Knee Extension Range Of Motion Research Articles

INCLINOMETERS AND APPS ARE BETTER THAN GONIOMETERS. MEASURING KNEE EXTENSION RANGE OF MOTION IN ANTERIOR CRUCIATE LIGAMENT PATIENTS. RELIABILITY AND MINIMAL DETECTABLE CHANGE FOR THE THREE DEVICES.

Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. Three common goniometric devices: a universal goniometer, an inclinometer, and a Smartphone app. During a single visit, knee extension ROM was measured in both knees of 92 ACL injured or reconstructed patients by two testers blinded to the other's measures. Intra-rater, inter-rater, and test-retest Intraclass Correlation Coefficients (ICC2,1) were calculated. Intra-rater ICC(2,1) was excellent for the three devices ranging from 0.93-0.96, with the smartphone app yielding the best results (ICC(2,1)=0.96, [95%CI:0.89-0.95]). Inter-rater ICC(2,1), however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95%CI:0.71-0.86) and 0.79 (95%CI:0.70-0.86) respectively, whereas the universal goniometer was 0.36 (95%CI:0.17-0.53). Test-retest ICC(2,1) for the inclinometer was 0.89 (95%CI:0.84-0.93), 0.86 (95%CI:0.79-0.91) for the app, and 0.83 (95%CI:0.74-0.89) for the goniometer. The intra-rater, inter-rater, and test-retest MDC95 values ranged from 1.6° to 3.5°, 3.7° to 10.4 and 2.6° to 5.4° respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its ease of use compared to the smartphone app.

Lower Extremity Kinematic and Kinetic Characteristics as Effects on Running Economy of Recreational Runners.

Determine associations between running economy (RE) and running sagittal plane kinematic and kinetic parameters. A total of thirty male recreational runners (age: 21.21 ± 1.22 years, VO2max: 54.61 ± 5.42 ml·kg-1·min-1) participated in two separate test sessions. In the first session, the participant's body composition and RE at 10 and 12 km·h-1 were measured. In the second session, measurements were taken for the sagittal plane of hip, knee, and ankle angles and range of motion (ROM), as well as ground reaction force. Moderate correlations were found between lower energy costs at 12 km·h-1 and smaller hip flexion at toe-off (r = 0.373) as well as smaller peak hip flexion during stance (r = 0.397). During the swing phase, lower energy costs at 10 km·h-1 were moderately correlated with smaller peak knee flexion and smaller knee flexion and extension ROM (r = 0.366 ~ 0.443). Lower energy costs at 12 km·h-1 were moderately correlated with smaller peak hip and knee flexion as well as knee extension ROM (r = 0.369 ~ 0.427). In terms of kinetics, there was a moderate correlation between higher energy costs at 10 km·h-1 and larger peak active force, as well as larger peak braking and propulsion force (r = -0.470 ~ 0.488). Lower energy costs at 12 km·h-1 were moderately to largely correlated with smaller peak impact and braking force (r = 0.486 and -0.500, respectively). Regarding the statistical parametric mapping analysis, most outcomes showed associations with RE at 10 km·h-1, including knee flexion (42.5% ~ 65.5% of the gait cycle), ankle plantarflexion (32.5% ~ 36% of the gait cycle), active force (30.5% ~ 35% of the stance phase), and propulsion force (68% ~ 72.5% of the stance phase). Lower energy costs at 12 km·h-1 were correlated with smaller hip flexion (5.5% ~ 12% and 66.5% ~ 74%) and smaller knee flexion (57% ~ 57.5%) during the running gait cycle. This study indicates that biomechanical factors are associated with RE in recreational runners. To design effective training methods to improve RE, coaches and runners should focus on the sagittal plane kinematics of the hip, knee, and ankle, as well as lower vertical and horizontal kinetic parameters.

