Knee Confidence Research Articles

Knee confidence in youth and young adults at risk of post-traumatic osteoarthritis 3–10 years following intra-articular knee injury

ObjectivesTo examine differences in knee confidence between individuals with a history of youth sport-related knee injury and uninjured controls. DesignHistorical cohort study. MethodsParticipants include 100 individuals who sustained a youth sport-related intra-articular knee injury 3–10 years previously and 100 age-, sex- and sport-matched uninjured controls. Outcomes included: Knee confidence (Knee Osteoarthritis and Outcome Score); fat mass index (FMI; dual-energy X-ray absorptiometry); and weekly physical activity (modified Godin–Shephard Leisure Time Questionnaire). Mean within-pair differences (95% CI) were calculated for all outcomes. Unadjusted and adjusted (FMI and physical activity) conditional (matched-design) logistic regression (OR 95% CI) examined the association between injury history and knee confidence. ResultsMedian age of participants was 22 years (range 15–26) and median age at injury was 16 years (range 9–18). Forty-nine percent (95% CI; 39.0, 59.0) of previously injured participants were bothered by knee confidence, compared to 12% (5.5, 18.5) of uninjured participants. Although there was no between group difference in physical activity, injured participants had higher FMI compared to controls (within-pair difference; (95% CI): 1.05kg/m2; (0.53, 1.57)). Logistic regression revealed that injured participants had 5.0 (unadjusted OR; 95% CI; 2.4, 10.2) and 7.5 times (adjusted OR; 95% CI: 2.7, 21.1) greater odds of being bothered by knee confidence than controls. ConclusionsKnee confidence differs between individuals with a previous youth sport-related knee injury and healthy controls. Knee confidence may be an important consideration for evaluating osteoarthritis risk after knee injury and developing secondary prevention strategies.

Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis

Background and purpose — No consensus exists on when to perform arthroscopic partial meniscectomy in patients with a degenerative meniscal tear. Since MRI and clinical tests are not accurate in detecting a symptomatic meniscal lesion, the patient’s symptoms often play a large role when deciding when to perform surgery. We determined the prevalence and severity of self-reported knee symptoms in patients eligible for arthroscopic partial meniscectomy due to a degenerative meniscal tear. We investigated whether symptoms commonly considered to be related to meniscus injury were associated with early radiographic signs of knee osteoarthritis.Patients and methods — We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged 35–65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least “mild” considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients.Results — At least monthly knee pain, pain during stair walking and when twisting on the knee, and lack of confidence in knee was present in at least 80% of the patients. Median severity was at least moderate for knee pain, pain when twisting on the knee, pain walking on stairs, lack of confidence in knee, and clicking. Mechanical symptoms such as catching were rare. Early radiographic signs of osteoarthritis were associated with an increased risk of self-reported swelling, catching, and stiffness later in the day; the odds ratio was 2.4 (95% CI 1.2–4.9), 2.3 (1.2–4.3), and 2.3 (1.1–5.0), respectively.Interpretation — Middle-aged patients with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not distinguish those with a meniscal tear alone from those with early radiographic knee OA. Our findings support the notion that symptoms reported by those with a degenerative meniscal tear represent early signs of knee osteoarthritis.

The effect of soft brace on self-reported knee instability and confidence, pain and physical function in patients with knee osteoarthritis

The effect of soft brace on self-reported knee instability and confidence, pain and physical function in patients with knee osteoarthritis

Association between sensory function and hop performance and self-reported outcomes in patients with anterior cruciate ligament injury.

