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According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2nd year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.

Background:Patients with TKA show impairments in standing balance up to 1 year after surgery. The impaired standing balance in TKA patients was found to be associated with falls risk and decreased functional level. Assessing of standing balance with objective and reliable assessments tools would therefore be extremely useful for determining accurate exercise program, and risks of falling, especially during the rehabilitative period when ambulation is at its most unsteady (1, 2). The stepping maneuver requires adequate strength and motor control to stabilize the body over the stance limb while the other leg is stepping, therefore the Step Test (ST) provides significant information for dynamic standing balance and lower limb motor control (3). The reliability of ST is reported in patient groups such as stroke, however, there is not any study that investigates the reliability of ST in patients with TKA in the current literature.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the ST in patients with TKA.Methods:40 patients with TKA due to knee osteoarthritis, operated by the same surgeon, were included in this study. Patients performed trials for ST twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the floor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. Scores for each lower extremity were recorded separately. Prior to the testing, the ST was demonstrated by the tester and all participants were allowed to a practice trial.Results:The ST showed an excellent test-retest reliability (ICC2,1=0.95) in this study. Standard error of measurement (SEM) and MDC95for ST were 0.37 and 1.02, respectively.Conclusion:This study found that the ST has an excellent test–retest reliability in patients with TKA. It is an effective and reliable tool for measuring dynamic standing balance and participant falls. As a performance-based clinical test, the ST is easy to score, can be applied in a short time as part of the routine medical examination. Therefore, inclusion of ST into a more comprehensive battery of performance-based measures of standing balance and lower limb motor control function in subjects with TKA should be considered.References:[1]Si, H. B., Zeng, Y., Zhong, J., et al. (2017). The effect of primary total knee arthroplasty on the incidence of falls and balance-related functions in patients with osteoarthritis. Scientific reports, 7(1), 1-9.[2]Moutzouri, M., Gleeson, N., Billis, E., et al. (2017). The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(11), 3439-3451.[3]Hill, K. D., Bernhardt, J., McGann, A. M., et al. (1996). A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiotherapy Canada, 48(4), 257-262.Disclosure of Interests:None declared

Background The joint related structures such as joint capsule, menisci, ligaments, muscles, skin provide the sensory input for the knee proprioception. Individuals with knee osteoarthritis (OA) have poor proprioceptive sense when compared with the same ages healthy individuals. Due to OA, the joint structures such as menisci, ligaments, and joint capsule rapidly undergo degeneration, and the deficiency of the knee proprioception progresses. Daily activities such as stair climbing, rise from a chair, walking require different knee joint angles. Therefore, the evaluation of the knee position sense at different joint angles is necessary for a better understanding of the knee proprioceptive sense deficit and for planning rehabilitation program in patients with knee OA. Objectives The purpose of this study was to analyse the knee joint position sense in different knee joint angles and to compare the results. Methods The study group consisted of 80 patients (62 female/18 male, 124 knees), with unilateral or bilateral knee OA and with a mean age 65.5±9.1 years were included in the study. Patients were evaluated regarding knee proprioception in knee joint angle 30°, 60° and 75°. The starting position was in knee joint angle 90° flexion, and the target angles was attempted to replicate using active knee extension movements. Patients performed active joint angle replication test in sitting position at a standard back supported chair. The average of the 3 repetitions of active joint repositioning test was recorded position sense score. The angular displacements from the target angles (in knee joint angle 30°, 60°, 75°) at the end of the active reproduction tests were recorded as position sense deficit scores. Results When the patients’ knee position sense deficit at different joint angles (in knee joint angle 30°, 60° and 75°) were compared, there were statistically differences between at joint angle 75° and 60° (p=0.002), and also there were statistically differences between at joint angle 75° and 30° (p=0.001). However, there were not statistically differences between the patients’ knee position sense deficit at joint angle 30° and 60° (p>0.05). Conclusions According to our results, the patients with knee OA have better proprioceptive acuity at knee joint angle 30°, 60° than at knee joint angle 75°. Specifically, the detection of active knee movement occurred with lower target angle displacement at a starting knee angle close to terminal extension (30°) than at knee angles closer to midrange (75°). These results can be reasonably speculated that proprioceptive input arose primarily from hamstring muscle stretching, posterior capsule tautness, and possibly ligament strain. It could be argued that the observation of the greater motor responses at decreased angles likely have been facilitated from enhanced sensitivity of these sensory terminals. Also, the results of this study may provide guidance for future proprioceptive sensory evaluations and provide guidance for planning rehabilitation programs in patient with knee OA. Disclosure of Interest None declared