Regional and widespread pain sensitivity decreases following stretching in both men and women – Indications of stretch-induced hypoalgesia

IntroductionThis study aimed to investigate the effect of sex on regional and widespread pain sensitivity following acute bouts of stretching and to investigate the acute effect of stretching on regional and widespread pain sensitivity following stretching. Methods73 healthy adults (36 females; mean age 25.6 ± 6.7 years) with an age range from 19 to 62 years were recruited for this experimental study. Regional and distant pain pressure pain thresholds, passive knee extension range of motion and passive resistive torque were measured before and 30 s after four bouts of 30-s static muscle stretching of the knee flexors with 20-s rest between bouts. ResultsNo significant sex differences were found for pressure pain thresholds (p > 0.132), range of motion (p = 0.446) or passive resistive torque (p = 0.559) between pre-stretch and post-stretch measures. There were significant increases in pressure pain thresholds (p = 0.010), range of motion (p = 0.001) and passive resistive torque (p = 0.007) between pre-stretch and post-stretch measures. ConclusionMuscle stretching significantly decreased regional and widespread pain sensitivity, indicating that central pain-modulating mechanisms are engaged during muscle stretching, resulting in stretch-induced hypoalgesia. Moreover, the results showed that the effect of stretching on regional and widespread pain sensitivity is not sex-specific.

Effects of Compressive Myofascial Release of Vastus Lateralis on Lateral Patellar Tracking in Patients with Knee Osteoarthritis

Knee osteoarthritis is highly prevalent around the world and 4th leading cause of disability. Lateral patellar tracking is a common complain of knee osteoarthritis. It causes Q-angle at knee joint to increase that further leads to gait abnormalities. Objective: To determine the effect of compressive myofascial release of vastus lateralis on lateral patellar tracking in terms of pain, range of motion, and functional disability in patients with knee OA. Methods: This Randomized controlled trial was conducted at the Ahad Medicare Clinic and Physiotherapy Centre, Rawalpindi, spanning from December 2020 to June 2021. In this study, 52 participants were carefully selected using the Open Epi software. These individuals were aged 50 years and above and had previously been diagnosed with Grade 2-3 knee osteoarthritis. Participants were then evaluated for the presence of lateral patellar tracking by measuring Q-angle. After meeting eligibility criteria participants were divided into two groups: the Experimental group (n=26) and the Control group (n=26). Numeric Pain Rating Scale (NPRS), Goniometer, and Western Ontario and McMaster Universities Arthrosis Index (WOMAC) were used to take measurements at baseline and at 15 days follow-up. Results: Statistical analysis revealed a significant difference (p<0.05) between the Experimental and Control groups in terms of pain reduction and knee extension range of motion (ROM). Conclusions: The study's findings revealed that the experimental group exhibited more significant improvements in pain reduction and knee extension compared to the conventional treatment group.

Toward a Better Understanding of Walking Speed in Ataxia of Charlevoix-Saguenay: a Factor Exploratory Study.

Mobility limitations, including a decrease in walking speed, are major issues for people with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). Improving our understanding of factors influencing walking speed in ARSACS may inform the development of future interventions for gait rehabilitation and contribute to better clinical practices. The objective of the study was to identify the factors influencing the self-selected walking speed in adults with ARSACS. The dependent variable of this cross-sectional study was the self-selected speed and the factors (independent variables) were age, sex, balance, balance confidence, knee flexion and extension cocontraction indexes, lower limb coordination, passive range of motion of ankle dorsiflexion, knee and hip extension, and global spasticity. Multiple regression models were used to assess the relationships between walking speed and each factor individually. Six factors were significantly associated with walking speed and thus included in regression models. The models explained between 42.4 and 66.5% of the total variance of the self-selected walking speed. The factors that most influence self-selected walking speed are balance and lower limb coordination. In order of importance, the other factors that also significantly influence self-selected walking speed are ankle dorsiflexion range of motion, lower limb spasticity, knee extension range of motion, and confidence in balance. Balance and lower limb coordination should be targeted in rehabilitation interventions to maintain walking ability and functional independence as long as possible. The six factors identified should also be included in future studies to deepen our understanding of walking speed.

Effect of Low-Level Laser Therapy on Knee Range of Motion and Functional Abilities After Total Knee Arthroplasty.