BackgroundIn patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferable. In contrast to kinesthesia, vibration sense is not well studied in these patients.Objectives1) To study the association between kinesthesia and vibration sense to investigate if one sensory measurement can replace the other; and 2) to determine the clinical relevance by investigating associations between the sensory measurements and functional performance and patient-reported outcomes in patients with ACLD or ACLR.MethodsTwenty patients with ACLD and 33 patients with ACLR were assessed with knee kinesthesia, vibration sense, the one-leg hop test for distance, as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale.ResultsThere were no significant correlations between kinesthesia and vibration sense (r= −0.267, p>0.269) or between the sensory measures and hop performance (r= −0.351, p>0.199). In patients with ACLD, worse knee kinesthesia was associated with worse scores on KOOS subscales pain (r= −0.464, p=0.046) and activities of daily living (r= −0.491, p=0.033), and worse vibration sense was associated with worse scores on KOOS subscale quality of life (r= −0.469, p=0.037) and worse knee confidence (item Q3 from subscale quality of life) (rs=0.436, p=0.054). In patients with ACLR, worse vibration sense was associated with worse scores on KOOS subscales pain (r= −0.402, p=0.020) and activities of daily living (r= −0.385, p=0.027).ConclusionKinesthesia and vibration sense cannot be used interchangeably as measures of sensory function in patients with ACLD or ACLR. Both sensory measurements were weakly related to hop performance. Adequate sensory function appears to have importance for perceived function in patients with ACLD or ACLR and may therefore be a factor that needs to be addressed in rehabilitation programs for these patients.

The Association Between Knee Confidence and Muscle Power, Hop Performance, and Postural Orientation in People With Anterior Cruciate Ligament Injury.

Study Design Cross-sectional. Background The association between muscle function and lack of knee confidence in people with anterior cruciate ligament (ACL) injury has not been well investigated. Such knowledge would help in the design of training programs for this population. Objective To investigate associations between self-reported knee confidence and muscle function in patients with ACL injury. Methods Cross-sectional data from 54 patients (mean age, 30 years; range, 20-39 years; 28% women) with ACL injury, treated with training and reconstructive surgery (n = 36) or training only (n = 18), were assessed 3 ± 1 years after injury. Univariate and multivariable ordinal regression analyses were conducted to test the association between the patient's knee confidence (question 3 from the Knee injury and Osteoarthritis Outcome Score as the dependent variable) and performance on tests of muscle power, hop performance, and postural orientation (test for substitution patterns score) as independent variables (absolute value on the injured leg, and limb symmetry index [LSI; injured leg/uninjured leg × 100] or absolute difference between the injured and uninjured legs). Results Sixteen patients reported no trouble with lack of knee confidence, 24 mild trouble, 10 moderate trouble, and 4 severe or extreme trouble. Univariate analyses revealed significant associations between worse knee confidence and lower (worse) LSIs for knee extension power, vertical jump, and side hop, and worse test for substitution patterns scores. In the multivariable analysis, worse vertical jump LSI (P = .043) and worse side hop LSI (P = .012) significantly accounted for 25% of the variation in perceived knee confidence. Conclusion Between-leg differences during demanding tasks are associated with knee confidence in individuals with ACL injury. J Orthop Sports Phys Ther 2016;46(6):477-482. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6374.

Knee confidence: An important consideration in youth and young adults at risk of post-traumatic osteoarthritis 3–10 years following intra-articular knee injury

