Search

Purpose: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer‐term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. Methods: Twenty‐two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. Results: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. Conclusion: The VER‐brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. Level of Evidence: Therapeutic study level I randomised crossover trial. [ABSTRACT FROM AUTHOR]

Both in tendon repair following a tear and in tendinopathy, recovery from pain and restoration of (acceptable) function does not go hand in hand with the appearance of the affected tendon at imaging. The tendon may remain altered for a long while and possibly forever, indicating a possible dissociation between morphology and symptoms. The predictive value of asymptomatic abnormal findings remains limited, and interventions in such instances are inappropriate and not supported by current evidence. Once an initial imaging investigation has depicted the condition of the tendon, additional imaging investigations are unlikely to provide further information or change prognosis in patients in whom abnormalities compatible with a diagnosis of tendinopathy have been identified by either ultrasonography or MRI. Patient education and close clinical monitoring are recommended. This is applicable to the patellar tendon, Achilles tendon, rotator cuff, for both tendon repair and tendinopathy. Given the modest risk of sonographic abnormalities to develop in symptomatic tendinopathy, planning and trying to implement any form of intervention may not be warranted. The current evidence mostly arises from low-quality studies, with heterogeneous risk factors and populations, and caution must be maintained when interpreting the significance of such incidental findings in athletes. [ABSTRACT FROM AUTHOR]

Purpose: To examine the biomechanical properties governing posterosuperior rotator cuff (RC) tear progression and dynamic shoulder abduction function, in the absence of excess loading. Methods: Twelve freshly frozen cadaveric shoulders were evaluated via an established dynamic shoulder abduction stimulator. The shoulder abduction functions were primarily evaluated using subacromial contact pressure (SACP) during an abduction procedure, and subsequent middle deltoid force (MDF) under 5 conditions: (1) intact, (2) anterior 1/3 posterosuperior rotator cuff (PSRC) tear, (3) anterior 2/3 PSRC tear, (4) entire PSRC tear, and (5) global RC tear (tear involving the entire superior RC). Results: No obvious differences were observed in the peak MDF required for abduction, and in the peak SACP among the four PSRC tear statuses (49.8 ± 9.2 N, 0.39 ± 0.05 mPa [1/3 PSRC tear]; 49.3 ± 6.8 N, 0.40 ± 0.06 mPa [2/3 PSRC tear]; 51.6 ± 7.0 N, 0.44 ± 0.08 mPa [entire PSRC tear]), as well as intact statuses (48.3 ± 9.8 N, 0.40 ± 0.05 mPa). However, significant elevations in the peak MDF and peak SACP levels were observed among the four PSRC tear statuses and global RC tear (68.1 ± 9.3 N; 4.12 ± 1.50 mPa, P < 0.01). Conclusion: In the absence of excess loading, the biomechanical function of the shoulder was not impaired by a simple PSRC tear. However, once the tear size reached the half superior portion of the humeral head, the humeral head migrated to the surface of the subacromion, and this action markedly decreased shoulder abduction function. [ABSTRACT FROM AUTHOR]

Purpose: The Knee injury and Osteoarthritis Outcome Survey (KOOS) profile of outcome measures are among the most commonly used outcome measures in knee arthroplasty (KA). The purpose was to develop and externally validate "score maps" (one-page figural depictions of most likely scores) for KOOS Pain and Function subscales to facilitate a variety of clinical decisions related to shared decision making prior to KA. Methods: Presurgical KA data collected within 1 year of surgery and obtained in two independent studies were used in this cross-sectional study. Score maps were designed to be easily understandable, single-page graphical depictions of predicted KOOS Pain, and KOOS Function, daily activity subscales. To create the score maps, individual item scores from one dataset were used to determine the most probable responses for each item for the entire range of possible scores. Predicted KOOS score maps were derived from Osteoarthritis Initiative (OAI) data and externally validated using an independent single site KA cohort study. Score map predicted scores from OAI were compared to actual presurgical KOOS subscale scores using Weighted Kappa (Κw) agreement coefficients and actual versus predicted differences in scores. Results: The score maps derived