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Razu, Swithin, Keiichi Kuroki, James Cook, and Trent Guess. "Function of the Anterior Intermeniscal Ligament." Journal of Knee Surgery 31, no. 01 (March 29, 2017): 068–74. http://dx.doi.org/10.1055/s-0037-1600089.
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AbstractThe function and importance of the anterior intermeniscal ligament (AIML) of the knee are not fully known. The purpose of this study was to evaluate the biomechanical and sensorimotor function of the AIML. Computational analysis was used to assess AIML and tibiomeniscofemoral biomechanics under combined translational and rotational loading applied during dynamic knee flexion–extension. Histologic and immunohistochemical examination was used to identify and characterize neural elements in the tissue. The computational models were created from anatomy and passive motion of two female subjects and histologic examinations were conducted on AIMLs retrieved from 10 fresh-frozen cadaveric knees. It was found that AIML strain increased with compressive knee loading and that external rotation of the tibia unloads the AIML, suppressing the relationship between AIML strain and compressive knee loads. Extensive neural elements were located throughout the AIML tissue and these elements were distributed across the three AIML anatomical types. The AIMLs have a beneficial influence on knee biomechanics with decreased meniscal load sharing with AIML loss. The AIML plays a significant biomechanical and neurologic role in the sensorimotor functions of the knee. The major role for the AIML may primarily involve its neurologic function.
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Wilding, Christopher P., Martyn Snow, and Lee Jeys. "Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901988551. http://dx.doi.org/10.1177/2309499019885510.
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Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
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&NA;. "Knee Function???Rasmussen." Journal of Orthopaedic Trauma 20, Supplement (September 2006): S88. http://dx.doi.org/10.1097/00005131-200609001-00017.
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Andrysek, Jan, Susan Klejman, Ricardo Torres-Moreno, Winfried Heim, Bryan Steinnagel, and Shane Glasford. "Mobility function of a prosthetic knee joint with an automatic stance phase lock." Prosthetics and Orthotics International 35, no. 2 (June 2011): 163–70. http://dx.doi.org/10.1177/0309364611408495.
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Background: There is a need for a prosthetic knee joint design that is technologically and functionally appropriate for use in developing countries.Objectives: To develop and clinically evaluate a new type of stance phase controlled prosthetic knee joint that provides stance phase stability without inhibiting swing phase flexion.Study design: A crossover repeated measures study design comparing the new knee joint to the participant's conventional low- or high-end prosthetic knee joint.Methods: The new knee joint was fitted to fourteen individuals aged 15 to 67 years with unilateral lower limb amputations. Walk tests were performed to measure walking speed. Energy expenditure was estimated using the physiological cost index (PCI).Results: Walking speeds with the new knee joint were on average 0.14 m/s faster than conventional low-end knees ( p < 0.0001), but 0.07 m/s slower than conventional high-end prosthetic knees ( p = 0.008). The PCI was similar across all three knee joint technologies ( p = 0.276).Conclusions: Mobility function with the new knee joint, in terms of walking speed, was more closely matched to high-end than low-end prosthetic knee joints. Therefore, given its relatively simple design, the new stance phase control mechanism may offer a functional and cost effective solution for active transfemoral amputees.Clinical relevance This paper describes a new type of prosthetic knee joint mechanism that is intended to be cost-effective while providing high-level stance phase function to active individuals with a transfemoral amputation. Initial clinical testing suggests that the new knee joint may have some functional advantages over existing technologies in this category.
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Matsumoto, Kazu, Hiroyasu Ogawa, Hiroki Yoshioka, and Haruhiko Akiyama. "Differences in patient-reported outcomes between medial opening-wedge high tibial osteotomy and total knee arthroplasty." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949901989563. http://dx.doi.org/10.1177/2309499019895636.
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Purpose: To compare patient subjective satisfaction between medial opening-wedge high tibial osteotomy (HTO) and total knee arthroplasty (TKA). Methods: This study enrolled 110 knees, including comprising 49 knees in the HTO group, and 61 knees in the TKA group. We assessed the overall satisfaction using a three-point questionnaire. The satisfaction questionnaire included three questions: (1) How satisfied are you with the results of your knee surgery? (2) How satisfied are you with your most recent knee surgery for reducing your pain? and (3) How satisfied are you with your most recent knee surgery for improving your ability to perform functions? Furthermore, we assessed knee pain and function by using the Knee Society Function Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) systems. Results: Overall, 93.8% of patients from the HTO group and 95.1% from the TKA group indicated subjective satisfaction (very satisfied and satisfied) with their surgeries. For pain relief, the HTO group showed significantly better outcomes for overall satisfaction ( p = 0.04 in walking on a flat surface and p = 0.02 in going upstairs or downstairs). For restored function, the HTO group scored significantly better on ascending stairs than the TKA group ( p = 0.007). Functional outcomes using the KSS scoring system did not show significant differences between the two groups. The KOOS pain score was significantly higher in the TKA group (89.9 ± 6.4) than in the HTO group (80.3 ± 12.5). Conclusion: HTO and TKA have comparable outcomes with respect to overall patient satisfaction. Level of evidence: Level III, therapeutic case series.
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Schumpe, G., M. Schuhmacher, K. Lehmacher, J. Oldenburg, P. Berdel, and A. Seuser. "Haemophilia and knee function." Hämostaseologie 29, S 01 (2009): S69—S73. http://dx.doi.org/10.1055/s-0037-1621612.
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SummaryWith early prophylactic treatment our haemophilic children grow up in good health. Nevertheless, we cannot prevent every bleeding. Those bleedings may be just subclinical but they could lead to overloading of the knee and more and more of the ankle joint in the long term. Motion analysis can help to understand this process and prevent it. A comparison of the gait function of haemophilic and healthy children of the age 3–18 years showed distinct functional differences especially in the youngest age group (3–6 years). Apparently, the coordination skill gait rhythm was significantly worse in the heamophilic group. All measured functional deficits can be treated with physiotherapy. Possible reasons for these early functional differences are overprotection and/or early subclinical bleedings.
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Chillakuru, Cherith Reddy, N. Jambu, and Akshay Deepak. "A comparison of the proprioception of osteoarthritic knees and post total knee arthroplasty." International Journal of Research in Orthopaedics 3, no. 4 (June 23, 2017): 781. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20172525.
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<p class="abstract"><strong>Background:</strong> Proprioception of the knee joint is an important factor for establishing balance, and smooth walking. The effect of arthroplasty on proprioception can be a determinant of post-operative function and subjective feeling of the arthroplasty. We wished to check the status of osteoarthritic knees and how their proprioceptive function is, in comparison to knees post total knee replacement.</p><p class="abstract"><strong>Methods:</strong> We compared 80 unilateral knee replacement patients with their osteoarthritic counterpart in the opposite knee. There was 50% Cruciate Retaining (n =40), Posterior Stabilized 50% (n =40). We assessed the proprioception using threshold to detection of passive motion and conscious awareness of passive joint position.<strong></strong></p><p class="abstract"><strong>Results:</strong> 73.8% (n =59) of patients experienced a better joint position sense, 21% (n =17) had decreased joint position sense and 5% (n =4) had the same, when compared to the contralateral osteoarthritic knee. The mean of threshold to detection of passive motion was 2.16+0.68 for the replaced knees versus 2.72±0.61 for the contralateral osteoarthritic knee.</p><p class="abstract"><strong>Conclusions:</strong> The proprioception of the knees that were replaced with arthroplasties had a better proprioceptive function then the osteoarthritic knees. This further solidifies the reasons to replace the dysfunctional osteoarthritic knee. </p>
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Noble, Philip C., Michael J. Gordon, Jennifer M. Weiss, Robert N. Reddix, Michael A. Conditt, and Kenneth B. Mathis. "Does Total Knee Replacement Restore Normal Knee Function?" Clinical Orthopaedics and Related Research &NA;, no. 431 (February 2005): 157–65. http://dx.doi.org/10.1097/01.blo.0000150130.03519.fb.