Purpose: An individual’s confidence in the weight bearing role of the knee may be fundamental in guiding their decisions about physical activity (PA) participation. In people with knee osteoarthritis (OA), low knee confidence has been associated with fear of movement, increased pain, and decreased strength. Little is known about knee confidence and the long-term influence it may have on the behaviours of young adults with a history of knee joint injury that are at high risk of post-traumatic osteoarthritis (PTOA). In addition, the association between knee confidence and other modifiable risk factors for OA such as body composition and PA participation have not been examined in this population. The aim of this investigation was to examine knee confidence in youth and young adults who have sustained a sport-related intra-articular knee injury in their youth compared to age, sex, and sport-matched uninjured controls, adjusting for body composition and PA participation. Methods: This historical cohort study included 200 youth and young adults (15–26 years; 55% female), 100 who sustained a sport-related intra-articular knee injury 3–10 years previously [median injury age (range); 16 (9–18) years] and 100 uninjured controls matched on age, sex and sport history. Knee confidence was based on a question from the Quality of Life subscale within the Knee Osteoarthritis and Outcome Score questionnaire (KOOS): “How much are you troubled by lack of confidence in your knee?” It was measured on a 5-point likert scale (not at all, mildly, moderately, severely, or extremely) then dichotomized into ‘not at all’ or ‘bothered to some degree’ for the main analysis. Body composition was assessed by fat mass index (total fat relative to height2; FMI; kg/m2) and measured using dual-energy x-ray absorptiometry. PA participation was obtained via the modified Godin-Shepard Leisure Time Questionnaire (total minutes/week). Study groups were compared using descriptive statistics (mean within-pair difference; 95% confidence interval [95%CI]). In the final model, multivariable conditional logistic regression (odds ratio; 95% CI) was used to examine the association between injury group and knee confidence adjusting for FMI (kg/m2) and PA participation (min). Results: Among the injured participants, 49% (95%CI; 39, 59) were bothered to some degree by lack of knee confidence (37%=mildly, 7%=moderately, 4%=severely, and 1%=extremely), compared to 12% (95%CI; 5.5, 18.5) of controls (11%=mildly, 1% moderately.) Injured participants had higher FMI compared to controls [mean within pair difference=1.05 kg/m2 (95% CI; 0.53, 1.57)], however the duration of total PA/week did not differ between study groups [mean within pair difference = −6.4 min (95% CI; −28.9, 16.2)]. The univariate analysis revealed injured participants were 5.0 times more likely to be bothered by knee confidence than controls [OR= 5.0 (95%CI=2.4, 10.2)]. In the final multivariable model, the odds of low knee confidence in the injured participants was 7.5-fold that in the uninjured controls [OR=7.5 (95%CI=2.7, 21.1)], where as no association was found between knee confidence and FMI (OR=0.98 (95%CI=0.70, 1.36)] or total PA week [OR=1.0 (95%CI=1.0, 1.0)]. Conclusions: Knee confidence may be important when evaluating PTOA risk. A greater appreciation of psychological factors, including knee confidence, will inform the development of secondary prevention strategies for PTOA. Injured participants had a higher FMI than uninjured controls suggesting this could be another modifiable risk factor for further consideration. It is recommended that additional research evaluating the association of knee confidence and objectively measured PA and other clinical outcomes will inform a more comprehensive understanding of risk factors for PTOA.