The aim of this study was to determine the effectiveness of combined low-level laser therapy (LLL) and rehabilitation in patients following recent total knee replacement (TKR). A double-blind randomized controlled study was conducted at the Orthopedic Department of Mansoura University Hospital. Forty-four patients were chosen from a total of 58 patients who met the inclusion criteria and were assigned randomly into control and experimental groups of equal size. Ultimately, 40 patients completed the study (20 from each group). Both groups participated in an intensive functional rehabilitation program, and the experimental group also received LLL therapy around the knee at the incisional line, the medial and lateral intra-articular space, above and below the patella, and at the popliteal fossa at low fluence (6 J/cm2, 650 nm continuous wave) and 60 s per point with a total dose of 48 J per session over 12 treatment sessions for six weeks. Knee range of motion (ROM) was measured with a digital goniometer, and functional abilities were assessed with the Arabic version of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. There were significant differences in all variables pre- and post-treatment within each group. Before treatment, there was no significant difference in any of the measured variables between the groups (P>0.05). After treatment, there were significant differences in knee flexion ROM and WOMAC index (P<0.05)but no significant difference in knee extension ROM between the groups (P>0.05). The addition of low-level laser therapy to a rehabilitation program post-TKR resulted in substantial enhancements in knee flexion range of motion and the WOMAC index.

Development of a clinical prediction rule for mobility status at discharge in patients with total knee arthroplasty: Using a decision tree model

BackgroundTotal knee arthroplasty (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a clinical prediction rule (CPR) to predict mobility after TKA. MethodsThis study included patients undergoing primary TKA. Predictors of outcome included patient characteristics, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of decision tree analysis was used for developing a CPR. ResultsOf the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853. ConclusionWe have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting.

Comparison of Impairments, Activity Limitations, Balance, and Quality of Life between Patients with and without Meniscus Repair or Partial Meniscectomy Post-ACL Reconstruction

(1) Background: The anterior cruciate ligament (ACL) is a crucial ligament in the knee joint. This study compares the differences in knee range of motion (ROM), knee proprioception error, balance, function, and quality of life (QOL) among participants with and without meniscus repair or partial meniscectomy nine months post ACL reconstruction. (2) Methods: In this cross-sectional study, 57 male participants were selected through convenience sampling from a tertiary care hospital. Knee flexion and extension ROM were assessed using a digital goniometer; a digital inclinometer was used to assess knee proprioception error; the Y balance test was used to evaluate balance; the lower extremity functional scale (LEFS) was used to assess activity; and QOL was assessed using the ACLQOL questionnaire. (3) Results: There were no significant differences in outcomes except balance. The YB composite score had a moderate negative correlation with knee proprioception error with an R-value of −0.372 **. (4) Conclusions: Nine to 12 months post ACL reconstruction, the isolated ACL reconstruction participants had better lower-quarter single-leg balance than those who underwent ACL reconstruction and meniscal repair or partial meniscectomy. The remaining parameters, like knee ROM, knee proprioception error, LEFS score, and ACLQOL scores, were similar between these two groups.

Investigating the Effects of Dry Needling on Hamstring Muscles Flexibility: A Randomized Controlled Trial

Introduction: Flexibility or the ability of a muscle to increase in length is an integral part of musculoskeletal characteristics and is essential in preventing musculoskeletal injuries and increasing functional levels. Hamstring muscles rupture is a common injury. One of the important factors in the occurrence of this injury is poor hamstring muscle flexibility, which because of its stiffened structure, has less ability to quickly increase in length. Some researchers have recently suggested that the dry needling technique could reduce the number of treatment sessions for hamstring muscle tightness and bring faster and more effective results. Accordingly, this study aims to investigate the effect of the application of dry needling through an acupuncture technique on hamstring muscle flexibility.&#x0D; Materials and Methods: The present study is a single-blinded randomized controlled trial in which 16 individuals with bilateral hamstring muscle shortness were randomly allocated into dry-needling and sham-needling groups. The sampling method was non-probability convenience. The outcome measures were the right and left active knee extension range of motion, assessed before and after the first, third, and fifth sessions of intervention. A 2-factor mixed analysis of variance was applied to determine the differences between and within the two groups.&#x0D; Results: Except for the group main effect, time main effect and interaction effect were statistically significant for the right and left active knee extension range of motion (P&lt;0.001). There were differences in behavioral patterns in groups; accordingly, in the real dry-needling group, a significant difference was detected across times. However, in the sham dry-needling group, no significant difference was observed.&#x0D; Conclusion: The application of dry needling into motor points of hamstring muscles in individuals with bilateral hamstring muscles shortness could improve flexibility and increase the range of knee extension after 3 and 5 sessions of intervention because of the therapeutic effects of the dry needling technique in improving the muscle flexibility.