from OAI and applied to actual scores in the validation sample demonstrated moderate to substantial chance-corrected agreement for both KOOS Pain and KOOS Function, daily activity subscale items. For example, KOOS Pain score map scores applied to the external validation dataset showed chance-corrected agreement with Κw ranging from 0.43 to 0.73. Score maps predicted actual item scores within ± 1 point at least 94% of the time. Findings for the KOOS Function, daily activity subscale items were similar. Conclusions: Score maps derived from OAI data agreed with actual KOOS scores obtained on an independent dataset at an acceptable degree of precision. Easy-to-use KOOS Pain and Function, daily activity score maps have potential to facilitate a variety of important clinical decisions during discussions between patients and surgeons prior to KA. Level of evidence: Level III prognostic study. [ABSTRACT FROM AUTHOR]

Purpose: Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function. Method: A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010–2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury (< 6 weeks), sub-acute (6 weeks–6 months) and chronic syndesmotic injury (> 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS). Results: Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p < 0.001), with the greatest difference in quality of life (− 20.7, 95% CI − 31.6 to − 9.8, p = 0.012). There was a mean follow-up of 4.3 years. Although the average FAOS subscales in those with sub-acute injuries were lower than in those with acute injuries, the difference was not statistically significant. Conclusion: The results of this study suggest that delayed surgical stabilisation (> 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: A proportion of TKA recipients following TKA are dissatisfied with their outcome. Our hypothesis is that patient satisfaction with TKA and perception of success of surgery are associated with patient comorbidities and overall health status, surgical and anaesthetic techniques as well as processes of post-operative care after TKA. The aims were to (i) measure the incidence of patient unfavourable outcomes-defined as dissatisfaction with the surgery or lack of joint-specific global improvement-1 year after TKA, and to explore the differences between these two outcomes of interest; (ii) assess the relationship between the development of these unfavourable outcomes and patient-reported knee function and overall quality of life; (iii) explore the associations between pre- and peri-operative variables and the development of these unfavourable outcomes 1 year after TKA.Methods: This study includes analysis of data from a prospective cohort of 1017 TKA recipients. Pre-operative patient variables, surgical and acute-care data were collected. The Oxford knee score and the global perception of improvement were used to assess satisfaction and success 365 days post-surgery.Results: From 1017 patients (56% female), mean age 68 years and BMI 32, 68 pts (7%) were dissatisfied with the outcome of surgery, 141 pts (14%) believed surgery was unsuccessful 1 year after TKA. A negative outcome was noted in 151 (15%) patients for either satisfaction or success, and 58 (6%) of patients reported neither good satisfaction nor success after surgery. Dissatisfied patients reported worse mean OKS (26.4 [SD 8.03] vs 42.3 [SD 5.21], p < 0.001) and mean EQ VAS (64.9 [SD 19.49] vs 81.8 [SD 14.38], p < 0.001) than satisfied patients. Patients who reported unsuccessful surgery also showed significantly lower mean OKS (30.9 [SD 9.29] vs 42.9 [SD 4.39], p < 0.001) and mean EQ VAS (68.2 [SD 18.61] vs 82.7 [SD 13.77], p < 0.001). Univariate analysis of predictors of unfavourable outcome post-TKA showed that financial status, obstructive sleep apnoea (OSA), ASA class > 2 and not resurfacing the patella were factors associated with the development of dissatisfaction with TKA and with patient perceived unsuccessful results of TKA. Multivariable logistic regression of patient satisfaction and success of TKA showed that compensation cases (OR 26.91, p < 0.001 for dissatisfaction and OR 11.49, p = 0.001 for unsuccessful TKA), obstructive sleep apnoea (OR 2.18, p = 0.04 for dissatisfaction and OR 1.82, p = 0.04 for unsuccessful TKA), ASA grade > 2 (OR 1.83, p = 0.04 for dissatisfaction and OR 1.57, p = 0.03 for unsuccessful TKA)and the development of a complication after TKA (OR 3.4, p < 0.001 for dissatisfaction and OR 2.39, p < 0.001 for unsuccessful TKA) were associated with the development of a negative outcome in both groups. Patella preservation (OR 1.96, p = 0.03) was associated with dissatisfaction, whereas the use of cruciate retaining femoral prosthesis was associated with less successful results of TKA (OR 1.78, p = 0.009).Conclusions: An unfavourable outcome occurs in approximately 7-15% of patients following TKA. The incidence varies with how an unfavourable result is defined and many factors are associated with this outcome though prosthetic design or patella resurfacing do not appear to be important. [ABSTRACT FROM AUTHOR]