A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative

Purpose: The Good Life with osteoArthritis in Denmark (GLA:D) Initiative is an evidence-based treatment programme for patients with knee and hip osteoarthritis (OA). It incorporates training physiotherapists to deliver care in accordance with the clinical guidelines by educating patients on their condition and by delivering supervised neuromuscular exercises to relieve pain and improve function. The importance of self-efficacy, and confidence in exercise, to exercise adherence has not been reported for the GLA:D population. In addition, worse knee confidence in people with knee OA is associated with higher pain and greater perceived knee instability. The aims of this study were to investigate the association between knee confidence and self-efficacy in patients with knee OA in the GLA:D registry; and to explore patients’ perception of their experiences with the GLA:D programme, and whether confidence and self-efficacy has a role to play in continuing with the GLA:D exercises in the long-term. Methods: This study used a mixed methods design. Patients with knee OA who were offered at least two educational sessions and six weeks of GLA:D exercise programme between January–March 2015 were identified from the GLA:D registry (n = 484) and sent an online survey. Ordinal regression analyses were performed. Knee confidence, assessed using the Knee injury and Osteoarthritis Outcomes Score (KOOS; quality of life subscale, question 3), was the dependent variable and self-reported measures for exercise self-efficacy; arthritis self-efficacy; multidimensional outcomes expectations for exercise; and KOOS pain and activities of daily living (ADL) were the independent variables. Knee confidence score ranged from 0–4 with 0 indicating higher knee confidence. The independent variables ranged from 0–10 or 0–100 with 0 indicating worse symptoms or confidence. Subsequently, semi-structured interviews (n = 4) were used to explore patients’ perceived confidence and adherence to the GLA:D exercises. Interviews were transcribed verbatim, and analysed using interpretative phenomenological analysis. Results: 200 patients (41.3%) responded to the survey. At 7–10 months following treatment initiation, 9.5% of patients were not at all troubled by lack of knee confidence; 39.5% were mildly troubled; 31.5% were moderately troubled; 15.5% were severely troubled; and 4% were extremely troubled. Patients with higher arthritis self-efficacy score were more likely to have higher knee confidence (odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.63, 0.93; P = 0.007). Patients with higher KOOS ADL score were more likely to have higher knee confidence, although this association was small (OR = 0.96; 95% CI 0.93, 0.99; P = 0.006). No association was found between knee confidence and exercise self-efficacy (OR = 1.00; 95% CI 0.99, 1.01; P = 0.90). Patients reflected on seeing great improvements in their confidence, pain and mobility with the programme. They felt their symptoms got worse if they did not keep up with the exercises. Patients reflected on the importance of continued contact with their physiotherapist after the 6-week programme for further motivation and reassurance. One of the barriers that discouraged patients from continuing with the exercises in the long-term was the cost for additional GLA:D exercise classes with their physiotherapist. Conclusions: Patients are troubled by the lack of knee confidence after the GLA:D exercise programme; they reflected this was due to their negative experiences prior to entering the GLA:D programme. Arthritis self-efficacy and KOOS ADL were significantly associated with knee confidence, but no association was found with exercise self-efficacy. Patients from the interview reflected that maintaining contact with their physiotherapist was an important factor to motivate them to continue exercising.

Gait Characteristics of People with Lateral Knee Osteoarthritis after ACL Reconstruction

Lateral knee osteoarthritis (OA) is common after anterior cruciate ligament reconstruction (ACLR), yet gait characteristics associated with lateral knee OA after ACLR are not well understood. This cross-sectional study aimed to compare knee, trunk, pelvis, hip, and ankle kinematics and moments between people with predominant lateral knee OA after ACLR and healthy controls. Nineteen post-ACLR people with lateral knee OA and 25 healthy controls were recruited. Quantitative gait analysis was conducted during walking, and knee pain, confidence, and kinesiophobia were assessed. Between-group differences in peak kinematics and moments were evaluated, and Pearson correlations evaluated relations between biomechanical and patient-reported measures (P < 0.05). Participants with lateral knee OA after ACLR had greater peak knee flexion (mean difference, 3.5°; 95% confidence interval, 0.9-6.1) and lower knee internal rotation angles (-3.3°; -6.2 to -0.5) than the controls. Those with lateral knee OA also had greater peak pelvic anterior tilt (3.1°, 0.4-5.9), hip flexion angles (5.1°, 1.9-8.3), and peak ankle dorsiflexion moment (0.1 N·m·kg(-1), 0.0-0.2). In the lateral knee OA group, worse knee confidence and kinesiophobia were significantly correlated with greater peak trunk flexion angle (r = 0.654 and r = 0.535, respectively) and greater knee pain was significantly correlated with greater peak knee flexion angle (r = 0.535). Gait characteristics associated with lateral knee OA after ACLR differ from those in healthy individuals, predominantly in the sagittal plane. Increased sagittal plane knee and trunk kinematics seem to be related to worse knee pain, confidence, and kinesiophobia. These findings will assist the development of compartment-specific interventions for individuals with posttraumatic lateral knee OA.

Knee Confidence as It Relates to Self-reported and Objective Correlates of Knee Osteoarthritis: A Cross-sectional Study of 220 Patients.

