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Background. Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. Objective. The aim of this study was to examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. Design. This was a cross-sectional study. Methods. Fifty-three people with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, completed self-administration questionnaires, and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. Results. Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity ([r.sub.s] = .325, P < .05) and stiffness ([r.sub.s] = .341, P < .05), lower pressure pain thresholds at the knee ([r.sub.s] = -.306, P < .05) and epicondyle ([r.sub.s] = -.308, P < .05), and higher scores with the Central Sensitization Inventory ([r.sub.s] = .456, P < .01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. Limitations. Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is needed. Conclusion. Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed., There is compelling evidence that central sensitization (CS) is present in a subgroup of people with knee osteoarthritis (OA) pain, especially in those with more advanced knee OA, and may [...]

Background. Quadriceps femoris muscle strengthening is a common rehabilitation exercise for knee osteoarthritis (OA). More information is needed to determine whether targeting muscle power is a useful adjunct to strengthening for people with knee OA. Objective. The purpose of this study was to identify the predictive ability of knee extensor strength and knee extensor power in the performance of physical tasks in adults with knee OA. Design. This study used a cross-sectional design. Methods. Fifty-five participants with clinical knee OA were included (43 women; mean [SD] age=60.9 [6.9] years). Dependent variables were: timed stair ascent, timed stair descent, and the Six-Minute Walk Test (6MWT). Independent variables were: peak knee extensor strength and mean peak knee extensor power. Covariates were: age, body mass index, and self-efficacy. Multiple regression analyses were run for each dependent variable with just covariates, then a second model including strength, and then a third model including power. The [R.sup.2] values were compared between models. Results. Power explained greater variance than strength in all models. Over and above the covariates, power explained an additional 6% of the variance in the 6MWT, increasing the [R.sup.2] value from .33 to .39; 8% in the stair ascent test, increasing the [R.sup.2] value from .52 to .60; and 3% in the stair descent test, increasing the [R.sup.2] value from .44 to .47. Limitations. The sample demonstrated very good mobility and muscle function scores and may not be indicative of those with severe knee OA. Conclusions. In adults with knee OA, knee extensor power was a stronger determinant of walking and stair performance when compared with knee extensor strength. Clinicians should consider these results when advising patients on exercise to maintain or improve mobility., Osteoarthritis (OA) is a chronic musculoskeletal disease that affects the articular cartilage of lower limb joints. Approximately 13 0% of Canadians live with this disease, (1) with incidence rates that [...]

Background. Comparative effectiveness research (CER) requires valid outcome measures that discriminate patients by risk factors in similar ways across settings. Standardized functional status (FS) measures in physical therapy are used routinely in multiple countries, creating the potential for CER among countries. Objective. The purpose of this study was to assess known-groups construct validity of a knee-specific FS measure within and between 2 countries for patients receiving outpatient physical therapy due to knee impairments. Design. This was a longitudinal, observational cohort study. Methods. The participants were 4,972 and 2,964 adult (age ≥ 18 years) patients with knee impairments from Israel and the United States, respectively. Differences in patient characteristics between the 2 countries were assessed using chi-square statistics and 2-sample t tests, as appropriate. Known-groups validity within and between the countries was assessed using 2-way analysis of covariance predicting FS at discharge, with sex, age, symptom acuity, surgical and exercise history, intake medication use, and country as risk-adjustment factors. Intake FS was the covariate. To compare how FS discriminated patient groups between countries, each factor was tested separately with models including an interaction term between the factor and country. Results. Patients were different between countries but had similar discharge FS trends, including: higher outcomes in patients who were male, were younger, had acute conditions, had one surgical procedure related to their knee impairment, were more physically active, and did not use related medication at admission. Interactions were not significant for sex, symptom acuity, and exercise history but were significant for age, surgical history, and medication use. Limitations. Although strict patient selection criteria were set, some patient selection bias still might have existed. Conclusions, The results demonstrated the knee FS measures would be valid for use in CER between Hebrew-speaking patients (Israel) and English-speaking patients (United States)., Construct validity often is used in health sciences to test validity of measures when no criterion standard exists. In the absence of a gold standard, a construct validation process is [...]

Background: Methods are needed to improve pediatricians' skills for physical examination of the ankle and knee. Objective: To compare the effect of 2 methods of teaching the physical examination of the ankle and knee on the knowledge and skills of pediatricians. Design: Prospective intervention trial with preintervention and postintervention tests. Setting: Pediatricians' offices. Participants: Twenty-three practice groups of community pediatricians, including 75 pediatricians (74% of the eligible sample). Interventions: Practice groups were assigned by clustered randomization to 1 of 2 teaching interventions: (1) a videotape showing correct performance of the ankle and knee physical examinations (videotape only; 15 groups) and (2) the same videotape plus a skills building session (18 groups). The randomization was stratified by practice size. Main Outcome Measures: Knowledge of ankle and knee examinations and ankle and knee physical examination skills, assessed by means of a Clinical Skills Assessment Examination (CSAE), at 18 weeks. Results: The pediatricians' baseline mean ankle CSAE score was 26% correct in both groups. These scores improved to 44% and 59% correct in the videotape and videotape plus skills instruction groups, respectively, at 18 weeks (P Conclusions: Pediatricians' skills were lacking at baseline. Both teaching interventions were associated with improved skills and knowledge.

Knee injuries are painful and disabling and can result in lifelong dysfunction. A comprehensive knee examination is essential if you're to identify the cause of knee pain and appropriately guide [...]

The purpose of this study was to examine the intratester and intertester reliability for goniometric measurements of knee flexion and extension passive range of motion (PROM). In addition, parallel-forms reliability for PROM measurements of the knee obtained by use of a goniometer and by visual estimation was examined. The intertester reliability for visual estimates of the PROM of the knee was also examined. Repeated measurements were obtained on 43 patients in a clinical setting. The intraclass correlation coefficients (ICCs) for intratester reliability of measurements obtained with a goniometer were .99 for flexion and .98 for extension. Intertester reliability for measurements obtained with a gooniometer was .90 for flexion and .86 for extension. The ICCs for parallel-forms reliability for measurements obtained with a goniometer and by visual estimation ranged from .82 to .94. The intertester reliability for measurements obtained by visual estimation was .83 for flexion and .82 for extension. Results suggest clinicians should use a goniometer to take repeated PROM measurements of a patient&apos;s knee to minimize the error associated with these measurements. [Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion in a clinical setting. Phys Ther. 1991; 71:90-97.] Key Words: Kinesiology/biomechanics, lower extremity; Lower extremity, knee; Tests and measurements, range of motion., Physical therapists frequently assess passive range of motion (PROM) of the knee as part of their examination of patients with knee complaints. The universal goniometer is frequently used to measure [...]

Table of Contents Abstract Anatomy Technique References Abstract A good exposure to access the knee joint is vital in the successful completion of a Total Knee Arthroplasty(TKA).Various approaches has been [...]

Table of Contents Abstract Case Report Discussion References Abstract A previously fit and well eighteen year old girl presented with a painful, swollen, locked knee following minimal trauma. The pain [...]

For patients who have osteoarthritis (OA) of the knee, even a small misalignment of the joint increases the risk of disease progression, suggests a prospective longitudinal cohort study that followed [...]