Comparative Study Between Kinesiotaping Versus Muscle Energy Technique in Patients with Knee Osteoarthritis

Osteoarthritis (OA) is a chronic progressive degenerative disorder of multifactorial etiology, causing greater disability and clinical symptoms among adults. Our study aim is to compare the effectiveness of kinesio taping with conventional therapy versus muscle energy technique with conventional therapy in subjects with knee osteoarthritis. Moreover, the assessed objectives are knee pain, range of motion, disability, quadriceps strength, and hamstring flexibility. It is a comparative study, where 30 subjects with knee osteoarthritis meeting the inclusion criteria were recruited and randomly divided into Group A (Kinesiotaping with conventional therapy) and Group B (Muscle energy technique with conventional therapy), each group containing 15 subjects. Both groups received the same conventional therapy, five sessions/week for three weeks. GROUP-A received Kinesiotaping 3 sessions/per week for three weeks, and GROUP-B received Muscle energy technique five sessions/per week for three weeks. Outcome parameters were a Visual Analogue Scale(VAS) for pain, a Goniometer for a range of motion, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) for pain, Stiffness, and physical dysfunction, Quadriceps strength test for quadriceps strength and Active knee extension test for hamstrings flexibility. Paired t-test and independent t-test were used to analyze both groups' pre-test and post-results. The study concluded that Group A showed more significant improvement in knee pain (t=3.862, p&lt;0.05), extension range of motion (t=5.983, p&lt;0.05), and hamstrings flexibility (t=5.983, p&lt;0.05) compared to Group B. However, there was no significant difference in improvement among the groups when compared between both groups. Hence, the intervention in Group A was more effective in decreasing pain and increasing knee extension range of motion and hamstrings flexibility in OA knee patients.

Changes in passive stiffness and length of the semitendinosus muscles in rats with arthritis-induced knee flexion contracture

BackgroundArthritis-induced joint contracture is caused by arthrogenic and myogenic factors. The arthrogenic factor, localized within the joint, is naturally accepted as the cause of contracture. However, the detailed mechanisms underlying arthritis-induced myogenic contracture are largely unknown. We aimed to elucidate the mechanisms of arthritis-induced myogenic contracture by examining the muscle mechanical properties. MethodsKnee arthritis was induced in rats by injecting complete Freund's adjuvant into the right knees, while the untreated contralateral knees were used as controls. After one or four weeks of injection, passive stiffness, length, and collagen content of the semitendinosus muscles were assessed, along with passive knee extension range of motion. FindingsAfter one week of injection, flexion contracture formation was confirmed by a decreased range of motion. Range of motion restriction was partially relieved by myotomy, but still remained even after myotomy, indicating the contribution of both myogenic and arthrogenic factors to contracture formation. After one week of injection, the stiffness of the semitendinosus muscle was significantly higher in the injected side than in the contralateral side. After four weeks of injection, the stiffness of the semitendinosus muscle in the injected side returned to levels comparable to the contralateral side, parallel to partial improvement of flexion contracture. Muscle length and collagen content did not change due to arthritis at both time points. InterpretationOur results suggest that increased muscle stiffness, rather than muscle shortening, contributes to myogenic contracture detected during the early stage of arthritis. The increased muscle stiffness cannot be explained by excess collagen.

Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis.

Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking. A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA. Seven databases, English-language. Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM. Systematic review and meta-analysis. Level 2. Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate. There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.

