at radiology clinics, together with the wide variety of knee disorders, calls for expanding the knowledge about the less common lesions seen in routine diagnostic practice. The purpose of this pictorial essay was to illustrate unusual lesions that distend the knee joint, selected by relevance and evaluated with multiple imaging modalities, including X-ray, computed tomography, and magnetic resonance imaging, as well as to perform a brief review of the literature.

  5. Use of Van Nes rotationplasty to manage a burnt knee.

    Science.gov (United States)

    Khatri, B; Richard, B

    2000-02-01

    An 11 month old child sustained a deep burn injury to the left knee causing total destruction and sequestration of the knee epiphyses. The ensuing leg length discrepancy with growth was managed by a Van Nes rotationplasty at age four with a good immediate functional result using a below 'knee' prosthesis and the prospect of continuing ambulation as he grows. The surgical options for managing this problem are discussed.

  6. Translation and cross-cultural adaptation of the international knee documentation committee subjective knee form into Turkish.

    Science.gov (United States)

    Çelik, Derya; Coşkunsu, Dilber; KiliÇoğlu, Önder; Ergönül, Önder; Irrgang, James J

    2014-11-01

    Clinical measurement. To translate and culturally adapt the International Knee Documentation Committee (IKDC) Subjective Knee Form into Turkish and to determine selected psychometric properties of the translated version. The IKDC Subjective Knee Form is widely used to evaluate disability associated with knee injuries, but it has not yet been translated or culturally adapted for Turkish-speaking individuals. The IKDC Subjective Knee Form was translated into Turkish, consistent with published methodological guidelines. The process included 2 forward translations, followed by the synthesis of these translations, and 2 backward translations, followed by an analysis of the translations and creation of the final version. The measurement properties of the Turkish IKDC Subjective Knee Form (internal consistency, construct validity, and floor and ceiling effects) were tested in 103 patients (52 male; average ± SD age, 34.9 ± 11.9 years) with a variety of knee pathologies. Reproducibility was tested in 58 patients (28 male; age, 33.7 ± 10.6 years) over 3 to 14 days, and responsiveness was tested in 33 patients (23 male; age, 30.8 ± 8.0 years) with anterior cruciate ligament reconstruction. Cronbach alpha was used to assess internal consistency, and intraclass correlation coefficients were used to estimate the test-retest reliability. Construct validity was analyzed with the Turkish version of the Lysholm knee score, the Kujala Anterior Knee Pain Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. The Turkish version of the IKDC Subjective Knee Form showed excellent internal consistency (Cronbach coefficient α = .89) and test-retest reliability (intraclass correlation coefficient = 0.91). The correlation coefficients between the IKDC Subjective Knee Form and the Lysholm knee score and Kujala Anterior Knee Pain Scale were 0.64 and 0.89, respectively (P<.001). The highest correlations between the IKDC Subjective Knee Form and the Medical Outcomes Study

  7. Periprosthetic fractures around total knee arthroplasty

    Science.gov (United States)

    Sarmah, SS; Patel, S; Reading, G; El-Husseiny, M; Douglas, S; Haddad, FS

    2012-01-01

    INTRODUCTION The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. PMID:22943223

  8. Lymphatic vessels in osteoarthritic human knees.

    Science.gov (United States)

    Walsh, D A; Verghese, P; Cook, G J; McWilliams, D F; Mapp, P I; Ashraf, S; Wilson, D

