Search

Judit Takacs,1 Judy E Anderson,1,3 Jeff RS Leiter,1,2,4 Peter B MacDonald,2,4 Jason D Peeler1,4 1Department of Human Anatomy and Cell Science, 2Department of Surgery, 3Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 4Pan Am Clinic, Winnipeg, Manitoba, Canada Background: Knee osteoarthritis (OA) is the most prevalent medical condition in individuals over the age of 65 years, and is a progressive joint degenerative condition with no known cure. Research suggests that there is a strong relationship between knee pain and loss of physical function. The resulting lifestyle modifications negatively impact not only disease onset and progression but also overall health, work productivity, and quality of life of the affected individual. Purpose: The goal of this investigation was to examine the feasibility of using an emerging technology called lower body positive pressure (LBPP) to simulate weight loss and reduce acute knee pain during treadmill walking exercise in overweight individuals with radiographically confirmed symptomatic knee OA. Design: Prospective case series. Methods: Twenty-two overweight individuals with knee OA completed two 20-minute treadmill walking sessions (one full weight bearing and one LBPP supported) at a speed of 3.1 mph, 0% incline. Acute knee pain was assessed using a visual analog scale, and the percentage of LBPP support required to minimize knee pain was evaluated every 5 minutes. Knee Osteoarthritis Outcome Scores were used to quantify knee pain and functional status between walking sessions. The order of testing was randomized, with sessions occurring a minimum of 1 week apart. Results: A mean LBPP of 12.4% of body weight provided participants with significant pain relief during walking, and prevented exacerbation of acute knee pain over the duration of the 20-minute exercise session. Patients felt safe and confident walking with LBPP support on the treadmill, and demonstrated no change in Knee Osteoarthritis Outcome Scores over the duration of the investigation. Conclusion: Results suggest that LBPP technology can be used safely and effectively to simulate weight loss and reduce acute knee pain during weight-bearing exercise in an overweight knee OA patient population. These results could have important implications for the development of future treatment strategies used in the management of at-risk patients with progressive knee OA. Keywords: knee osteoarthritis, knee pain, exercise, lower body positive pressure

Proprioceptive function of the knee was quantified and compared in three groups of patients: those with anterior cruciate ligament deficiency, with hamstring tendons-ligament augmentation device anterior cruciate ligament reconstructions, and with bone-patellar tendon-bone anterior cruciate ligament reconstructions. A total of 32 subjects, including 6 uninjured control subjects, were tested for threshold to perception of passive motion of the knee. All other sensory input was neutralized and testing occurred in the 30 degrees to 40 degrees range of knee flexion. The noninvolved contralateral knee served as a control for each subject. Each leg was moved at 0.5 deg/sec into flexion or extension in a random sequence. The variables of age, KT-1000 arthrometer scores, injury-to-surgery interval, injury-to-followup interval, and patient satisfaction were statistically analyzed for correlation with threshold to perception of passive motion of the knee. Control subjects showed no statistically significant differences in threshold between their two knees. The three test groups all showed significantly higher values in the involved knee compared with the noninvolved knee (P < 0.01). However, no statistically significant differences were found between the groups, including controls, with respect to mean threshold to perception of passive motion. According to these results, anterior cruciate ligament reconstruction did not improve proprioception in the patients in this study. [ABSTRACT FROM AUTHOR]

Forty patients with anterior cruciate reconstructions using semitendinosus and gracilis autografts and a ligament augmentation device were reviewed at a minimum of 20 months postoperatively to determine if an accelerated rehabilitation program was detrimental to intermediate follow-up results. The rehabilitation program included immediate full weightbearing, using crutches as aids for 2 weeks only, and a Generation II rehabilitation brace set at full range of motion for 2 weeks followed at 2 weeks by bicycle riding and strengthening exercises. Return to sports was allowed at 4 months for nonpivoting sports and at 6 months for level 1 sports involving pivoting. Thirty-seven patients were available for followup. At followup, three grafts were determined to be nonfunctional (KT-1000 arthrometer testing indicating >4 mm of side-to-side difference). The other 34 patients had good or excellent results, with all returning to their preinjury levels of sport with a brace. Early accelerated rehabilitation after anterior cruciate ligament reconstruction with semitendinosus and gracilis tendon autograft and a ligament augmentation device does not seem to affect the results adversely. Results in this series were as good as or better than other series using the same reconstructive technique. [ABSTRACT FROM AUTHOR]