Background Total knee arthroplasty (TKA) is offered to patients who have end-stage knee osteoarthritis (OA) to reduce pain and improve functional performance. Pain and functional level in patients with TKA can be measured using self-report questionnaires such as the Numeric Pain Rating Scale (NPRS), Hospital for Special Surgery (HSS), Iowa Level of Assistance Scale (ILAS), and Iowa Ambulation Velocity Scale (IAVS). Proprioception plays an integral role in neuro-motor control of the knee joint and deficits in knee joint proprioception are well documented in individuals with knee osteoarthritis. However, the patient-reported functional level relevance of these deficits is not clear in both individuals with knee OA and with TKA. Objectives The aim of this study was to assess relationship between pre-/post-surgery patient-reported outcomes and proprioceptive acuity in patient with TKA due to knee OA. Methods The study group consisted of 68 patients (12 males, 56 females), who underwent primary TKR because of knee arthrosis were included in the study with mean age 64.9±9.1 years. Patients were evaluated regarding the knee proprioception (in knee joint angle 15°, 30°), pain (NPRS), HSS knee function score. Functional activities were evaluated using the ILAS and walking speed was evaluated using the IAVS. Patients were evaluated preoperatively and at discharge. All patients underwent the same rehabilitation program. Results While there were correlations in different rates in individuals with knee OA between patient-reported outcomes and proprioceptive acuity, there were no correlations in individuals with TKA between patient-reported outcomes and proprioceptive acuity. Preoperatively, low-to-moderate significant correlations was found between pain and proprioceptive acuity deficit scores in knee joint angle 15°, 30° (r=−0.196, p=0.046 and r=−0.378, p 0.05). Conclusions There were correlations in different rates in patients with knee OA between patient-reported outcomes and proprioceptive acuity, however there were no correlations in patients with TKA between patient-reported outcomes and proprioceptive acuity. These results suggest that patients who have knee OA and with poor proprioception show more limitation in functional ability and have more pain level. On the other hand, deficits in joint position sense in patients with TKA may be due to factors other than pain and functional disability. Poor proprioception in patients with TKA may be due to surgery related resection of articular cartilage, meniscuses, articular ligaments. Disclosure of Interest None declared

Background Total Knee Arthroplasty (TKA) is a common procedure performed mainly due to advanced osteoarthritis (OA), pain, physical disability and reduced quality of life. However, approximately 20% of the patients respond poorly to the surgery and chronic pain and disability following TKA remains a major health burden for many patients. Among the most well documented predictors of poor outcome following TKA is pain catastrophizing. Inadequate pain relief can cause impaired functional performance, increased skeletal muscles tension which are close to surgery related incision site, longer length of hospital stay, unnecessary psychological distress and decreased patient satisfaction. There is high need of developing treatments aimed at improving self-management for patient with TKA at early postoperative period. Objectives The aim of this study is to investigate the effectiveness of progressive muscle relaxations exercises (PMR) on pain coping, physical function and muscle strength among patients with TKA due to OA. Methods The study group consisted of 22 patients (33 knees), who underwent primary TKA because of OA were consecutively allocated to an intervention group (n=11, with mean age; 66.18±13.29 years), and were allocated to a control group (n=11, with mean age; 62.45±7.28 years). After surgery, all patients underwent the same rehabilitation program. The intervention group also was instructed preoperative patient education about PMR exercises, and the intervention group received PMR exercises focusing on reducing overall body tension, anxiety and pain managed by a physiotherapist. Patients were evaluated regarding the pain (Numeric Pain Rating Scale (NPRS)), muscle strength, knee function score (Hospital for Special Surgery (HSS) score), pain-related fear (Tampa Scale for Kinesiophobia (TSK)), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale (HADS)) and quality of life (Short-Form 12 Health Survey (SF-12)). Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Also functional outcomes were evaluated with timed up and go (TUG) test and 10-metre walk test (10 MWT). Patients were evaluated preoperatively and at discharge. Results At baseline, demographic characteristics were similar in groups and there was no statistically difference between groups (p>0.05). It was determined at postoperatively that; the intervention group had better results in terms of reduction of pain severity (p=0.001), improvement of HADS anxiety level (p 0.05). Conclusions The current results suggest that the PMR exercises at early stage after TKA might be an effective method for patient rehabilitation outcomes. However, in this comparison to obtain more comprehensive results studies on larger series are needed. In this way, a more uniform and objective data can be achieved. Disclosure of Interest None declared