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Ammar, Ameni, Oussama Abcha, and Mohamed Samir Daghfous. "Iatrogenic injuries of the popliteus tendon during total knee arthroplasty." Orthopaedic Journal of Sports Medicine 9, no. 6_suppl2 (June 1, 2021): 2325967121S0018. http://dx.doi.org/10.1177/2325967121s00189.
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Introduction: The popliteus tendon is known to play a key role in the stability of the posterolateral corner of the knee. Its role in the stability of the replaced knee remains contentious. Objectives: The aim of this study was to determine the impact of an iatrogenic lesion of the popliteus tendon during total knee arthroplasty surgery on the stability and function of the knee Methods: We searched in the operating report registers, patients with complete iatrogenic injury of the popliteus tendon during total knee arthroplasty on genu-varum. We evaluated postoperative varus, mobility and stability and we calculated their International Knee Society scores Results: Among the 423 reports of total knee arthroplasties consulted in the operating report registers, we found seven patients with a complete iatrogenic injury of the popliteus tendon. All patients had preoperative extension deficit. All operated knees were stiff, tight and small. At postoperative follow-up, all the knees had good stability and function. All the patients were satisfied. Conclusion: we concluded that the isolated section of the popliteus tendon does not seem to modify the static stability of the knee. However, it can cause a decrease in long-term functional scores. More work is needed to increase understanding of the impact of this iatrogenic lesion on long-term function.
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Gill, Thomas J., Louis E. DeFrate, Conrad Wang, Christopher T. Carey, Shay Zayontz, Bertram Zarins, and Li Guoan. "The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function." American Journal of Sports Medicine 31, no. 4 (July 2003): 530–36. http://dx.doi.org/10.1177/03635465030310040901.
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Background The effectiveness of posterior cruciate ligament reconstruction in restoring normal kinematics under physiologic loading is unknown. Hypothesis Posterior cruciate ligament reconstruction does not restore normal knee kinematics under muscle loading. Study Design In vitro biomechanical study. Methods Kinematics of knees with an intact, resected, and reconstructed posterior cruciate ligament were measured by a robotic testing system under simulated muscle loads. Anteroposterior tibial translation and internal-external tibial rotation were measured at 0°, 30°, 60°, 90°, and 120° of flexion under posterior drawer loading, quadriceps muscle loading, and combined quadriceps and hamstring muscle loading. Results Reconstruction reduced the additional posterior tibial translation caused by ligament deficiency at all flexion angles tested under posterior drawer loading. Ligament deficiency increased external rotation and posterior translation at angles higher than 60° of flexion when simulated muscle loading was applied. Posterior cruciate ligament reconstruction reduced the posterior translation and external rotation observed in posterior cruciate ligament-deficient knees at higher flexion angles, but differences were not significant. Conclusion Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics. Clinical Relevance Abnormal knee kinematics may lead to development of long-term knee arthrosis.
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Kim, Hee-June, Jong-Uk Mun, Kwang-Hwan Kim, and Hee-Soo Kyung. "Total knee arthroplasty conversion for patients with ankylosed knees." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901668409. http://dx.doi.org/10.1177/2309499016684095.
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Introduction: The purpose of this study was to evaluate the results of total knee arthroplasty for patients with ankylosed knees. Methods: We evaluated seven patients (10 knees) who underwent total knee arthroplasties for ankylosed knees from 1995 to 2008. There were two men and five women, with a mean age of 44.1 years (42–48 years). The mean follow-up period was 10.2 years (1–19.5 years). A rectus snip was performed in all cases, and V-Y quadricepsplasty was used in one case of severe quadriceps contracture. In all cases, we used the PFC Sigma PS fixed model (DePuy Orthopaedics Inc., Warsaw, Indiana, USA). The goal was more than 90° of flexion. Clinical evaluation was performed using range of motion (ROM), Knee Society (KS) Knee Score, KS Function Score, and complications. Radiographs were used to evaluate loosening or osteolysis. Results: The ROF was improved from 9.5° (0–30°) to 78.5° (15–115°), The Knee Score improved from 42.6 (25–70) to 68.6 (41–97), and the Function Score improved from 39 (0–60) to 66 (40–90). A radiolucent line was detected in two cases (one patient) around the tibial component, and one case had a necrosis of skin edge. Only one case had no improvement of motion. Conclusion: Total knee arthroplasty conversion for patients with ankylosed knees can achieve good results for motion and function without osteotomy of the tibial tuberosity when there is good quality soft tissue of the thigh.
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Tomite, Takenori, Hidetomo Saito, Toshiaki Aizawa, Hiroaki Kijima, Naohisa Miyakoshi, and Yoichi Shimada. "Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer." Case Reports in Orthopedics 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/6875821.
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One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in thex-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning.
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Griffith, Chad J., Robert F. LaPrade, Steinar Johansen, Bryan Armitage, Coen Wijdicks, and Lars Engebretsen. "Medial Knee Injury: Part 1, Static Function of the Individual Components of the Main Medial Knee Structures." American Journal of Sports Medicine 37, no. 9 (July 16, 2009): 1762–70. http://dx.doi.org/10.1177/0363546509333852.
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Background There is a lack of knowledge on the primary and secondary static stabilizing functions of the posterior oblique ligament (POL), the proximal and distal divisions of the superficial medial collateral ligament (sMCL), and the meniscofemoral and meniscotibial portions of the deep medial collateral ligament (MCL). Hypothesis Identification of the primary and secondary stabilizing functions of the individual components of the main medial knee structures will provide increased knowledge of the medial knee ligamentous stability. Study Design Descriptive laboratory study. Methods Twenty-four cadaveric knees were equally divided into 3 groups with unique sequential sectioning sequences of the POL, sMCL (proximal and distal divisions), and deep MCL (meniscofemoral and meniscotibial portions). A 6 degree of freedom electromagnetic tracking system monitored motion after application of valgus loads (10 N·m) and internal and external rotation torques (5 N·m) at 0°, 20°, 30°, 60°, and 90° of knee flexion. Results The primary valgus stabilizer was the proximal division of the sMCL. The primary external rotation stabilizer was the distal division of the sMCL at 30° of knee flexion. The primary internal rotation stabilizers were the POL and the distal division of the sMCL at all tested knee flexion angles, the meniscofemoral portion of the deep MCL at 20°, 60°, and 90° of knee flexion, and the meniscotibial portion of the deep MCL at 0° and 30° of knee flexion. Conclusion An intricate relationship exists among the main medial knee structures and their individual components for static function to applied loads. Clinical Significance: Interpretation of clinical knee motion testing following medial knee injuries will improve with the information in this study. Significant increases in external rotation at 30° of knee flexion were found with all medial knee structures sectioned, which indicates that a positive dial test may be found not only for posterolateral knee injuries but also for medial knee injuries.
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Whittle, M. W. "Dynamic Assessment of Knee Joint Function." Engineering in Medicine 15, no. 2 (April 1986): 71–75. http://dx.doi.org/10.1243/emed_jour_1986_015_021_02.
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Clinical research into the pathology and treatment of knee disorders is greatly enhanced by the availability of objective data on knee function. A three-dimensional measurement system, using television cameras and force platforms interfaced to a computer, is used to make a combined kinetic and kinematic assessment of the knee. Information is provided on the standing knee alignment, the general gait parameters, and the knee angle and moment when walking, in both sagittal and coronal planes. An example is given of the use of these data in the assessment of unicompartmental knee replacement arthroplasty.