Cross-sectional study. The objective was to validate, if possible, previously reported associations and to investigate other potential associations between knee confidence and various self-reported and objective measures in an independent cohort of patients with knee osteoarthritis (OA). Lack of knee confidence is a frequent symptom in patients with knee OA, but little is known of associations between knee confidence and other common correlates of knee OA. Baseline data from 220 patients with knee OA were applied in ordinal regression analyses, with knee confidence, assessed using item Q3 of the Knee injury and Osteoarthritis Outcome Score, as the dependent variable and self-reported (pain on walking, general health, fear of movement, self-efficacy, function, and previous serious injury) and objective measures (muscle strength, 20-m walk time, and radiographic severity of tibiofemoral OA) as predictor variables. Most (95%) of the participants reported lack of knee confidence, and 54% experienced severe or extreme lack of knee confidence. Fear of movement (odds ratio [OR] = 2.06; 95% confidence interval [CI]: 1.15, 3.68), pain on walking (OR = 1.21; 95% CI: 1.09, 1.34), and general health (OR = 0.024; 95% CI: 0.002, 0.259) explained 19% of the variance in knee confidence (P<.001). Severe lack of knee confidence is a common finding in individuals with knee OA. Pain on walking was confirmed as a correlate of knee confidence, whereas muscle strength was not. Fear of movement and poor general health were new variables associated with lack of knee confidence. The noncorrelations or poor correlations with other tested variables suggest that a lack of knee confidence may represent an independent treatment target in knee OA of importance to improve mobility. Trials registered at ClinicalTrials.gov (NCT01410409 and NCT01535001).

Knee Instability and Basic and Advanced Function Decline in Knee Osteoarthritis.

Manifestations of instability in knee osteoarthritis (OA) include low overall knee confidence, low confidence that the knees will not buckle, buckling, and excessive motion during gait. Confidence and buckling may particularly influence activity choices, contributing to events leading to disability. Buckling is more likely to affect advanced than basic functional tasks. In this prospective longitudinal study, we tested the hypothesis that overall knee confidence, buckling confidence, buckling, and frontal plane motion during gait are associated with advanced 2-year function outcomes in persons with knee OA. Persons with knee OA were queried about overall knee confidence (higher score = worse confidence), buckling confidence, and knee buckling, and underwent quantitative gait analysis to quantify varus-valgus excursion and angular velocity. Physical function was assessed using the Late-Life Function and Disability Instrument Basic and Advanced Lower Extremity Domain scores. Logistic regression was used to evaluate the relationship between baseline instability measures and baseline-to-2-year function outcome, adjusting for potential confounders. The sample was comprised of 212 persons (mean age 64.6 years, 76.9% women). Buckling was significantly associated with poor advanced function outcome (adjusted odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.03-4.20) but not basic function outcome. Overall knee confidence was significantly associated with advanced outcome (adjusted OR 1.65, 95% CI 1.01-2.70), while associations between buckling confidence and both outcomes approached significance. Neither varus-valgus excursion nor angular velocity during gait was associated with either outcome. Knee buckling and low knee confidence were each associated with poor 2-year advanced function outcomes. Current treatment does not address these modifiable factors; interventions to address them may improve outcome in knee OA.

Assessing Improvement in Diagnostic Knee Arthroscopic Skill During the AAOS Fundamentals of Knee and Shoulder Arthroscopy Course for Orthopaedic Residents