Background Proprioception has been defined as the perceived sense of knee joint position (joint position sense) and movement (kinesthesis) (1). The sensory input from the joint capsule, muscles, ligaments, skin improve proprioceptive acuity. With total knee arthroplasty (TKA) surgery articular cartilage, meniscuses, articular ligaments are removed. Also articular effusion and hematoma formation increase following surgery. Therefore, proprioceptive acuity decrease after TKA surgery (2). The proprioceptive improvement might prevent patients with TKA from falling down and increase their sense of security during physical activities. The clinical effect of neoprene knee sleeves on knee proprioception has been evaluated by studies in both injured and uninjured populations (3). But there is not any study research on the effect of neoprene knee sleeves on knee proprioception in patients with TKA. Objectives The aim of this study was to determine the effect of the neoprene knee sleeves on knee joint proprioception in patients with TKA. Methods Sixty patients (50 female/10 male) with a median age 64.95±8.84 years were included in the study. Knee joint proprioception of all the patients was evaluated with and without a neoprene knee sleeves preoperatively and at discharge. Patients attempted to replicate target angles (in knee joint angle 15°, 30°, 60°) using active knee extension movements in sitting position. The average of the 3 repetitions of active joint repositioning test was recorded position sense score. The angular displacements from the target angles (in knee joint angle 15°, 30°, 60°) at the end of the active reproduction tests were recorded as position sense deficit scores. Results Preoperatively (p 0.05). Conclusions In patients with TKA due to osteoarthritis, application of neoprene knee sleeves has increased the proprioceptive acuity. The current results suggest that neoprene knee sleeves might be used for improving proprioception in early stage of patients with TKA. References Herrington L, Simmonds C, Hatcher J. The effect of a neoprene sleeve on knee joint position sense. Research in Sports Medicine. 2005; 13(1):37–46. Pap G, Meyer M, Weiler H-T, et al. Proprioception after total knee arthroplasty: a comparison with clinical outcome. Acta Orthopaedica Scandinavica. 2000;71(2):153–9. Chuang S-H, Huang M-H, Chen T-W, et al. Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis. The Kaohsiung Journal of Medical Sciences. 2007;23(8):405–11. Disclosure of Interest None declared

Background Various measurement methods have been defined to assess the alignment of the lower extremities. The Q-angle measurement is reported to be associated with knee injury and patellofemoral dysfunction. The Q-angle has been assessed using radiography scans, goniometer and photogrammetry methods in supine and standing positions. The radiography method is accepted to be the most accurate and valid measurement technique in measurement the Q-angle. But as a result of being expensive and time-consuming, this invasive method is not mostly preferred in research and clinics. The goniometric measurement of Q-angle is practical because it is simple, requires inexpensive equipment (only a goniometer), and can be applied in a short time. Photogrammetry measurement technique is also an advantageous method for reducing measurement errors caused by goniometers and reduction of investigator errors. Objectives The aim of the present study, was to compare the clinical assessment of the Q-angle (goniometric and photogrammetric measurement methods) to a radiological assessment using radiograph (criterion validity) in patients with varus knee osteoarthritis. Methods The study group consisted of 15 (median age 68.6±11.9 years) patients with unilateral and bilateral varus knee osteoarthritis. Q-angle measurements were assessed on both lower extremities with three different goniometric methods (goniometric measurement method in standing position with quadriceps muscle relaxed; goniometric measurement method in supine position with quadriceps muscle relaxed; and contracted) using a 360° universal goniometer. After the goniometric measurements, photographs were taken with quadriceps muscle relaxed in standing position. For radiographic assessment, we used patients9 lower extremity scanograms, which had been taken to determine the diagnosis and treatment from the Computer Patient Archiving System database. Results There was a good correlation between the radiographic assessment and photogrammetric measurement (r=0.623, p Conclusions According to our result, the photogrammetric measurement and the goniometric measurement appear to be valid alternatives to the radiographic measurement for determining the Q-angle. These alternative measures might be used by clinicians and researchers to measure the Q-angle of patients with varus knee osteoarthritis in orthopaedic clinics. Disclosure of Interest None declared