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Garner, Amy, Oliver Dandridge, Andrew A. Amis, Justin P. Cobb, and Richard J. van Arkel. "The extensor efficiency of unicompartmental, bicompartmental, and total knee arthroplasty." Bone & Joint Research 10, no. 1 (January 1, 2021): 1–9. http://dx.doi.org/10.1302/2046-3758.101.bjr-2020-0248.r1.
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Aims Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods Extensor function was measured for 16 cadaveric knees and then retested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensor efficiency was calculated for ranges of knee flexion associated with common activities of daily living. Data were analyzed with repeated measures analysis of variance (α = 0.05). Results Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70° and 90° flexion (p < 0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles (p < 0.05), resulting in 12% to 43% reductions in extensor efficiency for the daily activity ranges. Conclusion This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in function and satisfaction differences between partial and total knee arthroplasty. Cite this article: Bone Joint Res 2021;10(1):1–9.
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Nassif, Jeffrey M., and William S. Pietrzak. "Clinical Outcomes in Men and Women following Total Knee Arthroplasty with a High-Flex Knee: No Clinical Effect of Gender." Scientific World Journal 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/285919.
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While it is generally recognized that anatomical differences exist between the male and female knee, the literature generally refutes the clinical need for gender-specific total knee prostheses. It has been found that standard, unisex knees perform as well, or better, in women than men. Recently, high-flex knees have become available that mechanically accommodate increased flexion yet no studies have directly compared the outcomes of these devices in men and women to see if gender-based differences exist. We retrospectively compared the performance of the high-flex Vanguard knee (Biomet, Warsaw, IN) in 716 male and 1,069 female knees. Kaplan-Meier survivorship was 98.5% at 5.6–5.7 years for both genders. After 2 years, mean improvements in Knee Society Knee and Function scores for men and women (50.9 versus 46.3; 26.5 versus 23.1) and corresponding SF-12 Mental and Physical scores (0.2 versus 2.2; 13.7 versus 12.2) were similar with differences not clinically relevant. Postoperative motion gains as a function of preoperative motion level were virtually identical in men and women. This further confirms the suitability of unisex total knee prostheses for both men and women.
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Hagberg, E., Ö. K. Berlin, and P. Renström. "Function after through-knee compared with below-knee and above-knee amputation." Prosthetics and Orthotics International 16, no. 3 (December 1992): 168–73. http://dx.doi.org/10.3109/03093649209164336.
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Fifty-nine amuptees, 24 below-knee (BK), 17 through-knee (TK) and 18 above-knee (AK) who had prosthetic replacements, were evaluated using a questionnaire which provided a quantitative and qualitative assessment scale for the prosthetic function. The ability to apply or don the prosthesis was noted in 100% of the BK, 70% of the TK and 56% of the AK amputations (p < 0.001). Daily use of the prosthesis was recorded in 96% of the BK, 76% of the TK and 50% of the AK amputations (p < 0.001). A higher level of amputation resulted in a significantly lower degree of rehabilitation (p < 0.05). The qualitative evaluation shows that the higher the level of amputation, the lower the usefulness of the prosthesis. Four percent of the BK, 12% of the TK and 39% of the AK amputees had no use whatsoever of their prosthesis (p < 0.01). From a functional standpoint, TK amputation should always be considered as the primary alternative to AK amputation when a BK amputation is not feasible.
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Ercan, Sabriye, Hilmi Mustafa Demir, Yurdagül Baygül, Ozan Turgay, Tolga Atay, and Cem Çetin. "Qualifications of Safe Return to Play Criteria." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0008. http://dx.doi.org/10.1177/2325967117s00089.
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Anterior cruciate ligament (ACL) injury has various negative implications for thigh muscle function, including reduction of muscle strength and instability of torque. Conservative treatment and / or surgical procedures may be preferred by considering patient’s age, activity level, additional injury and the patient’s expectations. Aim of ACL surgery in athletes is to allow a safe return to preoperative activity level. Literatures have shown different criterias about returning to sports. Some of these criterias are time after surgery, negative Lachman and Pivot shift tests, range of motion, extension/flexion muscle strength of the knee, functional knee tests and lower limb symmetry indexes. Although these criteria provide, second-injury risks are high within 2 years of primary ACL reconstruction. The risk of re-injury rates for the ACL vary between 0 and 19% for the ipsilateral side and between 7 and 24% for the uninjured contralateral knee. The purpose of this study was to investigate value of knee function between the return to normal knee function following ACL reconstruction (ipsilateral and uninjured contralateral side) and the healthy knees, and present recommendation for reduce the risk of rerupture. Totally 14 healthy male and 15 male patients who had unilateral ACL reconstruction, followed knee rehabilitation programme regularly and returned to normal knee function following after minimum 8th month the operation participated in the study. We applied Tegner activity level, Lysholm knee score, operated, intact and healthy knee range of motion, one leg hop test, flamingo balance test, isokinetic muscle strength test and proprioception test in the study. No statistically significant differences were found in the demographic data, activity level, and knee score between groups (p>0,05). The test that assesses passive joint position sense at 30˚ showed statistically significant differences between operated and intact non-operated knee (p<0,05). This data was better at operated knee. There were statistically significant differences in functional tests, isokinetic hamstring muscle test at operated knee and proprioception test between patients and control groups (p<0,05). Arthrogenic muscle inhibition occurs bilaterally after unilateral ACL ruptures. Thus, normal lower limb symmetry determined by tests. On the other hand; muscle strength, motor coordination, proprioception and knee function may be insufficient compared to healthy control groups. For this reason, we should consider that it is important to improve bilateral lower extremity functions at ACL rehabilitation program. [Table: see text]
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Gergely, István, Tudor Sorin Pop, Tiberiu Bățagă, Andrei-Marian Feier, Sándor-György Zuh, and Octav Russu. "Will Total Knee Replacement Ever Provide Normal Knee Function?" Journal of Interdisciplinary Medicine 2, s3 (May 1, 2017): 22–26. http://dx.doi.org/10.1515/jim-2017-0040.
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AbstractKnee osteoarthritis or gonarthrosis is considered the most common joint disease, affecting more than 70% of subjects aged over 65 years. Its occurrence is increasing with age and is more problematic with the current rise in the incidence of obesity. In severe and advanced cases, total knee arthroplasty is recommended as a gold standard therapy for pain relief, restoration of normal knee function, and quality of life improvement. There are numerous controversies whether total knee arthroplasty is able to reach and provide end-point outcomes and restore previous function of the knee joint. Studies suggest that the surgeons’ experience, type of prosthesis used, associated pathology, underlying pathologies, risk factors, continuous passive movement, and patient expectations about the surgery may influence the outcomes to a great extent. “Normal knee function” is a statement that is hardly defined in the current literature, as authors usually refer to subjective results when analyzing outcomes. Objective results may be more straightforward, but they do not always symbolize the actual state that the patient is reporting or the actual quality of life. Our objective was to analyze and present summaries of the current literature regarding normal knee function restoration after total knee replacement surgery. Our literature review results confirm the hypothesis that subjective and objective results are difficult to interpret and unravel. Complex future trials may bring supplementary and clearer conclusions regarding knee function and kinematics, clinical improvement, patient satisfaction, and quality of life.
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Boonstra, M. C., M. C. De Waal Malefijt, and N. Verdonschot. "How to quantify knee function after total knee arthroplasty?" Knee 15, no. 5 (October 2008): 390–95. http://dx.doi.org/10.1016/j.knee.2008.05.006.