Objectives:The purpose of the AAOS Fundamentals of Knee and Shoulder Arthroscopy Course for Orthopaedic Residents is to provide an opportunity for orthopaedic trainees to practice and improve basic arthroscopic surgical skills. During the course, residents spend the majority of their time in the Orthopaedic Learning Center laboratory performing basic arthroscopic procedures on cadaveric specimens under the direction of an expert faculty. Residents are also exposed to various didactic lectures during this intensive three-day course. Historically, feedback from the course has been extremely positive from both resident participants and faculty, however no attempt has previously been made to more objectively determine the degree to which improvement in resident skill has occurred. The purpose of this study is to determine whether participation in the AAOS Fundamentals of Arthroscopic Surgery Course for Residents led to improved diagnostic knee arthroscopy performance. We hypothesized that scores on post course assessments of knee arthroscopy skills and confidence would be higher in comparison to scores on the same assessments prior to the course.Methods:46 orthopaedic surgical residents enrolled in the AAOS Fundamentals of Arthroscopic Surgery Course volunteered to participate in the study. Participants were asked to perform a diagnostic knee arthroscopy on a cadaveric knee specimen both before and immediately after the conclusion of the knee portion of the course. Diagnostic knee arthroscopy performance was assessed using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Residents were also assessed before and after the course using the TolTech virtual reality simulator which enables the objective assessment of several measures that correlate with arthroscopic proficiency. Confidence, before and after the course, for several arthroscopic procedures was also assessed via a self-reported questionnaire.Results:Following the course, residents demonstrated a 9.2% improvement in mean ASSET score (p=0.001). ASSET score improved most (13.2%) for those with less than 20 arthroscopic cases (p=0.007). On the TolTech virtual reality simulator, mean scores demonstrated significant improvements for multiple measures of proficiency including: Time, which improved 18% (p=.01), Arthroscope path distance, which improved 13% (p=.02), Probe path distance, which improved 16% (p=.05), Smoothness, which improved 10% (p=.001), and excessive probe pressure, which improved 440% (p=.02). Overall completeness improved 1.8%, but this was not significant (p=0.11). Confidence in performing arthroscopic partial menisectomy improved 13% (p=.002) and confidence in performing ACL reconstruction improved 9% (p=.01).(Table 1).Conclusion:It was feasible to assess several outcomes related to resident proficiency and confidence within the structure of the AAOS Fundamentals of Arthroscopic Surgery Course. Resident participation in the course resulted in modest improvements for many of the outcomes measured demonstrating the value of this and similar courses. This data will be critically evaluated to determine curricular changes in an effort to maximize course benefit for future participants.

Effects of an unloader knee brace on knee-related symptoms and function in people with post-traumatic knee osteoarthritis after anterior cruciate ligament reconstruction

Background and purposeThis pilot study evaluated the immediate and four-week effects of an unloader knee brace on knee-related symptoms and performance-based function in people with knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). MethodsIndividuals with knee OA, five to 20years post-ACLR, were recruited for two within-subject randomized studies: immediate effects (n=18) and four-week effects (n=11). Patient-reported knee-related symptoms (knee pain, perceived task difficulty, confidence, stability) were assessed during hop for distance and step-down tests, while performance-based function was assessed with hopping distance under three conditions: i) no brace; ii) unadjusted brace (sagittal plane support); and iii) adjusted brace (sagittal plane support with varus/valgus readjustment). Participants in the four-week brace effect study were randomized to wear the unadjusted or adjusted brace for four weeks after baseline (no brace) testing, and repeated tests in their allocated brace at four-week follow-up. Friedman tests evaluated differences between the three brace conditions for each variable for the immediate brace effect study (p<0.05), and Wilcoxon signed-rank tests evaluated differences between no brace and allocated brace for the four-week study (p<0.05). ResultsThe adjusted and unadjusted unloader braces produced immediate improvements in knee confidence during hop for distance, and knee pain during step-down. Following the four-week brace intervention, the allocated brace improved knee confidence, perceived task difficulty and stability during hop for distance; and knee pain, perceived task difficulty, confidence, and stability during step-down. ConclusionsThe unloader knee brace, adjusted or unadjusted, has the potential to improve knee-related symptoms associated with knee OA after ACLR.