Purpose: Pain management after total knee arthroplasty (TKA) is still under debate. Continuous peripheral nerve blocks (PNB) can provide long pain relief but impair muscle function. Continuous intraarticular analgesia could result in longer pain relief than local infiltration analgesia without negative effects on muscle function. This study investigated the efficacy of pain control between PNB's and continuous intraarticular analgesia after TKA.Methods: A prospective randomized study on 140 patients undergoing TKA was performed. Patients received either a combination of continuous femoral nerve block, continuous sciatic nerve block and single-shot obturator nerve block (group R) or a local infiltration analgesia and a continuous intraarticular catheter with ropivacaine (group L). Primary outcome was pain measured on a numerical rating scale. Knee function, patient-reported outcome (PRO) and adverse events were assessed until 1 year after surgery.Results: Pain at rest was lower in group R on the day of surgery (mean NRS 3.0 vs. 4.2) and the morning of postoperative day 1 (mean NRS 3.4 vs. 4.4). Motor blockade longer than postoperative day 3 occurred more often in group R compared to group L (15.3% vs. 1.5%). Pain levels, PRO and satisfaction 3-month and 1-year after surgery were similar.Conclusion: Continuous PNB's were slightly more effective in the first 24 h after surgery but were associated more often with motor blockade which should be avoided. It must be balanced if the small amount of better pain relief immediately after surgery justifies the risks associated with motor blockade following PNB's.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Purpose: To report outcomes following proximal hamstring reconstruction employing an ipsilateral distal hamstring tendon autograft, in patients with chronic proximal ruptures.Methods: Six patients presenting with a chronic proximal hamstring avulsion and a medial time from injury of 11.0 months (range 7-18), confirmed via magnetic resonance imaging, underwent proximal hamstring repair using a free graft harvested from the ipsilateral distal hamstrings. Patients were evaluated at 6, 12 and 24 months post-surgery, via the Perth Hamstring Assessment Tool, the Short Form Health Survey, the Lower Extremity Functional Scale, a Patient Satisfaction Questionnaire, the Active Knee Extension and 6 min walk tests, the single and triple hop tests for distance, and isokinetic knee extensor and flexor strength. Knee strength was assessed at 180° and 240°/s (total work, peak and average torque), and both mean absolute scores and limb symmetry indices (LSIs) comparing the operated and non-operated limbs were presented.Results: Patients demonstrated good clinical improvement throughout the post-operative timeline in all subjective and objective outcomes. Mean knee extensor LSIs had recovered by 12 and 24 months. At 24 months post-surgery, while mean LSIs for knee flexor peak and average torque were at (or above) 90%, a significant difference still existed between the operated and non-operated limbs in knee flexor total work. At 24 months, five patients (83%) were satisfied with the results of the surgery, as well as their ability to return to recreational and sporting activities. There were two adverse events including an early deep vein thrombosis and a secondary surgery to remove a loosened staple.Conclusions: While isokinetic hamstring strength had not fully recovered by 24 months, this surgical technique demonstrated a high level of patient satisfaction and return to function, in patients with chronic proximal hamstring ruptures. As the clinical relevance, this surgical technique provides a viable option with good post-operative outcomes for patients with chronic proximal hamstring tears that cannot be approximated back to the ischium.