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Riddle, Daniel L., and Mateusz Makowski. "Knee Pain Patterns and Associations with Pain and Function in Persons with or at Risk for Symptomatic Radiographic Osteoarthritis: A Cross-sectional Analysis." Journal of Rheumatology 42, no. 12 (November 15, 2015): 2398–403. http://dx.doi.org/10.3899/jrheum.150545.
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Objective.Knee pain location is routinely assessed in clinical practice. We determined the patterns of patient-reported pain locations for persons with knee osteoarthritis (OA). We also examined associations between knee pain patterns and severity of self-reported pain with activity and self-reported functional status.Methods.The Osteoarthritis Initiative data were used to examine reports of pain location (localized, regional, or global) and type and extent of knee OA. Multivariable ANCOVA models were used to determine associations between the Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function scales and pain location after adjusting for potential confounding. We also used radar graphs to illustrate pain patterns for various locations and severity of knee OA.Results.Radar graphs of 2696 knees indicated that pain pattern and location and extent of knee OA demonstrate substantial overlap. An interaction between race and pain location was found for WOMAC Function, but not for KOOS Pain scores. Global knee pain was associated (p < 0.001) with substantially worse function (by 6.5 points in African Americans) compared with pain that was localized. Knee pain reported as global was independently associated (p < 0.001) with clinically important lower (worse by 3.9 points) KOOS Pain scores compared with pain that was localized.Conclusion.Pain patterns are not useful for inferring potential location or severity of knee OA in individual patients, but knee pain patterns that are global are independently associated with worse pain and function compared with localized pain, and associations differ for function based on race.
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Shelbourne, K. Donald, Rodney Benner, Tinker Gray, and Scot Bauman. "Range of Motion, Strength, and Function After ACL Reconstruction Using a Contralateral Patellar Tendon Graft." Orthopaedic Journal of Sports Medicine 10, no. 11 (November 1, 2022): 232596712211381. http://dx.doi.org/10.1177/23259671221138103.
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Background: Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results. Purpose: To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG). Study Design: Case series; Level of evidence, 4. Methods: Included were 2148 patients (1238 male patients, 910 female patients) who underwent primary ACL reconstruction with a contralateral PTG between 1995 and 2017 and had complete objective data through 3 months of follow-up. All patients participated in a rehabilitation program specific to goals for each knee. Patients were evaluated objectively with goniometric measurement of ROM, isokinetic quadriceps strength testing, and laxity with a KT-2000 arthrometer. Subjective data were collected at 2 and 5 years. Results: Normal extension on the reconstructed knee was attained for 95% of patients at 1 week postoperatively; normal flexion on the reconstructed knee was reached by 77% of patients by 3 months. At 3 months postoperatively, mean limb symmetry index strength was 104%, and the strength on the ACL-reconstructed and graft-donor knees was 87% and 86% of their respective preoperative strength. Mean manual maximum side-to-side difference in laxity was 2.0 mm at 1 month. Most patients (90%) returned to level 8 sports or higher and did so at an average of 5.7 months. Mean International Knee Documentation Committee scores for the ACL-reconstructed and graft-donor knees were 89 and 91 at 2 years (n = 1015 patients) and 84 and 90 at 5 years (n = 1275 patients), respectively. Mean Cincinnati Knee Rating Scale scores for the ACL-reconstructed and graft-donor knees were 92 and 96 at 2 years (n = 1184) and 88 and 94 at 5 years (n = 1236), respectively. Conclusion: For patients who underwent ACL reconstruction with a contralateral PTG, postoperative ROM and strength were restored quickly by splitting the rehabilitation into different goals between the two knees. Using a contralateral PTG, this structured rehabilitation plan can lead to a relatively quick return to sport and good subjective long-term outcomes.
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McHugh, Michael, Erin Droy, Stefano Muscatelli, and Joel J. Gagnier. "Measures of Adult Knee Function." Arthritis Care & Research 72, S10 (October 2020): 219–49. http://dx.doi.org/10.1002/acr.24235.
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Fuchs, Susan, L. Thorwesten, and S. Niewerth. "PROPRIOCEPTIVE FUNCTION IN KNEES WITH AND WITHOUT TOTAL KNEE ARTHROPLASTY1." American Journal of Physical Medicine & Rehabilitation 78, no. 1 (January 1999): 39–45. http://dx.doi.org/10.1097/00002060-199901000-00011.
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Muaidi, Qassim Ibrahim, Leslie Lorenda Nicholson, Kathryn Margaret Refshauge, Roger David Adams, and Justin Phillip Roe. "Effect of Anterior Cruciate Ligament Injury and Reconstruction on Proprioceptive Acuity of Knee Rotation in the Transverse Plane." American Journal of Sports Medicine 37, no. 8 (May 13, 2009): 1618–26. http://dx.doi.org/10.1177/0363546509332429.
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Background Studies assessing proprioceptive acuity in anterior cruciate ligament (ACL)–deficient knees have only considered proprioception for knee movements in the sagittal plane rather than in the transverse plane (ie, rotation), despite the fact that the ACL plays a critical role in knee rotational stability and that the ACL is injured almost exclusively with a rotation mechanism. Therefore a test of proprioception is needed that involves movements similar to the mechanism of injury, in this case, rotation. Purpose To determine whether proprioceptive acuity in rotation changes after ACL injury and reconstruction, and to examine differences in proprioceptive acuity, range, laxity, and activity level among injured knees, contralateral knees, and healthy controls. Design Cohort study; Level of evidence, 2. Methods Proprioceptive acuity for active knee rotation movements, passive rotation range of motion, anterior knee laxity, and knee function were measured in 20 consecutive participants with unilateral ACL rupture and 20 matched controls. Reconstruction was performed using a single-incision technique with a 4-strand hamstring tendon autograft. Thirty participants (15 control and 15 ACL reconstructed) were retested at 3 months, and 14 with ACL reconstruction were tested at 6 months. Results A deficit was found in preoperative knee rotation proprioception compared with healthy controls (P =. 031). Three months after reconstruction, there was a significant improvement (P =. 049) in proprioceptive acuity, single-plane anterior laxity (P =. 01), and self-reported knee function (P =. 001). At 3 months after reconstruction, proprioceptive acuity of the ACLreconstructed knee was correlated with reported activity level (r =. 63; P =. 021). Conclusion Knee rotation proprioception is reduced in ACL-deficient participants compared with healthy controls. Three to 6 months after reconstruction, rotation proprioceptive acuity, laxity, and function were improved. While these findings are consistent with a return to previous activity level 6 months after reconstruction, the extent of graft maturation and restoration of kinematics should also inform the decision about return to sport.
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Tillu, Abhay, Chris Roberts, and Sumedha Tillu. "Unilateral versus Bilateral Acupuncture on Knee Function in Advanced Osteoarthritis of the Knee – a Prospective Randomised Trial." Acupuncture in Medicine 19, no. 1 (June 2001): 15–18. http://dx.doi.org/10.1136/aim.19.1.15.
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We report a prospective randomised trial of acupuncture given to 44 patients with advanced osteoarthritis (OA) of the knee awaiting total knee joint replacement. Patients were randomly allocated into two groups, group A receiving acupuncture to the most affected knee only and group B receiving acupuncture to both knees. Acupuncture was given to four local points around the knee and one distal point. The local points were Spleen 9 (Yinlinquan, SP9), Spleen 10 (Xuehai, SP10), Stomach 34 (Liangqui, ST34), and Stomach 36 (Zusanli, ST36). The distal point was Large Intestine 4 (Hegu, LI4) on the first web space of the ipsilateral hand. A blinded observer assessed knee function before starting treatment, and at the end of two and six months. Analysis of the results showed a significant reduction in symptoms in both groups, and this improvement was sustained for six months. There was no statistically significant difference between the groups. In conclusion, unilateral acupuncture is as effective as bilateral acupuncture in increasing function and reducing the pain associated with OA of the knee. This trial is not able to distinguish the specific from the non-specific effects of the treatment.