Lack of Confidence, Strength and Hop Performance in Young Adults 3 Years post-ACL Reconstruction

Psychosocial factors after anterior cruciate ligament reconstruction (ACLR) are garnering increased attention for their role in knee function and return to sport. Lack of confidence has been related to decreased knee function, yet the effects of confidence on strength and hop performance in younger adults following ACLR are not well defined. PURPOSE: To compare quadriceps strength and hop test performance between individuals who are confident and those who lack confidence in their knee 3 years after ACLR. METHODS: 45 individuals 3 years post ACLR (22 males, 23.2±5.0 years, BMI 25.0±3.8) participated. Based on their Likert scale response to the question “How much are you troubled with lack of confidence in your knee?” from the Knee Injury and Osteoarthritis Outcome Score (KOOS), participants were divided into “Confident” and “Not Confident” groups [Confident answered “not at all” (n=27) vs. not confident answered “mildly” or “moderately” (n=18)]. Quadriceps strength was quantified as the peak of 3 maximal volitional isometric contractions at 60° knee flexion for the involved and uninvolved limbs. A clinical hop testing battery was performed: 3 tests for distance [single hop (SH), triple hop (TrH), triple crossover hop (CH)] and 1 test for time [timed 6 meter hop (TiH)]. Three trials were performed and averaged for each limb. The hop and strength data were log transformed to satisfy normality assumptions and compared with analyses of variance and covariance. RESULTS: Quadriceps strength was not different between groups. Confident individuals performed better on all hop tests except the involved SH [Mean difference (cm or sec), p-value; Involved: SH 17.3, p=.09; TrH 69.3, p=.05; CH 74.8, p=.017; TiH 0.24, p=.025; Uninvolved: SH 22.8, p=.017; TrH 77.8, p=.017; CH 73.8, p=.031; TiH 0.30, p=.008]. After controlling for height, weight and quadriceps strength, differences between groups persisted for the involved CH (p=.036) and TiH (p=.05), and uninvolved SH (p=.03), and TiH (p=.05). CONCLUSIONS: Those who lacked confidence had worse hop performance 3 years after ACLR. Although quadriceps strength was not different between groups, controlling for strength affected the differences in hop performance between groups. The interplay between strength, hop performance and confidence requires further investigation. Supported by NIH 5RO1AR053684 (KPS) and OSU Sports Medicine, Sports Health and Performance Institute (SHPI) Grant (LCS).

Triangular fibrocartilage complex injury accompanied by distal radius fracture

Triangular fibrocartilage complex injury accompanied by distal radius fracture

Return to sport and quality of life in people with knee symptoms 5–20 years following anterior cruciate ligament reconstruction

Introduction:Anterior cruciate ligament reconstruction (ACLR) can result in psychological and physical impairments that impact on participation in desired activities and sports. To date, no study has explored the impact of sports restrictions on quality of life (QOL) in people with knee symptoms following ACLR. The aims of this study were to (i) quantify QOL; and (ii) explore relationships between participant characteristics, sport-related factors and QOL 5–20 years following ACLR. Methods: We conducted a cross-sectional analysis on 139 individuals with knee pain, stiffness or activity limitations 5–20 years following ACLR. Participants were recruited from surgical records of four experienced orthopaedic surgeons. All patients aged 18–55 years who had a hamstring or patellar-tendon autograft ACLR 5–20 years ago were invited to participate. People with significant comorbidities and those not fluent in English were excluded. Participants completed the Anterior Cruciate Ligament QOL Questionnaire (ACL-QOL), Knee injury andOsteoarthritis Outcome Score (KOOS) and a demographics questionnaire. KOOS and ACL-QOL scores range from 0 (worst) to 100 (best). KOOS cut-off criteria were applied to ensure all participants were symptomatic. Spearman rank correlations explored relationships between participant characteristics, return to sports information and QOL. Results: A total of 139 participants completed the questionnaires at a mean 9 years (range 5–20) following ACLR. Participants had a mean age of 38 years (range 20–55), a mean BMI of 27 (range 19–43) and 42% were female. Participants scored a mean 55±20on theKOOS-QOL subscale and57±21on theACL-QOL. The most impaired ACL-QOL itemswere sport/recreational frustrations (33±31), playing sport under caution (36±35) and fear of contact sports (35±37). The least impaired ACL-QOL subscale was workrelated concerns (78±22). Returning to sport at a lower level (27%) or not returning to sport (34%) was correlated with poor KOOSQOL scores (r=0.32, p<0.01). Reporting the knee as the reason for not returning to the same level of sport (77%) was correlated with competitive needs not being met (r=0.25, p=0.01) and poor knee confidence (r=0.20, p=0.05). Pain-free sport or exercise participation was considered preferable (78%) to pain-free participation in work (2%), family (15%) or social activities (5%). Discussion: The ability to participate in sport and exercise appear to be a high priority and is associatedwith QOL impairment in peoplewith knee symptoms 5–20 years after ACLR. Knee-related QOL was considerably lower than population norms. Addressing knee confidence, sport-related concerns, frustrations and fearsmay assist in improving QOL following ACLR.