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: A mobile-bearing (MB) posterior-stabilized total knee arthroplasty (TKA) system with ball and socket post-cam mechanism has been developed with the aims of better prosthesis fit and enhanced stability. However, the data are limited to compare its clinical outcomes with an already established fixed-bearing (FB) implant design.Methods: This is a prospective randomized study comparing 260 patients in the MB group and 133 patients in FB group with a minimum 2 years of follow-up. Intraoperative variables, post-operative functional outcomes and incidence of adverse events were compared.Results: MB group showed better prosthesis fit as the incidence of over-hang of femoral component at junction (medial: 1% vs. 5% and lateral: 2% vs 4%, p < 0.001) and trochlea (medial: 2% vs 30%, p = 0.042 and lateral: 13% vs 21%, p = 0.015) was less than FB group. MB group also showed better gap balancing as the incidence of medio-lateral gap difference more than 2 mm was less in flexion (2.3% vs. 16%, p < 0.001) and extension (3.1% vs. 9.8%, p = 0.005). Post-operative functional outcomes and incidence of adverse events showed no difference between the two groups at 2 years.Conclusions: New MB design offers similar functional outcomes and stability along with better intraoperative prosthesis fit and gap balancing compared to an established fixed-bearing design. Hence, this new MB design could be an alternative prosthesis of choice for posterior-stabilized TKA.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Purpose: The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.Methods: A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.Results: Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.Conclusion: Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we examined whether the OKS demonstrated a floor or a ceiling effect when used to measure the outcome of knee replacement surgery in a large national cohort.Methods: NHS PROMs database, containing pre- to 6 month post-operative OKS on 72,154 patients, mean age 69 (SD 9.4), undergoing knee replacement surgery, was examined to establish the proportion of patients achieving top or bottom OKS values pre- and post-operatively.Results: Pre-operatively, none of patients achieved the maximum/'best' (48) and minimum (0) scores. Post-operatively, no patients (0 %) achieved the minimum/'worst' score, but the percentage achieving the maximum score increased to 2.7 %. Subgroup analyses demonstrated that the highest post-operative overall ceiling percentage was 3 %, in a subgroup of patients between 60 and 79 years of age and 13.7 % in a group of patients who had a pre-operative OKS above 41. Furthermore, 10.8 % of patients achieved the top post-operative OKS-PCS and 4.7 % top post-operative OKS-FCS.Conclusion: Based on NHS PROMs data, the OKS does not exhibit a ceiling or floor effect overall, or for both its pain and function subscales, and remains a valid measure of outcomes for patients undergoing TKA.Level Of Evidence: Large-scale retrospective observations study, Level II. [ABSTRACT FROM AUTHOR]

Management of combined bony and tendinous deficiency of the posterosuperior rotator cuff represents a challenge in young patients. In this case report, a 44-year-old woman that presented an osteonecrosis of the greater tuberosity had a pseudoparalytic shoulder. She beneficiated from a fresh-frozen Achilles tendon allograft with calcaneal bone, which was used to reconstruct the rotator cuff and the concomitant bony defect. At 12-month follow-up, the patient was pain free and had complete range of motion, normal strength, a SANE score of 95 and radiographically the allograft was healed. An Achilles tendon allograft may therefore be a viable surgical option to reconstruct a combine posterosuperior rotator cuff tear and greater tuberosity bone defect. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate how strongly the concentric and eccentric quadriceps strengths were correlated with the joint position sense, functional outcomes and painful activities in patients with patellofemoral pain syndrome (PFPS).Methods: The study included forty-six women diagnosed with unilateral PFPS. Eccentric and concentric quadriceps strengths were recorded at 60 and 180°/s. Active knee joint position sense (JPS) was measured at 20° and 60° of flexion. Functional levels were determined by using Kujala patellofemoral scores. Pain levels during stair descending and ascending, squatting and prolonged sitting were measured using 0-10 cm visual analogue scale. The relationship of isokinetic quadriceps strength with JPS results, Kujala score and pain levels were evaluated using Spearman's correlation coefficient test.Results: Eccentric and concentric quadriceps strengths were significantly lower on involved side than uninvolved side. JPS results were poorer on the painful knee when compared to uninvolved side. While eccentric strength correlated with both JPS target angles, concentric strength was correlated only with 20°. Both eccentric and concentric strengths were significantly correlated with Kujala scores and pain levels.Conclusion: Quadriceps eccentric strength was correlated more to joint position sense than concentric strength. Both eccentric and concentric quadriceps strength related to pain and functional level in PFPS patients. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to compare the functional results and the impact on quality of life after a single-radius or a multiradius TKA implantation. The secondary objectives were to compare range of motion, satisfaction and the ability to perform daily life activities with both types of implant. It was hypothesized that the single-radius TKA would lead to better functional results and better quality of life than the multiradius TKA.Methods: This is a prospective non-randomized study that included 250 cases of a single-radius TKA and 224 of a multiradius posterior-stabilized TKA implanted with the same surgical and rehabilitation protocol.Results: In the 1- and 5-year follow-up, we found similar knee KSS scores (89.7 ± 12.1 in the multiradius group and 90.3 ± 11.7 in the single-radius group) and functional KSS scores (78.6 ± 21.4 in the multiradius group and 75.8 ± 20.9 in the single-radius group). The pain and the Physical SF-36 scores were also similar. Range of motion (112° ± 12° in the multiradius group and 112 ± 12° in the single-radius group), patients' satisfaction and the ability to perform daily life activities were also similar in both groups.Conclusion: The use of a single-radius or a multiradius posterior-stabilized knee prosthesis can improve the function of the knee and the patients' quality of life in a similar way at the short-term and midterm follow-up. Moreover, range of motion, patient satisfaction and the ability to perform daily life activities are similar with both types of prosthesis. As both types of prosthesis can improve the function and quality of life of the patients in a similar way, the sagittal radius of the femoral component should not be considered the main factor when choosing the model of TKA.Level Of Evidence: Therapeutic study: Prospective comparative study, Level II. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess activation patterns of medial (MH) versus lateral (LH) hamstrings in female athletes who had undergone ACL reconstruction (ACLR) using a hamstrings-graft during single-limb functional testing.Methods: Eighteen athletes (1-6 years since ACLR) and 18 healthy controls were recruited from the Icelandic women's top divisions in football, handball, and basketball. Activation of the MH and LH was monitored bilaterally using surface electromyography. Peak activation of the normalized signal was identified for two phases of the single-limb crossover (SLC) hop test and performance (distance jumped) registered. Self-reported knee symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A repeated measures general linear model was used for main statistical data analyses, comparing variables of interests between limbs (within-subjects factor) and between groups.Results: ACLR athletes had worse KOOS-symptoms scores (p < 0.05) than controls, while hop distance was equal. Overall, MH and LH muscle activation levels differed between the two phases of the SLC hop test (p < 0.05). Moreover, inter-limb differences in MH and LH activity were identified between groups (p < 0.05), mainly explained by greater LH than MH activation in the uninjured limb of ACLR athletes.Conclusion: One to 6 years after ACLR, female athletes performed on par with uninjured controls, but demonstrated inter-limb differences in muscle activation patterns of the hamstrings that were not evident in controls. This may be an important factor to consider during postsurgical rehabilitation in order to lower the risk of a second injury.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Since the early years of orthopaedics, it is a well-known fact that anatomy follows function. During the evolution of mankind, the knee has been optimally adapted to the forces and loads acting at and through the knee joint. However, anatomy of the knee joint is variable and the only constant is its complex function. In contrast to the time of open surgery, nowadays the majority of reconstructive knee surgery is done arthroscopically. Keyhole surgery is less invasive, but on the backside, the knee surgeon lacks daily visualisation of the complex open anatomy. As open anatomical knowledge is less present in our daily practice, it is even more important to highlight this complex anatomy and function of the knee. It is the purpose of this review to perform a systematic review of knee anatomy, highlight the complex function