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Zou, Longqiang, Yibin Yang, and Yihai Wang. "A Meta-Analysis of Systemic Evaluation of Knee Ligament Injury or Intervention of Knee Proprioceptive Function Recovery." Journal of Healthcare Engineering 2022 (February 17, 2022): 1–9. http://dx.doi.org/10.1155/2022/9129284.
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Objective. The knee ligaments, as a passive knee joint stability device, provide protection for the knee joint and ensure its functional integrity. This role has long been known and recognized by people. The original purpose of knee ligament reconstruction after knee ligament injury is to restore its anatomical structure and mechanical stability mechanism. Methods. Taking athletes as the research object, randomized controlled trials (RCTs) on improving ankle joint function of athletes related to proprioception training at home and abroad were included. The search time was from the establishment of the database to December 31, 2019, and the references of related documents were traced. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature. RevMan 5.3 software was used for data analysis. Results. The extensor strength, flexor strength, and flexor strength/extensor strength of the affected limb were higher than before the operation one year after surgery ( P < 0.01 ). The Lysholm score, Lysholm instability score, and one-foot jump distance were all higher than those before surgery ( P < 0.05 ); the difference of KT-2000 for both knees was smaller than that before surgery ( P < 0.05 ). Conclusion. In maintaining the anterior stability of the knee joint, the knee ligament provides 85% static resistance to prevent the tibia from moving forward, so knee ligament injury will cause knee instability. The proprioceptive feedback mechanism plays an important role in maintaining the functional stability of joints.
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Jasim, Nizar Abdulateef. "Association of radiological osteoarthritis of the knee joint with locomotor disability." AL-Kindy College Medical Journal 15, no. 1 (September 12, 2019): 36–42. http://dx.doi.org/10.47723/kcmj.v15i1.76.
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Background: Knee osteoarthritis (KOA) is a common joint disorder leading to considerable pain and locomotor disability in lower limb function. Locomotor disability, which is difficulty in activities of daily living related to lower limb function, can be the consequence of KOA, so early diagnosis and management may improve quality of life.
Objective: To assess the contribution of radiological osteoarthritis of the knees to disability in the activities of daily living related to lower limb function.
Methods: One hundred twenty Iraqi KOA patients (104 females and 16 males) who were attending to Rheumatology Unit, Full history was taken and complete clinical examination was done for all patients. Wight-bearing X-rays of both knees (anteroposterior and lateral view) were taken for patients and were graded according to Kellgren and Lawrence scale.
Results: The frequency of locomotor disability, was 62.50% for men and 72.11% for women (p=0.431). The frequency of radiological osteoarthritis of the knee was 50% for men and 40.37% for women (p=0.651). There was significant statistical differences between; locomotor disability, and increased age, morning stiffness, muscle wasting & BMI (p=0.000, p=0.003, p=0.002 and p=0.028 respectively). There was no statistical significant association between; KOA radiological grading, and gender, morning stiffness, BMI & lower limb locomotor functions disability (p=0.651, p=0.357 and p=0.972 respectively).
Conclusion: Radiological osteoarthritis of the knee is only weak independent predictors of locomotor disability. Patient's age, pain of the knees, muscle wasting, morning stiffness and obesity seem to be the most important independent determinants of locomotor disability.
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Ishibashi, Yasuyuki, Eiichi Tsuda, Akira Fukuda, Harehiko Tsukada, and Satoshi Toh. "Intraoperative Biomechanical Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction Using a Navigation System." American Journal of Sports Medicine 36, no. 10 (September 3, 2008): 1903–12. http://dx.doi.org/10.1177/0363546508323245.
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Background Recently, more anatomic anterior cruciate ligament reconstructions have been developed to improve knee laxity. Purpose The objective of this study is to assess knee kinematics after double-bundle reconstruction with hamstring tendon and after anatomically oriented reconstruction with a patellar tendon using navigation during surgery. Study Design Cross-sectional study; Level of evidence, 3. Methods Eighty knees received double-bundle reconstruction with a hamstring tendon graft, and 45 knees received anatomically oriented reconstruction with a patellar tendon graft. Before reconstruction, knee laxity was measured using a navigation system. After the posterolateral bundle or anteromedial bundle was temporarily fixed during double-bundle reconstruction, knee laxity was measured to assess the function of each bundle. After double-bundle reconstruction or anatomically oriented reconstruction with patellar tendon, knee laxity was measured in the same manner. Results Both double-bundle reconstruction and anatomically oriented reconstruction similarly improved knee laxity compared With before reconstruction in all knee flexion angles. Regarding the function of the anteromedial and posterolateral bundles in double-bundle reconstruction, the 2 grafts showed contrasting behavior. The posterolateral bundle restrained tibial displacement mainly in knee extension, whereas the anteromedial bundle restrained it more in the knee flexion position. The posterolateral bundle has a more important role in controlling rotation of the tibia than the anteromedial bundle. Conclusion Although the posterolateral bundle has an important role in the extension position, the anteromedial bundle is more important in the flexion position. Therefore, both bundles should be reconstructed to improve knee laxity throughout knee range of motion. Even with single-bundle reconstruction using a patellar tendon, anatomic reconstruction might improve knee laxity similar to double-bundle reconstruction.
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Murabayashi, Mai, Takuya Mitani, and Koh Inoue. "Development and Evaluation of a Passive Mechanism for a Transfemoral Prosthetic Knee That Prevents Falls during Running Stance." Prosthesis 4, no. 2 (April 14, 2022): 172–83. http://dx.doi.org/10.3390/prosthesis4020018.
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Existing prosthetic knees used by transfemoral amputees have function almost akin to non-friction hinge joints during the running stance phase. Therefore, transfemoral amputees who wish to run need sufficient strength in their hip extension muscles and appropriate prosthetic leg swing motion to avoid falling due to unintended prosthetic knee flexion. This requires much training and practice. The present study aimed to develop a passive mechanism for a transfemoral prosthetic knee to prevent unintended prosthetic knee flexion during the running stance phase. The proposed mechanism restricts only flexion during the prosthetic stance phase with a load on the prosthetic knee regardless of the joint angle of the prosthetic knee. The load on the prosthetic knee required to maintain locked flexion was analyzed. We developed a rough prototype and conducted an evaluation experiment with an intact participant attached to a simulated prosthetic limb and the prototype. The results of level walking showed that the proposed mechanism limits knee flexion, as designed. The results of the preliminary trial suggest that the proposed mechanism functions appropriately during running, where the load on the prosthetic knee is larger than that during walking.
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White, Leigh, Nicholas Hartnell, Melissa Hennessy, and Judy Mullan. "The Impact of an Intact Infrapatellar Fat Pad on Outcomes after Total Knee Arthroplasty." Advances in Orthopedic Surgery 2015 (November 16, 2015): 1–6. http://dx.doi.org/10.1155/2015/817906.
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Background. The infrapatellar fat pad (IPFP) is currently resected in approximately 88% of Total Knee Arthroplasties (TKAs). We hypothesised that an intact IPFP would improve outcomes after TKA. Methods. Patients with an intact IPFP participated in this cross-sectional study by completing two surveys, at 6 and 12 months after TKA. Both surveys included questions regarding kneeling, with the Oxford Knee Score also included at 12 months. Results. Sixty patients participated in this study. At 6 and 12 months, a similar number of patients were able to kneel, 40 (66.7%) and 43 (71.7%), respectively. Fifteen (25.0%) patients were unable to kneel due to knee pain at 6 months; of these, nine (15%) were unable to kneel at 12 months. Moreover, at 12 months, 90.0% of the patients reported minimal or no knee pain. There was no correlation between the inability to kneel and knee pain (p=0.13). There was a significant correlation between the inability to kneel and reduced overall standardised knee function scores (p=0.02). Conclusions. This was the first study to demonstrate improved kneeling and descending of stairs after TKA with IPFP preservation. These results in the context of current literature show that IPFP preservation reduces the incidence of knee pain 12 months after TKA.