Is impaired knee confidence related to worse kinesiophobia, symptoms, and physical function in people with knee osteoarthritis after anterior cruciate ligament reconstruction?

To compare knee confidence and kinesiophobia (fear of re-injury) in those with and without knee osteoarthritis following anterior cruciate ligament reconstruction, and determine whether poorer knee confidence is associated with greater kinesiophobia, worse knee-related symptoms, and functional impairments in those with knee osteoarthritis. Cross-sectional. Sixty-six individuals, 5-12 years following anterior cruciate ligament reconstruction, with (n=30) and without (n=36) knee osteoarthritis were included. Knee injury and Osteoarthritis Outcome Score quality-of-life question (Q3), assessed knee confidence and Tampa Scale of Kinesiophobia assessed kinesiophobia. In the osteoarthritis group, knee-related symptoms (International Knee Documentation Committee and Anterior Knee Pain Scale), self-reported function (Knee injury and Osteoarthritis Outcome Score activities daily living), sport/recreation (Knee injury and Osteoarthritis Outcome Score-sport and recreation), and performance-based function (hopping, one leg rise tasks) were assessed. Between-group differences in knee confidence and kinesiophobia were evaluated with the Chi square test and analysis of variance, respectively. In the osteoarthritis group, between-group differences (none, mild/moderate and severe/extreme problems with knee confidence) in kinesiophobia, symptoms and function were determined with analysis of variances: p<0.05. Following anterior cruciate ligament reconstruction, participants with knee osteoarthritis had significantly worse knee confidence (p=0.010) and greater kinesiophobia (p=0.006) than those without osteoarthritis. In those with knee osteoarthritis, poorer knee confidence was significantly associated with worse symptoms (Anterior Knee Pain Scale, p=0.001; International Knee Documentation Committee, p<0.001), kinesiophobia (p=0.030), Knee injury and Osteoarthritis Outcome Score-activities of daily living (p=0.005), Knee injury and Osteoarthritis Outcome Score-sport and recreation (p=0.001), single-leg hop (p=0.011), side-to-side hop (p=0.013) and one leg rise (p=0.001). Psychological impairments are evident in people with knee osteoarthritis following anterior cruciate ligament reconstruction, compared to those without. Future studies should further investigate the psychological impairments associated with knee osteoarthritis after anterior cruciate ligament reconstruction.

Association of Knee Confidence With Pain, Knee Instability, Muscle Strength, and Dynamic Varus–Valgus Joint Motion in Knee Osteoarthritis

To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001). Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target.

A comparison of knee extensor and hip abductor torque, pain, stifness and physical function between healthy and men with early knee osteoarthritis

A comparison of knee extensor and hip abductor torque, pain, stifness and physical function between healthy and men with early knee osteoarthritis

Knee confidence is associated with self-rated health and fear of moving but not with self-efficacy and radiographic severity – a cross-sectional study in knee osteoarthritis

Knee confidence is associated with self-rated health and fear of moving but not with self-efficacy and radiographic severity – a cross-sectional study in knee osteoarthritis

The association between knee confidence and muscle power, hop performance, and movement quality in people with anterior cruciate ligament injury at high risk of knee osteoarthritis

The association between knee confidence and muscle power, hop performance, and movement quality in people with anterior cruciate ligament injury at high risk of knee osteoarthritis