Effect of novel diagonal stretching combining trunk rotation and trunk flexion on contralateral knee extension

BACKGROUND: Most previous studies have focused on increasing hamstring flexibility when knee extension range of motion (KE ROM) is restricted. However, it was demonstrated that the tensile force generated in the upper body could be transmitted to the contralateral lower extremity. OBJECTIVE: This study examined the effect of novel diagonal stretching combining trunk rotation and trunk flexion on the contralateral KE ROM. METHODS: Two different positions (sitting with a neutral pelvis position and sitting with trunk rotation) were randomly selected and the contralateral and ipsilateral KE ROM was measured in each position. As for the stretching intervention, trunk rotation and slight trunk flexion were applied in sitting with a neutral pelvic position. RESULTS: On the contralateral side, KE ROM was significantly different in all pairwise comparisons (p&lt; 0.001). On the ipsilateral side, a significant difference in KE ROM was only observed between measurements taken after stretching compared to measurements taken during trunk rotation (p= 0.005). CONCLUSIONS: The tensile force in the upper body significantly affects tissue extensibility in the lower extremity in the contralateral side, leading to the restriction of active maximum knee extension. Diagonal stretching techniques may successfully enhance mobility in the contralateral leg.

The influence of passive extensibility of the posterior oblique sling’s upper portion on contralateral knee extension

IntroductionThe posterior oblique sling (POS) serves to improve stability by transferring the force and load during an active movement in muscle contraction. The purpose of this study was to investigate the influence of pelvic positions on the knee extension range of motion (KE ROM) and the influence of trunk positions on the mobility of the lower extremity.MethodsSixteen subjects (age 21.0 ± 1.9 years, height 165.3 ± 7.6 cm, weight 59.56 ± 7.9 kg) participated in this study. The therapist measured the active KE ROM of the dominant leg at three different pelvic positions (neutral position, maximal anterior, and posterior pelvic tilt) and at two different trunk positions (trunk flexion and trunk rotation) using a Bluetooth embed inertial measurement unit sensor. A 10-minute rest was taken between positions. During trunk flexion and trunk rotation, the pelvis was maintained in a neutral position to prevent the change in length of the hamstring muscles. Statistical significance was set at &lt;i&gt;p&lt;/i&gt; &lt; 0.05.ResultsIn comparison to the neutral position, the anterior and posterior pelvic tilt significantly decreased (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and increased the KE ROM (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). In addition, the trunk rotation significantly decreased the KE ROM (&lt;i&gt;p&lt;/i&gt; = 0.002). However, the trunk flexion did not significantly change the KE ROM.ConclusionsThe findings in this study indicate that the changes in the length of the POS significantly influenced the functional mobility in the lower extremity. In clinical practice, the flexibility of POS must be considered during reciprocal movements involving the upper body and contralateral lower extremities.

Development of a Real-Time Knee Extension Monitoring and Rehabilitation System: Range of Motion and Surface EMG Measurement and Evaluation.

In this paper, a real-time knee extension monitoring and rehabilitation system for people, such as patients, the elderly, athletes, etc., is developed and tested. The proposed system has three major functions. The first function is two-channel surface electromyography (EMG) signal measurement and processing for the vastus lateralis (VL) and vastus medialis (VM) muscles using a developed EMG device set. The second function is the knee extension range of motion (ROM) measurement using an angle sensor device set (i.e., accelerometer sensor). Both functions are connected and parallelly processed by the NI-myRIO embedded device. Finally, the third function is the graphical user interface (GUI) using LabVIEW, where the knee rehabilitation program can be defined and flexibly set, as recommended by physical therapists and physicians. Experimental results obtained from six healthy subjects demonstrated that the proposed system can efficiently work with real-time response. It can support multiple rehabilitation users with data collection, where EMG signals with mean absolute value (MAV) and root mean square value (RMS) results and knee extension ROM data can be automatically measured and recorded based on the defined rehabilitation program. Furthermore, the proposed system is also employed in the hospital for validation and evaluation, where bio-feedback EMG and ROM data from six patients, including (a) knee osteoarthritis, (b) herniated disc, (c) knee ligament injury, (d) ischemic stroke, (e) hemorrhagic stroke, and (f) Parkinson are obtained. Such data are also collected for one month for tracking, evaluation, and treatment. With our proposed system, results indicate that the rehabilitation people can practice themselves and know their rehabilitation progress during the time of testing. The system can also evaluate (as a primary treatment) whether the therapy training is successful or not, while experts can simultaneously review the progress and set the optimal treatment program in response to the rehabilitation users. This technology can also be integrated as a part of the Internet of Things (IoT) and smart healthcare systems.