of the knee joint and present an overview about recent and current knowledge about knee function. Level of evidence Systematic review, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this prospective study was to determine the clinical value of lateral radiographs and corresponding MRI scans in the preoperative evaluation of the functional integrity of the anterior cruciate ligament (ACL) in a consecutive series of 78 patients (93 knees) with medial compartment osteoarthritis. Methods: All knees received standardised radiographs and MRI imagery. The wear pattern on the lateral radiograph was described based on a modified Keyes classification. On MRI, the ACL and the percentage of intact posterior cartilage in relation to the anteroposterior tibia width were assessed. Results: The MRI showed an intact ACL in 23 (25 %) knees, evidence of ACL degeneration in 54 (58 %) knees and a complete ACL tear in 16 (17 %) knees. All knees with an intact ACL showed ≥14 % intact posterior cartilage on sagittal MRI scans, except for one knee. All knees with a torn ACL demonstrated <14 % intact posterior cartilage. Of the 54 knees with evidence of ACL degeneration, eight knees had <14 % intact posterior cartilage similar to the wear pattern present in knees with torn ACLs. Out of the 24 knees with a torn or degenerated ACL and <14 % intact posterior cartilage on MRI, 23 (96 %) knees demonstrated posterior bony erosion on corresponding lateral radiographs. Conclusions: The assessment of intact posterior tibial cartilage on MRI and lateral radiographs helps to identify knees with functional ACL insufficiency. MRI with assessment of both the ACL morphology and the underlying tibial wear pattern appears to provide additional clinical benefit in cases in which the extent of posterior bony erosion on the lateral radiograph cannot be assessed with confidence. Level of evidence: Diagnostic study, Level II. [ABSTRACT FROM AUTHOR]

Purpose: To explore associations between MRI-defined structural abnormalities and clinical features related to knee osteoarthritis (OA). Methods: Structural and clinical knee OA features were assessed in 87 women (45 with knee OA symptoms). Structural features were quantified by the Kellgren and Lawrence grade on radiography and by the Boston-Leeds Osteoarthritis Knee Score on MRI. Clinical features were assessed using the Knee Injury and Osteoarthritis Outcome Score, functional tests and muscle strength measurements. Associations were examined using regression analyses. Results: Limited significant associations between structural and clinical features were found. An increased meniscal signal was associated with more pain/symptoms ( P < 0.027). An anterior cruciate ligament tear was associated with poorer stair climbing test performance ( P = 0.045). In a stepwise linear regression model, patellofemoral cartilage integrity and pain explained 28 % of the isometric quadriceps strength variability. The amount of cartilage lesions, loose bodies and pain explained 38 % of the isokinetic quadriceps strength variability. Synovitis/effusion and patellofemoral cartilage integrity combined with pain explained 34 % of the isometric hamstring strength variability. Conclusion: Although MRI-detected cartilage lesions, synovitis/effusion and loose bodies did explain part of the muscle strength variability, results suggest that MRI does not improve the link between joint degeneration and the clinical expression of knee OA. MRI contributes less than expected to the understanding of pain and function in knee OA and possibly offers little opportunity to develop structure-modifying treatments in knee OA that could influence the patient's pain and function. Level of evidence: Case series with no comparison groups, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative function has been shown to persist posttotal knee arthroplasty. However, it remains unclear whether asymmetries are task specific. Therefore, we investigated postoperative asymmetries in loading during quiet stance and walking gait. Methods: Ten patients with end-stage knee osteoarthritis scheduled for total knee arthroplasty were studied at baseline (preoperative), 6-week, 3- and 6-month postoperative. Load distribution and balance were quantified during quiet stance. Furthermore, dynamic loading was quantified during walking gait. Patient satisfaction was assessed using the Knee Osteoarthritis and injury Outcome Score. Results: Preoperatively, load distribution was significantly different between limbs, with approximately 70 % of the load through the contralateral or 'good' side. Asymmetries persisted and up to 6-month postoperative during quiet