    2012-05-01

    The distribution and function of lymphatic vessels in normal and diseased human knees are understood incompletely. This study aimed to investigate whether lymphatic density is associated with clinical, histological or radiographic parameters in osteoarthritis (OA). Sections of synovium from 60 knees from patients with OA were compared with 60 post mortem control knees (from 37 individuals). Lymphatic vessels were identified using immunohistochemistry for podoplanin, and quantified as lymphatic vessel density (LVD) and lymphatic endothelial cell (LEC) fractional area. Effusion status was determined by clinical examination, radiographs were scored for OA changes, and inflammation grading used haematoxylin and eosin stained sections of synovium. Lymphatic vessels were present in synovia from both disease groups, but were not identified in subchondral bone. Synovial lymphatic densities were independent of radiological severity and age. Synovia from patients with OA displayed lower LVD (z=-3.4, P=0.001) and lower LEC fractional areas (z=-4.5, Plymphatics and OA/effusion appeared to be independent of other measured confounders. Lymphatic vessels are present in lower densities in OA synovia. Abnormalities of synovial fluid drainage may confound the value of effusion as a clinical sign of synovitis in OA. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Shifting bone marrow edema of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Moosikasuwan, Josh B.; Schultz, Elizabeth [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, NY 11021, Great Neck (United States); Math, Kevin [Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, NY 10003, New York (United States)

    2004-07-01

    The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis. (orig.)

  10. [SECOT consensus on painful knee replacement].

    Science.gov (United States)

    Vaquero, J; Macule, F; Bello, S; Chana, F; Forriol, F

    2013-01-01

    The opinions of 21 experts in knee surgery were evaluated in this study, using a DELPHI questionnaire method in two successive rounds, on 64 controversial scenarios that covered both the diagnosis and possible treatment of painful knee replacements. The level of consensus was significantly unanimous in 42 items and of the design in 5, with no agreement in 17 of the questions presented. light of the published scientific evidence, the surgeons who took part showed to have a notable level of information on the most effective diagnostic tests, although, it should be pointed out that there was a lack of confidence in the possibility of ruling out an infection when the erythrocyte sedimentation rate and the C-reactive protein were within normal values, which have been demonstrated in the literature to have a high negative predictive value As regards the treatments to employ in the different situations, the responses of the expert panel were mainly in agreement with the data in the literature. The conclusions of this consensus may help other surgeons when they are faced with a painful knee prosthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  11. Mechanisms Undlerlying Quadriceps Weakness in Knee Osteoarthritis

    Science.gov (United States)

    PETTERSON, STEPHANIE C.; BARRANCE, PETER; BUCHANAN, THOMAS; BINDER-MACLEOD, STUART; SNYDER-MACKLER, LYNN

    2013-01-01

    Purpose To identify determinants of quadriceps weakness among persons with end-stage knee osteoarthritis (OA). Methods One-hundred twenty-three individuals (mean age 64.9 ± 8.5 yr) with Kellgren/Lawrence grade IV knee OA participated. Quadriceps strength (MVIC) and volitional muscle activation (CAR) were measured using a burst superimposition test. Muscle composition (lean muscle cross-sectional area (LMCSA) and fat CSA (FCSA)) were quantified using magnetic resonance imaging. Specific strength (MVIC/LMCSA) was computed. Interlimb differences were analyzed using paired-sample t-tests. Regression analysis was applied to identify determinants of MVIC. An alpha level of 0.05 was adopted. Results The OA limb was significantly weaker, had lower CAR, and had smaller LMCSA than the contralateral limb. CAR explained 17% of the variance in the contralateral limb's MVIC compared with 40% in the OA limb. LMCSA explained 41% of the variance in the contralateral limb's MVIC compared with 27% in the OA limb. Conclusion Both reduced CAR and LMCSA contribute to muscle weakness in persons with knee OA. Similar to healthy elders, the best predictor of strength in the contralateral, nondiseased limb was largely determined by LMCSA, whereas CAR was found to be the primary determinant of strength in the OA limb. Deficits in CAR may undermine the effectiveness of volitional strengthening programs in targeting quadriceps weakness in the OA population. PMID:18379202

  12. Balance control and knee osteoarthritis severity.

    Science.gov (United States)

    Kim, Hee-Sang; Yun, Dong Hwan; Yoo, Seung Don; Kim, Dong Hwan; Jeong, Yong Seol; Yun, Jee-Sang; Hwang, Dae Gyu; Jung, Pil Kyo; Choi, Seong He

    2011-10-01

    To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax®). A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax®, which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax®. Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups. These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.