Education level has an effect on the recovery of total knee arthroplasty: a retrospective study

ObjectiveThis study aimed to observe the relationship between education level and outcomes after total knee arthroplasty (TKA).MethodsOne thousand two hundred sixty four patients after TKA in our hospital from April 2016 to April 2020 were reviewed. These patients were divided into 4 groups (A who were illiterate, B who had elementary school degree, C who had junior high school degree, D who had senior high school degree or higher) by the educational level, which was blinded to the observers. The postoperative outcomes of KSS score, pain, joint extension and flexion function were observed 1 year after discharged from hospital.ResultsAmong 1253 patients met the inclusion criteria, the average age was 68.63 years, the average body mass was 57.73 kg. There are no distinctions among 4 groups one day after the surgery. However, the outcomes of the follow up were that, the KSS score was: 77.84 ± 10.635; 80.70 ± 8.956; 87.92 ± 8.123;91.27 ± 8.262, with significant differences (P < 0.05). The mean VAS scores were: 1.97 ± 1.60; 2.07 ± 1.66; 1.197 ± 1.5265, 1.044 ± 1.4662. Patients in Group C and D had significantly less pain than that in Group A and B (P < 0.05). The knee flexion range of motion (ROM) was: 91.21 ± 11.69°; 91.77 ± 11.95°; 102.12 ± 11.38°; 109.96 ± 10.64°, Group D performed best, with significant differences (P < 0.05). The knee extension ROM were: – 2.41 ± 4.49°; – 0.91 ± 2.82°; – 0.83 ± 2.87°; – 0.35 ± 1.60°, with significant difference between Group D and the others (P < 0.05).ConclusionEducation level affects the outcomes such as VAS score, KSS score, the extension and flexion ROM of the knee after TKA. The patients with higher education level have better outcomes.

EFFECTIVENESS OF SLIDER AND TENSIONER NEURODYNAMIC MOBILIZATION TECHNIQUES COMPARED TO STRETCHING EXERCISES ON PAIN, FUNCTION, AND RANGE OF MOTION IN PATIENT WITH CHRONIC DISCOGENIC SCIATICA

Objective: To compare the effectiveness of the slider, tensioner neurodynamic mobilization techniques and stretching exercises on pain, range of motion (ROM), and functional disability in patients with chronic discogenic sciatica. Design: A pre-test post-test multi arm parallel RCT. Setting: Outpatient clinics, faculty of physical therapy, Kafrelsheikh University. Participants: Thirty-six patients with unilateral chronic discogenic sciatica were randomly allocated into three equal groups: Group (A) slider neurodynamic mobilization, Group (B) tensioner neurodynamic mobilization, and Group (C) stretching exercises of back extensors, hamstrings, and gastrocnemius muscles. Treatment was given three sessions per week for two weeks. Outcome measures: All patients were examined by visual analogue scale (VAS) for pain intensity, Modified-Modified Schober test (MMST) for lumbar flexion ROM, goniometer for hip flexion and knee extension ROM, and Oswestry Disability Index (ODI) for functional assessment. Results: There were no statistically significant differences between groups at baseline ([Formula: see text] 0.05). There were statistically significant differences in the slider and tensioner groups compared to the stretching group for all variables. Furthermore, statistically significant differences were found in the slider technique as compared to the tensioner technique regarding ROM of lumbar flexion ([Formula: see text] = 0.03), hip flexion ([Formula: see text] = 0.004), and knee extension ([Formula: see text] = 0.005). Conclusion: Slider and tensioner neurodynamic mobilization techniques are more effective than stretching exercises in terms of reducing pain, increasing ROM, and improving function. Slider technique is more effective in ROM improvement.

Decrease in medial meniscal extrusion after physical therapy to improve knee pain and range of motion in patients with knee osteoarthritis: A retrospective study.