stance. No significant change was found in balance. During walking, preoperative loading asymmetry was present; however, no significant postoperative loading asymmetries were identified. Conclusions: Total knee arthroplasty does not appear to significantly change load distribution or balance 6-month postoperative during quiet stance; however, during walking gait, symmetry appears to be restored. This could be potentially improved through enhanced rehabilitation. Level of evidence: Therapeutic study, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The possibility to return to sporting activity can be an important consideration in the decision-making process in femorotibial osteoarthritis. We analyzed functional outcomes and sport participation in a continuous series of HTO and asked whether this procedure could match expectations in active and motivated patients. Methods: We retrospectively investigated activities, sports participation, and the level of satisfaction in 139 patients with unilateral noncomplicated HTO. The study included 41 women and 98 men with a mean age of 59 years and a mean 50 months of follow-up. Results: Eighty-seven patients (63%) reported that their knee was 'normal,' and eighty-six patients (62%) felt that their activities were limited by their knee. A total of 78 patients (56%) reported that they were as active as they expected to be before the intervention. Of these patients, 98% were satisfied. Of the patients who were not as active as they thought they would be, 51% were satisfied ( P < 0.0001). The duration of preoperative pain, the age at evaluation, and the number of previous surgeries did not influence the subjective result. Among patients under 75 years, 28% regularly participated in strenuous sports, but 40% were motivated for these activities. 66% of the motivated patients regularly participated in at least one impact sport. Conclusion: This study shows that young motivated patients are able to resume strenuous activities following HTO. However, patients must be informed that they will typically not recover their pre-pathology level and that residual pain during strenuous sports is not exceptional. Level of evidence: Therapeutic study, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: To develop a self-administered questionnaire for the evaluation of donor-site-related functional problems after anterior cruciate ligament (ACL) reconstruction with autograft harvested from the hamstring tendon or patellar tendon and to determine the content validity, reliability and preliminary factor structure of this new instrument. Methods: Seven physiotherapists with long clinical experience of rehabilitation after ACL reconstruction and 60 patients from the target population participated as experts in the developmental stages of the questionnaire. Content validity was determined and quantified with the content validity index (CVI). Test-retest reliability, internal consistency and factor structure were evaluated in another 64 patients reconstructed with an autograft. Results: The final questionnaire included 16 items on symptoms and function during activities of daily living and exercise. Excellent content validity on both item level (I-CVI ≥ 0.83, range 0.83-1.00) and scale level (S-CVI = 0.93) was found. The test-retest reliability was good, ICC = 0.94. Internal consistency was high, and Cronbach's α was 0.92 and 0.94 at each test occasion. The principal components analysis yielded a four-component structure. Conclusions: The questionnaire 'Donor-site-Related Functional Problems following Anterior Cruciate Ligament (ACL) Reconstruction' is a patient-reported questionnaire with high content validity and reliability for the evaluation of donor-site-related functional problems after ACL reconstruction, with autograft harvested from the hamstring tendon or patellar tendon. The results of this study support the use of this questionnaire as a standardized outcome measure for both research purposes and in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: Successful outcomes for an athlete usually consist of returning to their sport. The Subjective Patient Outcome for Return to Sports (SPORTS) score has been recently proposed as an easy to use score for evaluating an athlete's ability to return to their sport. The aim of this study was to test the reliability and validity of the SPORTS score in athletes 5-10 years after anterior cruciate ligament reconstruction. Methods: A total of 47 athletes (average age 30, range 15-45), 5-10 years, after an anterior cruciate reconstruction were included in this study. Athletes were asked to complete the SPORTS score with an intermediate period