  13. Dynamic control of knee axial deformities

    Directory of Open Access Journals (Sweden)

    E. E. Malyshev

    2013-01-01

    Full Text Available The authors have evaluated the clinical examination of the patients with axial malalignments in the knee by the original method and device which was named varovalgometer. The measurements were conducted by tension of the cord through the spina iliaca anterior superior and the middle of the lower pole of patella. The deviation of the center of the ankle estimated by metal ruler which was positioned perpendicular to the lower leg axis on the level of the ankle joint line. The results of comparison of our method and computer navigation in 53 patients during the TKA show no statistically significant varieties but they differ by average 5° of valgus in clinical examination in comparison with mechanical axis which was identified by computer navigation. The dynamic control of axial malalignment can be used in clinical practice for estimation of the results of treatment of pathology with axial deformities in the knee; for the control of reduction and secondary displacement of the fractures around the knee; for assessment of instability; in planning of correctional osteotomies and intraoperative control of deformity correction; for estimation of Q angle in subluxation and recurrent dislocation of patella; in planning of TKA; during the growth of child it allows to assess the progression of deformity.

  14. Topical Treatment of Degenerative Knee Osteoarthritis.

    Science.gov (United States)

    Meng, Zengdong; Huang, Rongzhong

    2018-01-01

    This article reviews topical management strategies for degenerative osteoarthritis (OA) of the knee. A search of Pubmed, Embase and the Cochrane library using MeSH terms including "topical," "treatment," "knee" and "osteoarthritis" was carried out. Original research and review articles on the effectiveness and safety, recommendations from international published guidelines and acceptability studies of topical preparations were included. Current topical treatments included for the management of knee OA include topical nonsteroidal anti-inflammatory drugs, capsaicin, salicylates and physical treatments such as hot or cold therapy. Current treatment guidelines recommend topical nonsteroidal anti-inflammatory drugs as an alternative and even first-line therapy for OA management, especially among elderly patients. Guidelines on other topical treatments vary, from recommendations against their use, to in favor as alternative or simultaneous therapy, especially for patients with contraindications to other analgesics. Although often well-tolerated and preferred by many patients, clinical care still lags in the adoption of topical treatments. Aspects of efficacy, safety and patient quality of life data require further research. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  15. Management of knee osteoarthritis with cupping therapy

    Directory of Open Access Journals (Sweden)

    Asim Ali Khan

    2013-01-01

    Full Text Available The study aimed to evaluate the effect of cupping therapy at a clinical setting for knee osteoarthritis. A randomized, controlled clinical trial was conducted. Cupping was performed on 0-6 th day; 9-11 th day and 14 th day, i.e., 11 sittings follow-up to determine longer term carryover of treatment effects utilizing both objective and subjective assessment. The assessment was performed before and after treatment spreading over a period of 15 days. The results of this study shows significant and better results in the overall management of knee osteoarthritis, particularly in relieving pain, edema, stiffness and disability. The efficacy of treatment with cupping therapy in relieving signs and symptoms of knee osteoarthritis is comparable to that of acetaminophen 650 mg thrice a day orally, in terms of analgesia, anti-inflammatory and resolution of edema with minimal and temporary side-effects like echymosis and blister formation while as control drug has greater side-effects particularly on upper gastrointestinal tract. It is recommended that further studies are conducted with a larger study samples and of longer duration.

  16. Mechanisms underlying quadriceps weakness in knee osteoarthritis.

    Science.gov (United States)

    Petterson, Stephanie C; Barrance, Peter; Buchanan, Thomas; Binder-Macleod, Stuart; Snyder-Mackler, Lynn