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Andriacchi, T. P. "Functional Analysis of Pre and Post-Knee Surgery: Total Knee Arthroplasty and ACL Reconstruction." Journal of Biomechanical Engineering 115, no. 4B (November 1, 1993): 575–81. http://dx.doi.org/10.1115/1.2895543.
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This paper examines the biomechanics of total knee arthroplasty as a treatment for arthritis and anterior cruciate ligament (ACL) reconstruction for repair of torn anterior cruciate ligaments of the knee. These are two of the most frequent reconstructive procedures for the knee joint. Functional testing of patients while performing various activities of daily living was used to study the relationship between the intrinsic biomechanics of the knee and function. The results of the study of patients following total knee replacement demonstrated a dynamic interaction between the posterior cruciate ligament and quadriceps function during stairclimbing. The study of patients with ACL-deficient knees demonstrated that loss of the anterior cruciate ligament can cause the avoidance of quadriceps contraction during activities when the knee is near full extension. Other studies demonstrated a relationship between tibiofemoral joint mechanics and patellofemoral mechanics. In addition, the importance of combined ligamentous laxity with higher than normal adduction moments during gait was examined in relationship to progressive degenerative changes to the medial compartment of the knee. In summary, functional testing such as gait analysis has proven to be an important basic research tool as well as extremely effective for clinical testing of new procedures and devices.
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Iriuchishima, Takanori, and Keinosuke Ryu. "A Comparison of Rollback Ratio between Bicruciate Substituting Total Knee Arthroplasty and Oxford Unicompartmental Knee Arthroplasty." Journal of Knee Surgery 31, no. 06 (July 25, 2017): 568–72. http://dx.doi.org/10.1055/s-0037-1604445.
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AbstractThe purpose of this study was to compare the rollback ratio in bicruciate substituting (BCS) total knee arthroplasty (TKA) and bicruciate-retaining Oxford unicompartmental knee arthroplasty (UKA). In this study, 64 subjects (64 knees) undergoing BCS-TKA (Journey II: Smith and Nephew) and 50 subjects (50 knees) undergoing Oxford UKA (Zimmer-Biomet holdings, Inc., IN) were included. Approximately 6 months after surgery, and when the subjects had recovered their knee range of motion, following the Laidlow's method, lateral radiographic imaging of the knee was performed with active full knee flexion. The most posterior tibiofemoral contact point was measured for the evaluation of femoral rollback (rollback ratio). Flexion angle was also measured using the same radiograph and the correlation of rollback and flexion angle was analyzed. As a control, radiographs of the asymptomatic contralateral knees of subjects undergoing Oxford UKA were evaluated (50 knees). The rollback ratios of the BCS-TKA, Oxford UKA, and control knees were 37.9 ± 4.9, 35.7 ± 4.2, and 35.3 ± 4.8% respectively. No significant difference in rollback ratio was observed among the three groups. The flexion angles of the BCS-TKA, Oxford UKA, and control knees were 123.8 ± 8.4, 125.4 ± 7.5, and 127 ± 10.3 degrees, respectively. No significant difference in knee flexion angle was observed among the three groups. Significant correlation between rollback ratio and knee flexion angle was observed (p = 0.002; Pearson's correlation coefficient = − 0.384). BCS-TKA showed no significant difference in rollback ratio when compared with control knees and Oxford UKA knees. The BCS-TKA design is likely to reproduce native anterior cruciate ligament and posterior cruciate ligament function, and native knee rollback.
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Maxwell, Jessica L., David T. Felson, Jingbo Niu, Barton Wise, Michael C. Nevitt, Jasvinder A. Singh, Laura Frey-Law, and Tuhina Neogi. "Does Clinically Important Change in Function After Knee Replacement Guarantee Good Absolute Function? The Multicenter Osteoarthritis Study." Journal of Rheumatology 41, no. 1 (December 1, 2013): 60–64. http://dx.doi.org/10.3899/jrheum.130313.
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Objective.Poor functional outcomes post–knee replacement are common, but estimates of its prevalence vary, likely in part because of differences in methods used to assess function. The agreement between improvement in function and absolute good levels of function after knee replacement has not been evaluated. We evaluated the attainment of improvement in function and absolute good function after total knee replacement (TKR) and the agreement between these measures.Methods.Using data from The Multicenter Osteoarthritis (MOST) Study, we determined the prevalence of achieving a minimal clinically important improvement (MCII, ≥ 14.2/68 point improvement) and Patient Acceptable Symptom State (PASS, ≤ 22/68 post-TKR score) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function subscale at least 6 months after knee replacement. We also assessed the frequency of co-occurrence of the 2 outcomes, and the prevalence according to pre-knee replacement functional status.Results.We included 228 subjects who had a knee replacement during followup (mean age 65 yrs, mean body mass index 33.4, 73% female). Seventy-one percent attained the PASS for function after knee replacement, while only 44% attained the MCII. Of the subjects who met the MCII, 93% also attained the PASS; however, of subjects who did not meet the MCII, 54% still achieved a PASS. Baseline functional status was associated with attainment of each MCII and PASS.Conclusion.There was only partial overlap between attainment of a good level of function and actually improving by an acceptable amount. Subjects were more likely to attain an acceptable level of function than to achieve a clinically important amount of improvement post–knee replacement.
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Vermeijden, Harmen D., Edoardo Monaco, Fabio Marzilli, Xiuyi A. Yang, Jelle P. van der List, Andrea Ferretti, and Gregory S. DiFelice. "Primary Repair versus Reconstruction in Patients with Bilateral Anterior Cruciate Ligament Injuries: What Do Patients Prefer?" Advances in Orthopedics 2022 (September 13, 2022): 1–7. http://dx.doi.org/10.1155/2022/3558311.
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Purpose. The purpose is to evaluate knee preference and functional outcomes of patients with primary anterior cruciate ligament (ACL) repair in one knee and ACL reconstruction in the contralateral side. Methods. All patients who underwent both procedures were retrospectively reviewed at minimum two-year follow-up. Patients were asked to complete questionnaires regarding their operated knees’ preferences during rehabilitation, daily activities, sports activities, and overall function. Furthermore, the Subjective International Knee Documentation Committee, Forgotten Joint Score-12, and Anterior Cruciate Ligament-Return to Sport after Injury were completed. Results. Twenty-one patients were included. All patients underwent ACL reconstruction first, which was displayed at younger age at surgery (24 vs. 33 years, p = 0.010 ) and longer follow-up (10.2 vs. 2.3 years, p < 0.001 ), respectively. Thirty-three percent preferred the repaired knee, 11% the reconstructed knee, and 56% had no preference; however, 78% indicated that their repaired knee was less painful during rehabilitation and 83% reported earlier range of motion (ROM) return following repair, which was similar for both knees in 17%. Eighty-three percent of patients indicated better function and progression during rehabilitation with their repaired knee and 11% with their reconstructed knees. No statistical differences were found in patient-reported outcomes between both procedures (all p > 0.4 ). Objective laxity assessment showed mean side-to-side difference of 0.6 mm between both sides in favor of the reconstructed knee. Conclusion. This study showed that ACL repair and ACL reconstruction lead to similar functional outcomes. However, patients undergoing both procedures may have less pain, earlier ROM return, and faster rehabilitation progression following primary repair.