of 2 weeks in order to measure reliability by using the Bland-Altman method and the ICC score. The criterion validity was assessed by calculating the Spearman correlation coefficient between the SPORTS score and Lysholm score, KOOS score and the SF-36. Results: The SPORTS score showed excellent reliability (ICC = 0.967). The systematic error was 0 points (95% upper limit of agreement = 1.8 points). A strong correlation was found between the SPORTS score and the sports and recreation component on the KOOS score ( r = 0.55, P < 0.001). The floor effect was 9% and the ceiling effect 32%. Conclusion: This study suggests that the SPORTS score is a valid and reliable tool to assess and quantify return to sport. Level of evidence: Diagnostic study, Level I. [ABSTRACT FROM AUTHOR]

Purpose: The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction. Methods: Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed. Results: The triple-hop ratio was moderately but significantly correlated with the IKDC, KOOS Sports and Recreation subscale, and the KOOS Knee Related Quality of Life subscale, as well as with the specific questions related to jumping. Similar but weaker relationship patterns were found for the single-hop ratio and timed hop. No significant correlations were found for the Marx activity level or crossover-hop ratio. Multivariable modeling showed almost no significant additional contribution to predictability of the IKDC or KOOS subscores by gender, BMI, or the number of faults on either leg. Conclusions: The triple-hop test is most significantly correlated with patient-reported outcome scores. Multivariable modeling indicates that less than a quarter of the variability in outcome scores can be explained by hop test results. This indicates that neither test can serve as a direct proxy for the other; however, assessment of patient physical function by either direct report using validated outcome tools or by the hop test will provide relatively comparable data. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Function and sport participation was analyzed via a self-administered questionnaire in 347 patients with unilateral noncomplicated TKA. It was 227 women and 120 men with a mean age of 75 (range, 28 to 94) and a mean follow-up of 44 months (range 13–71). Two hundred and thirty-seven patients (68%) reported that their knee was “normal”, 56% that their activities were limited by their knee, and 66% that they were as active as they expected to be before the intervention. Of them, 98% were satisfied. Of the patients who were insufficiently active, 52% were not satisfied with their outcome ( P < 0.0001). Neither the duration of preoperative pain, the age at evaluation or the number of previous surgeries influenced the subjective result or the degree of patient satisfaction. Among patients under 75 years, 10% regularly participated in strenuous sports but only 13% felt that this ability was important. When participation was analyzed in the motivated patients subgroup, 63% regularly took part in at least one impact sport. [ABSTRACT FROM AUTHOR]

The supporting structures on the medial side of the knee consist of a superficial fascial layer (I), a deep capsular layer (III) with the deep medial collateral ligament in it and in between the superficial collateral ligament (layer II). The attachment sites of the different ligaments and the functions of the various ligamentous structures are described and suggestions for surgical repair are given. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the validity of the newly designed functional ability test (FAT) for the normal population and patients with deficiency of the anterior cruciate ligament (ACL). The FAT consists of four tests: the figure-of-eight hop, the up-down hop, the side hop, and the single hop. Sixty control subjects and 50 patients with unilateral ACL deficiency were tested. In the control group, the values measured were significantly different between males and females in all of the tests. On the other hand, when left/right difference values were compared, no significant difference was found between males and females in any of the tests. More than 95% of control group exhibited symmetrical function in each part of the FAT, whereas in the ACL-deficient group, the percentage of patients who showed abnormal symmetry was 68% in the figure-of-eight hop, 58% in the up-down hop, 44% in the side hop, and 42% in the single hop. The percentage of ACL-deficient patients with functional asymmetry in at least one of the four tests was 82%. The FAT was found to be useful in evaluating lower limb function in ACL-deficient patients. [ABSTRACT FROM AUTHOR]