    2008-03-01

    To identify determinants of quadriceps weakness among persons with end-stage knee osteoarthritis (OA). One-hundred twenty-three individuals (mean age 64.9 +/- 8.5 yr) with Kellgren/Lawrence grade IV knee OA participated. Quadriceps strength (MVIC) and volitional muscle activation (CAR) were measured using a burst superimposition test. Muscle composition (lean muscle cross-sectional area (LMCSA) and fat CSA (FCSA)) were quantified using magnetic resonance imaging. Specific strength (MVIC/LMCSA) was computed. Interlimb differences were analyzed using paired-sample t-tests. Regression analysis was applied to identify determinants of MVIC. An alpha level of 0.05 was adopted. The OA limb was significantly weaker, had lower CAR, and had smaller LMCSA than the contralateral limb. CAR explained 17% of the variance in the contralateral limb's MVIC compared with 40% in the OA limb. LMCSA explained 41% of the variance in the contralateral limb's MVIC compared with 27% in the OA limb. Both reduced CAR and LMCSA contribute to muscle weakness in persons with knee OA. Similar to healthy elders, the best predictor of strength in the contralateral, nondiseased limb was largely determined by LMCSA, whereas CAR was found to be the primary determinant of strength in the OA limb. Deficits in CAR may undermine the effectiveness of volitional strengthening programs in targeting quadriceps weakness in the OA population.

  17. Shifting bone marrow edema of the knee.

    Science.gov (United States)

    Moosikasuwan, Josh B; Miller, Theodore T; Math, Kevin; Schultz, Elizabeth

    2004-07-01

    The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis.

  18. Management of knee osteoarthritis with cupping therapy.

    Science.gov (United States)

    Khan, Asim Ali; Jahangir, Umar; Urooj, Shaista

    2013-10-01

    The study aimed to evaluate the effect of cupping therapy at a clinical setting for knee osteoarthritis. A randomized, controlled clinical trial was conducted. Cupping was performed on 0-6(th) day; 9-11(th) day and 14(th) day, i.e., 11 sittings follow-up to determine longer term carryover of treatment effects utilizing both objective and subjective assessment. The assessment was performed before and after treatment spreading over a period of 15 days. The results of this study shows significant and better results in the overall management of knee osteoarthritis, particularly in relieving pain, edema, stiffness and disability. The efficacy of treatment with cupping therapy in relieving signs and symptoms of knee osteoarthritis is comparable to that of acetaminophen 650 mg thrice a day orally, in terms of analgesia, anti-inflammatory and resolution of edema with minimal and temporary side-effects like echymosis and blister formation while as control drug has greater side-effects particularly on upper gastrointestinal tract. It is recommended that further studies are conducted with a larger study samples and of longer duration.

  19. Efficacy of Magnetotherapy in knee osteoarthritis.

    Directory of Open Access Journals (Sweden)

    José Alberto Rodríguez-Gallo

    2012-04-01

    Full Text Available Osteoarthritis is the most common of Artropathies, highly heterogeneous in their causes and clinical evolution which have a negative economical impact in terms of productivity in the presence of the problematic situation. An almost experimental prospective and longitudinal study was carried out with the objective of evaluating the efficacy of treatment with magnetic field in patients suffering from knee osteoarthritis in Rehabilitation Provincial Hospital Dr. Faustino Pérez Hernández in Sancti Spíritus. The universe is constituted by 126 patients who have knee osteoarthritis diagnosed from clinical and X-ray view by Rheumatology Services, so as orthopedics and Internal Medicine Services who attended the Rehabilitation Provincial Hospital. In order to work with statistical analysis, several variables were used such as: Wilcoxon Signed Ranks Test (to determine the statistical differences using statistical significance levels (p=0.05. That’s why, as a conclusion knee Magneto therapy treatment is effective and better up the functional capacity and relief of pain.

  20. Reach/frequency for printed media: Personal probabilities or models

    DEFF Research Database (Denmark)

    Mortensen, Peter Stendahl

    2000-01-01

    that, in order to prevent bias, ratings per group must be used as reading probabilities. Nevertheless, in most cases, the estimates are still biased compared with panel data, thus overestimating net ´reach. Models with the same assumptions as with assignments of reading probabilities are presented......The author evaluates two different ways of estimating reach and frequency of plans for printed media. The first assigns reading probabilities to groups of respondents and calculates reach and frequency by simulation. the second estimates parameters to a model for reach/frequency. It is concluded...