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Hohmann, Erik, Adam Bryant, and Kevin Tetsworth. "Strength does not influence knee function in the ACL-deficient knee but is a correlate of knee function in the and ACL-reconstructed knee." Archives of Orthopaedic and Trauma Surgery 136, no. 4 (December 30, 2015): 477–83. http://dx.doi.org/10.1007/s00402-015-2392-6.
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Goetschius, John, and Joseph M. Hart. "Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 51, no. 1 (January 1, 2016): 22–27. http://dx.doi.org/10.4085/1062-6050-51.1.12.
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Context When returning to physical activity, patients with a history of anterior cruciate ligament reconstruction (ACL-R) often experience limitations in knee-joint function that may be due to chronic impairments in quadriceps motor control. Assessment of knee-extension torque variability may demonstrate underlying impairments in quadriceps motor control in patients with a history of ACL-R. Objective To identify differences in maximal isometric knee-extension torque variability between knees that have undergone ACL-R and healthy knees and to determine the relationship between knee-extension torque variability and self-reported knee function in patients with a history of ACL-R. Design Descriptive laboratory study. Setting Laboratory. Patients or Other Participants A total of 53 individuals with primary, unilateral ACL-R (age = 23.4 ± 4.9 years, height = 1.7 ± 0.1 m, mass = 74.6 ± 14.8 kg) and 50 individuals with no history of substantial lower extremity injury or surgery who served as controls (age = 23.3 ± 4.4 years, height = 1.7 ± 0.1 m, mass = 67.4 ± 13.2 kg). Main Outcome Measure(s) Torque variability, strength, and central activation ratio (CAR) were calculated from 3-second maximal knee-extension contraction trials (90° of flexion) with a superimposed electrical stimulus. All participants completed the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and we determined the number of months after surgery. Group differences were assessed using independent-samples t tests. Correlation coefficients were calculated among torque variability, strength, CAR, months after surgery, and IKDC scores. Torque variability, strength, CAR, and months after surgery were regressed on IKDC scores using stepwise, multiple linear regression. Results Torque variability was greater and strength, CAR, and IKDC scores were lower in the ACL-R group than in the control group (P < .05). Torque variability and strength were correlated with IKDC scores (P < .05). Torque variability, strength, and CAR were correlated with each other (P < .05). Torque variability alone accounted for 14.3% of the variance in IKDC scores. The combination of torque variability and number of months after surgery accounted for 21% of the variance in IKDC scores. Strength and CAR were excluded from the regression model. Conclusions Knee-extension torque variability was moderately associated with IKDC scores in patients with a history of ACL-R. Torque variability combined with months after surgery predicted 21% of the variance in IKDC scores in these patients.
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Gracitelli, Guilherme C., Luis Eduardo Passarelli Tirico, Julie C. McCauley, Pamela A. Pulido, and William D. Bugbee. "Fresh Osteochondral Allograft Transplantation for Fractures of the Knee." CARTILAGE 8, no. 2 (July 7, 2016): 155–61. http://dx.doi.org/10.1177/1947603516657640.
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Objective The purpose of this study was to evaluate functional outcomes and allograft survivorship among patients with knee fracture who underwent fresh osteochondral allograft (OCA) transplantation as a salvage treatment option. Design Retrospective analysis of prospectively collected data. Setting Department of Orthopaedic Surgery at one hospital. Patients Fresh OCAs were implanted for osteochondral lesions after knee fracture in 24 males and 15 females with an average age of 34 years. Twenty-nine lesions (74%) were tibial plateau fractures, 6 (15%) were femoral condyle fractures, and 4 (10%) were patella fractures. Main Outcome Measurements Clinical evaluation included modified Merle d’Aubigné-Postel (18-point), International Knee Documentation Committee, and Knee Society function scores, and patient satisfaction. Failure of OCA was defined as revision OCA or conversion to total knee arthroplasty (TKA). Results Nineteen of 39 knees (49%) had further surgery. Ten knees (26%) were considered OCA failures (3 OCA revisions, 6 TKA, and 1 patellectomy). Survivorship of the OCA was 82.6% at 5 years and 69.6% at 10 years. Among the 29 knees (74%) that had the OCA still in situ, median follow-up was 6.6 years. Pain and function improved from preoperative to latest follow-up; 83% of patients reported satisfaction with OCA results. Conclusion OCA transplantation is a useful salvage treatment option for osteochondral lesions caused by knee fracture. Although the reoperation rate was high, successful outcome was associated with significant clinical improvement.
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Shirinsky, I., and V. Shirinsky. "FRI0422 HOW MANY OA PATIENTS WILL BE OVERTREATED IF TREATED WITH DMOADS? ANALYSIS OF OSTEOARTHRITIS INITIATIVE DATA." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 809.1–809. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2277.
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Background:Significant research effort is currently put on discovering drugs able to slow structural progression of osteoarthritis (OA). In many patients OA shows little or no increase in pain or function deterioration over time. Thus, giving disease-modifying OA drugs (DMOAD) for long periods to this subset of patients can be considered as overtreatment. There is a lack of studies directly evaluating how many patients with diagnosed OA experience no impact of the disease during long-term follow up and thus probably do not need any disease modification.Objectives:To assess proportions of patients with diagnosed symptomatic knee OA or frequent knee pain that does not result in sustained pain and limitation of function during long-term follow up.Methods:For the current study we used 8-year longitudinal data obtained from the Osteoarthritis Initiative (OAI) progression (n= 1390) and incidence (n = 3284) subcohorts, which are publically available athttps://oai.nih.gov. For the analyses we included knees having frequent knee symptoms in the past 12 months before the baseline for at least one month. Thus the analyzed group comprised patients fulfilling the definition of symptomatic knee OA (frequent symptoms + Kellgren-Lawerence (KL) grade ≥ II) and people who might have early OA (frequent symptoms + KL grade < II) in accordance with the proposed draft classification criteria [1].The proportion of knees experiencing no impact of OA at the 8 years follow-up was assessed.No impact of OA was defined if a knee fulfilled all the following criteria: 1. WOMAC pain score within normative values 2. WOMAC disability score within normative values 3. Absence of joint replacement.We used previously reported reference population age and gender adjusted values for WOMAC knee pain and WOMAC knee function [2]. It is unlikely that any OA treatment is capable to improve WOMAC pain and function measures above these reference ranges in a given person [2].Results:We included 3092 knees from 2147 participants in the analysis. The mean age of participants was 61.16 years, the mean BMI was 28.59. Almost half of symptomatic knees with baseline KL grades 0-I were not impacted by the disease at 8 year follow up. Every fifth knee with symptomatic knee OA (KL grades ≥ II) had no impact of the disease at the end of follow up. Every third knee with symptomatic KL grade II OA did not develop pain or disability outside the reference range. The percentage of symptom-free knees at year 8 declined progressively with higher KL grades (Table).Table.Percentage of knees with no impact of OA on 8 year follow up depending on baseline KL grade.Baseline KL gradeTotal n of kneesPercentage of knees with no impact of OA089447 %45.78%I46943.1%II92331.31%19%III60917.7%IV1977.1%Conclusion:If given DMOADs, a substantial proportion of OA patients would be overtreated, especially those with early OA.References:[1]Luyten FP, Bierma-Zeinstra S, Dell’Accio F, Kraus VB, Nakata K, Sekiya I, Arden NK, Lohmander LS: Toward classification criteria for early osteoarthritis of the knee.Semin Arthritis Rheum2018, 47(4):457-463.[2]Bellamy N, Wilson C, Hendrikz J: Population-based normative values for the Western Ontario and McMaster (WOMAC) Osteoarthritis Index: part I.Semin Arthritis Rheum2011, 41(2):139-148.Disclosure of Interests:None declared
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Harman, Melinda K., Stephanie J. Bonin, Chris J. Leslie, Scott A. Banks, and W. Andrew Hodge. "Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament." Advances in Orthopedics 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/178156.