Medial meniscal extrusion (MME) is the medial displacement of the meniscus, which extends beyond the tibial margin. Studies have shown an association between MME and knee pain and that surgical treatment can reduce the extent of MME. Here, we describe the beneficial effects of physical therapy as a feasible conservative treatment for MME. Data of 30 patients with knee osteoarthritis who underwent stretching of the semimembranosus tendon and passive range of motion (ROM) exercises twice a week for 8 weeks were retrospectively analyzed. MME was the measured distance between the medial meniscus and the line connecting the medial borders of the femur and tibia using ultrasound. Ultrasound findings of surrounding tissues, including the deep posterior bundle of the medial collateral ligament (dMCL), were recorded. Additionally, knee extension ROM was measured, and inner knee pain when walking was evaluated using a numerical rating scale. There were significant improvements between the baseline and 8 weeks for MME in the non-weight-bearing position (3.6 ± 0.3 mm vs. 3.0 ± 0.4 mm), MME in the weight-bearing position (4.3 ± 0.4 mm vs. 3.8 ± 0.5 mm), ROM (-12.3° ± 4.1° vs. -3.1° ± 3.8°), and knee pain (7.0 ± 0.9 vs. 1.1 ± 1.4) (each p < 0.001). In almost all cases in which the knee extension ROM improved, the dMCL was bulging at the baseline; after 8 weeks, the dMCL was flattened, suggesting ligament tension on ultrasound imaging. Stretching of the semimembranosus tendon and passive ROM exercises may reduce the extent of MME in patients with knee osteoarthritis. The ultrasound findings suggest that improvement in knee extension ROM may have led to the re-acquisition of MCL tension, which may have influenced MME reduction. Therefore, physical therapy may be a feasible conservative treatment for the reduction of MME.

Mechanical properties within and beyond the physiological length of the semitendinosus muscle of knee-immobilized rats

BackgroundThe effects of immobilization on passive muscle mechanical properties are inconsistent between studies. Here, we investigated the mechanical properties of immobilized muscle by obtaining length-force curves within and beyond the physiological muscle-tendon length in a knee-contractured rat model. MethodsUnilateral rat knee joints were immobilized using an external fixator for up to 21 days. Length-passive force relationships in the immobilized and contralateral semitendinosus muscles were determined by tensile testing. FindingsThe semitendinosus muscle-tendon length at end physiologic length in vivo was approximately at 5% strain of the slack length. Dynamic, elastic, and viscous force (three aspects of muscle mechanical properties) evoked by instantaneous constant stretch were higher than contralateral side within the physiological muscle-tendon length limit (strains of 5% or 5%–7.5% slack length). When beyond muscle-tendon length corresponding to the maximum knee extension (strains of 7.5% or 10%–20% slack length), there was no difference between the two sides. Dynamic and elastic stiffness were also larger, as estimated by tangent angles of length-force curves, at strains of 5% slack length, and matched contralateral levels at strains of 7.5% slack length on day 21. There were no differences in semitendinosus muscle-tendon lengths overtime. Despite significantly reductions in knee extension range of motion, collagen content only showed slight changes and correlation was hardly detected between collagen and mechanical properties on day 21. InterpretationViscoelasticity in immobilized semitendinosus muscle increased within the physiological muscle-tendon length. Collagen content may have little effect on passive force and stiffness.

Psychological readiness at 9 months after anterior cruciate ligament reconstruction –which factors affect?

ObjectiveTo investigate the association of psychological readiness at 9 months after anterior cruciate ligament reconstruction (ACLR) with knee strength and range-of-motion (ROM) at 3 and 9 months postoperatively. DesignRetrospective cohort study. SettingPrivate orthopedic hospital. ParticipantsSeventy-eight patients after ACLR. Main outcomes measuresThe participants completed the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale as an assessment of psychological readiness at 9 months after ACLR. Isometric and isokinetic quadriceps and hamstring strength were measured by a dynamometer at 3 and 9 months postoperatively. Knee extension and flexion ROM were measured in 5° increments with a standard goniometer at 3 and 9 months postoperatively. ResultsUnivariate regression analysis showed that age, limb symmetry index (LSI) of quadriceps strength at 3 and 9 months, and knee extension ROM deficit (>5°) at 3 and 9 months were associated with ACL-RSI scores at 9 months (P < 0.05). Age and LSI of quadriceps strength at 3 months remained significant predictors of ACL-RSI scores at 9 months in multiple regression analysis (R2 = 0.20, P < 0.001). ConclusionsEarly improvements in quadriceps strength after ACLR may have a positive impact on psychological readiness at 9 months postoperatively.