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Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee(96±7)and function(92±13)scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged124˚±9˚, with 126 knees exhibiting≥120°flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.
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Wojtys, Edward M., and Laura J. Huston. "Longitudinal Effects of Anterior Cruciate Ligament Injury and Patellar Tendon Autograft Reconstruction on Neuromuscular Performance." American Journal of Sports Medicine 28, no. 3 (May 2000): 336–44. http://dx.doi.org/10.1177/03635465000280030901.
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We examined persons after anterior cruciate ligament injury and for 1.5 years after anterior cruciate ligament reconstruction to analyze changes in anterior knee laxity, lower extremity muscle strength, endurance, and several parameters of neuromuscular function. Sixteen men and nine women (average age, 23.8 years) were evaluated preoperatively, then underwent intraarticular autogenous patellar tendon anterior cruciate ligament reconstruction by the same surgeon and were evaluated at 6, 12, and 18 months postoperatively. Muscle strength was measured isokinetically and neuromuscular function was quantified with simultaneous anterior tibial translation and surface electromyography tests. Forty subjects (26 men and 14 women; average age, 23.5 years) with no known knee abnormalities served as the control group. Subjective questionnaire results showed that by 18 months postoperatively, 20 subjects (80%) believed they had regained their preoperative levels of function. Unfortunately, muscle function in most subjects had not returned to normal. At 12 to 18 months postoperatively, when knee rehabilitation was terminated, significant deficiencies in muscle performance persisted in most patients. Interestingly, in this group of stable knees, quadriceps and hamstring muscle reaction times appeared to be the best objective indicators of subjective knee function.
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Early, Samuel, Luís E. P. Tírico, Pamela A. Pulido, Julie C. McCauley, and William D. Bugbee. "Long-Term Retrospective Follow-Up of Fresh Osteochondral Allograft Transplantation for Steroid-Associated Osteonecrosis of the Femoral Condyles." CARTILAGE 12, no. 1 (October 31, 2018): 24–30. http://dx.doi.org/10.1177/1947603518809399.
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Objective No studies currently exist with long-term follow-up of use of osteochondral allografting (OCA) for treatment of steroid-associated osteonecrosis of femoral condyles in young, active patients who wish to avoid total knee arthroplasty (TKA). We evaluate the extent to which fresh osteochondral allografts can (1) prevent or postpone need for prosthetic arthroplasty and (2) maintain long-term clinically meaningful decrease in pain and improvement in function at mean 11-year follow-up. Design Twenty-five patients (33 knees) who underwent OCA transplantation for osteonecrosis of the knee between 1984 and 2013 were evaluated, including 22 females and 11 males with average age of 25 years (range, 16-48 years). Mean total allograft surface area was 10.6 cm2 (range, 4.0-19.0 cm2). Evaluation included International Knee Documentation Committee (IKDC) scores, Knee Society function (KS-F) score, and modified (for the knee) Merle d’Aubigné-Postel (18-point) score. Results OCA survivorship was 90% at 5 years and 82% at 10 years. Twenty-eight of 33 knees (85%) avoided arthroplasty and 25 of 33 knees (73%) avoided other surgical intervention. Mean IKDC pain score improved ( P = 0.001) from 7.2 preoperatively to 2.8 at latest follow-up, mean IKDC function score increased ( P = 0.005) from 3.3 to 6.5, and mean IKDC total score improved ( P = 0.001) from 31.9 to 61.1. Mean KS-F score improved ( P = 0.003) from 61.7 to 87.5. Mean modified Merle d’Aubigné-Postel (18-point) score improved ( P < 0.001) from 11.4 to 15.1. Conclusions Our findings suggest that OCA transplantation is a reasonable surgical treatment option for steroid-associated osteonecrosis of the femoral condyles, with durable long-term outcomes.
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Mosalem, Douaa M., Shothour M. Alghunaim, Diaa K. Shehab, Ayyoub B. Baqer, Aziz K. Alfeeli, and Mohieldin M. Ahmed. "Soft Tissue Pathology Detected By Ultrasound Seem To Be Risk Factors for Painful Flare in Osteoarthritic Knee." Open Access Macedonian Journal of Medical Sciences 6, no. 9 (September 18, 2018): 1599–605. http://dx.doi.org/10.3889/oamjms.2018.237.
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BACKGROUND: To our knowledge, the importance of US findings, pain (brief pain inventory (BPI)) and disability in osteoarthritic knee (OA) pain patients remain uncertain.
AIM: The objectives are to evaluate the correlation of US findings, pain (brief pain inventory (BPI)) and disability in OA pain patients.
MATERIALS AND METHODS: Eighty - three patients with OA knee were divided into two groups. The first group was OA as symptomatic knee group and the second group was an asymptomatic control group. The maximum sagittal height of synovial fluid in 12 scans at 0, 30, 60 and 90 degrees flexion knee in 3 major recesses were measured.
RESULTS: There were a significant positive correlation between BPI Pain severity index, or BPI function interference index and a maximum height of effusion at 30-degree flexion angle in a supra-patellar recess in painful symptomatic knees. But, there was a significant negative correlation between BPI Pain severity index, and BPI function interference index and cartilage thickness in painful symptomatic knees.
CONCLUSION: The increase of maximum height of synovial effusion at different angles of knee and decrease of cartilage thickness associated with pain and disability in OA pain patients and are being predictors for pain severity and disability in OA pain patients.
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Rud, Bjarne, and Uffe H. Jensen. "Function after arthrodesis of the knee." Acta Orthopaedica Scandinavica 56, no. 4 (January 1985): 337–39. http://dx.doi.org/10.3109/17453678508993029.
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Marx, Robert G. "Patient-Reported Measure of Knee Function." Journal of Bone and Joint Surgery-American Volume 82, no. 8 (August 2000): 1199. http://dx.doi.org/10.2106/00004623-200008000-00031.
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Irrgang, James J., Lynn Snyder-Mackler, Robert S. Wainner, Freddie H. Fu, and Christopher D. Harner. "Patient-Reported Measure of Knee Function." Journal of Bone and Joint Surgery-American Volume 82, no. 8 (August 2000): 1199–200. http://dx.doi.org/10.2106/00004623-200008000-00032.
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Irrgang, James J., Lynn Snyder-Mackler, Robert S. Wainner, Freddie H. Fu, and Christopher D. Harner. "Patient-Reported Measure of Knee Function." Journal of Bone and Joint Surgery-American Volume 82, no. 8 (August 2000): 1201–2. http://dx.doi.org/10.2106/00004623-200008000-00034.
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Courtney, Carol A., Michael A. O’Hearn, and T. George Hornby. "Neuromuscular Function in Painful Knee Osteoarthritis." Current Pain and Headache Reports 16, no. 6 (September 29, 2012): 518–24. http://dx.doi.org/10.1007/s11916-012-0299-2.
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Sensi, Lorenzo, Roberto Buzzi, Francesco Giron, Lapo De Luca, and Paolo Aglietti. "Patellofemoral Function After Total Knee Arthroplasty." Journal of Arthroplasty 26, no. 8 (December 2011): 1475–80. http://dx.doi.org/10.1016/j.arth.2011.01.016.
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Lennox, Iac, R. Murali, J. Scott, D. Williams, and R. Wytch. "An objective assessment of knee function." Clinical Rehabilitation 9, no. 3 (August 1995): 227–33. http://dx.doi.org/10.1177/026921559500900308.
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