Knee ROM Research Articles

Rectus femoris distal tendon resection improves knee motion in patients with spastic diplegia.

Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest the transfer does not generate a knee flexor moment but diminishes knee extension moment in swing and MRI studies show the transferred tendons can be constrained by scarring to underlying muscles. Thus, it is possible knee flexion would be improved by distal rectus release rather than transfer since it would not be adherent to the underlying muscles. We therefore determined whether rectus femoris distal tendon resection improves knee ROM and kinematic characteristics of stiff-knee gait in patients with spastic diplegia. We studied 45 patients who underwent rectus femoris distal tendon resection as a part of multilevel surgery. Rectus femoris procedures were indicated based on kinematic characteristics of stiff-knee gait. All patients were walkers and had a mean age at surgery of 13 years (range, 6-22 years). We obtained gait analyses before surgery and at mean 2-year followup. We based postoperative assessment on clinical evaluation and gait analysis data. At followup, rectus femoris distal tendon resection was associated with improved knee ROM and timing of peak knee flexion in swing, and the absolute values of peak knee flexion became normal for those patients who showed abnormal preoperative values. Kinematic parameters of stiff-knee gait improved after rectus femoris distal tendon resection. Given the preliminary nature of our report, we intend to study the same patients to assess outcomes at a longer followup. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Lateral Unicompartmental Knee Arthroplasty Through a Lateral Parapatellar Approach Has High Early Survivorship

The literature suggests lateral unicompartmental knee arthroplasties are associated with low revision rates. However, there are fewer reports describing techniques for lateral unicompartmental arthroplasty and whether technique influences ROM and function compared to reports for medial unicompartmental arthroplasty. We report our indications for lateral unicompartmental arthroplasty, how we perform this procedure, and the subsequent Knee Society scores, ROM, and revision and reoperation rates. From a retrospective review of electronic records from 2004 through 2008, we identified 93 patients who had 100 lateral unicompartmental arthroplasties. Indications were complete lateral bone-on-bone arthrosis with a correctible deformity and maintenance of the medial joint space on varus stress radiographs or isolated lateral disease by diagnostic arthroscopy. Average age was 68 years. Seventy percent of patients were women. At followup, we obtained Knee Society scores and ROM. Minimum followup was 24 months (average, 39 months; range, 24-81 months). At followup, Knee Society scores averaged 46 for pain, 94 for clinical, and 89 for function, and ROM averaged 124°. Three patients had reoperations: one an open reduction and internal fixation for fracture at 2 years postoperatively, one an arthroscopy for a medial meniscal tear, and one a revision for pain. Based on our observations, we believe complete cartilage loss laterally and correctible deformity with maintenance of the medial joint on varus stress radiographs are reasonable indications for lateral unicompartmental arthroplasty. We recommend a lateral parapatellar approach can be utilized. The early reoperation and revision rates were low.

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation. We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort. We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively. The area of hypesthesia was measured using Mesurim Pro 9(®) software. Patient knee ROM, Knee Injury and Osteoarthritis Outcome Score (KOOS), and WOMAC clinical score also were assessed. The area of hypesthesia was less after an anterolateral compared with a midline incision up to 1 year after surgery: the areas of hypesthesia were, respectively, 32 cm(2) versus 76 cm(2) at 6 weeks, 14 cm(2) versus 29 cm(2) at 6 months, and 7 cm(2) versus 19 cm(2) at 1 year. Clinical scores and knee ROM were similar in both groups at each followup. At 1 year, in the entire group we observed a correlation between a smaller area of paresthesia and better WOMAC and KOOS scores and greater knee flexion. Compared with the midline skin incision, the anterolateral incision is associated with fewer sensory disturbances and appears to be a reasonable alternative in TKA. Level I, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.

Change in Kinetics and Kinematics during 1-Footed Drop Landing with an Increase in Upper Body Weight

The purpose of this study was to investigate changes in kinetic and kinematic variables associated with an increase in upper body weight. Eighteen healthy male university students(<TEX>$175.96{\pm}4.19\;cm$</TEX>, <TEX>$70.79{\pm}8.26\;kg$</TEX>) participated. Eight motion analysis cameras(Qualysis Oqus 500) and 2 force AMTI platforms(Advanced Mechanical Technologies Inc. OR6-7, US) were used to record motion and forces during the drop landing at a frequency of 120 Hz and 1200 Hz, respectively. QTM software(Qualisys Track Manager) was used to record the data, and the variables were analyzed with Visual 3D and Matlab 2009. For the drop landing, a box of <TEX>$4{\times}2{\times}0.46\;m$</TEX> was constructed from wood. Knee and ankle maximum flexion angle, knee flexion angle, knee and ankle angle at landing, time for maximum ankle flexion after landing, and time for maximum knee flexion after landing were calculated. There was a significant change in the time for maximum and minimum ground force reaction and the time for maximum dorsal flexion after landing(p<.05) with increasing weight. There was no significant change for the hip, knee, and ankle ROM, whereas there was an increase in the angle ROM as the weight increased, in the order of ankle, knee, and hip ROM. This result shows that the ankle joint ROM increased with increasing weight for shock attenuation during the drop landing. There was a trend for greater ankle ROM than knee ROM, but there was no clear change in the ROM of the hip joint with increasing weight. In conclusion, this study shows the importance of ankle joint flexibility and strength for safe drop landing.

Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study

The authors performed this study to compare the outcomes of robotic-assisted and conventional TKA in same patient simultaneously. It was hypothesized that the robotic-assisted procedure would produce better leg alignment and component orientation, and thus, improve patient satisfaction and clinical and radiological outcomes. Thirty patients underwent bilateral sequential total knee replacement. One knee was replaced by robotic-assisted implantation and the other by conventional implantation. Radiographic results showed significantly more postoperative leg alignment outliers of conventional sides than robotic-assisted sides (mechanical axis, coronal inclination of the femoral prosthesis, and sagittal inclination of the tibial prosthesis). Robotic-assisted sides had non-significantly better postoperative knee scores and ROMs. Robotic-assisted sides needed longer operation times (25 min, SD ± 18) and longer skin incisions. Nevertheless, postoperative bleeding was significantly less for robotic-assisted sides. The better alignment accuracy of robotic TKA and the good clinical results achieved may favorably influence clinical and radiological outcomes.

A prospective randomized comparison of irradiated and non-irradiated hamstring tendon allograft for ACL reconstruction

To analyze the outcome of arthroscopic anterior cruciate ligament reconstruction with irradiated versus non-irradiated hamstring tendon allograft. All hamstring tendon allografts were obtained from a single certified tissue bank, and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 78 patients who met the inclusion and exclusion criteria of the study were prospectively randomized consecutively into two groups (Non-ir-Allo vs. Ir-Allo). All the operations were done by the same senior surgeon. Before surgery and at follow-up, patients were evaluated by the same observer according to clinical evaluations including the Lachman test, ADT, pivot shift test, varus/valgus stress test, the instrumented KT-2000 arthrometer testing, vertical jump test, one-leg hop test, ROM of knee, Cincinnati knee score, IKDC Subjective Knee Form, Tegner activity score, modified Lysholm knee scoring scale, and the standard knee ligament evaluation form of the IKDC. Of these patients, 69 (Non-ir-Allo 38, Ir-Allo 31) were available for full evaluation. When compared the Ir-Allo group with Non-ir-Allo group at the final follow-up by Lachman test, ADT, pivot shift test, and KT-2000 arthrometer testing, statistically significant differences were found (P<0.05). Most importantly, 84% of patients in the Non-ir-Auto group and just only 32% in the Ir-Allo group had a side-to-side difference of less than 3mm according to KT-2000. The anterior and rotational stability decreased significantly in the Ir-Allo group. According to the overall IKDC, functional, subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups (n.s.). As to the osteoarthritis (OA) rate, for the Non-ir-Allo group, there was no significant difference (n.s.) in development of OA between the operated knee and contralateral knee at the final follow-up. While for the Ir-Allo group, significant difference (P<0.05) was found in development of OA between the operated knee and contralateral knee. There was statistical difference (P<0.05) between the Non-ir-Allo and Ir-Allo groups when comparing the development of OA of the operated knees at the final follow-up. There was a significant difference in knee stability between the two groups (in favor of Non-ir-Allo), but no differences in functional scores should be pointed out clearly. I.

Gait kinematic analysis in patients with a mild form of central cord syndrome

BackgroundCentral cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed.MethodsTwelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion - ROM) were compared between the two groups walking at similar speeds.ResultsThe kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05).ConclusionsThe gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Distal femoral osteotomies (DFO) can be used to correct deformities around the knee. Although osteotomies can be fixed with either internal or external fixation techniques, the advantages of one over the other are unclear. We asked whether (1) for both techniques, we could accurately correct the deformities based on our preoperative goals for mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA), and (2) intraoperative times, (3) preoperative and postoperative knee ROM, and (4) complications differed. We identified 26 patients (34 limbs) who underwent femoral osteotomies. We compared accuracy of correction (based on correction of the MAD and the LDFA), duration of surgery, preoperative and postoperative knee ROM, and complications. The minimum followup was 20 months (mean, 29 months; range, 20-40 months). We achieved the desired MAD within 10 mm of the goal in 18 of 21 limbs with the unilateral frame and in 12 of 13 limbs using fixator-assisted plating. Operative time for fixator-assisted plating was longer (122 ± 34 minutes) than when using a unilateral frame (94 ± 65 minutes). Preoperative and postoperative knee ROMs were similar for both techniques and there were no major complications. We obtained accurate correction of deformities with both fixation techniques. Our experience suggests the method to be used should be left to the discretion of the surgeon and the needs and wishes of the patient after adequate explanation of the advantages and disadvantages. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

The Effect of Electrical Passive Cycling on Spasticity in War Veterans with Spinal Cord Injury

Introduction: Muscle atrophy, spasticity, and deformity are among long term complication of spinal cord injury (SCI) veterans. There are numerous studies evaluating effect of functional electrical stimulation on muscle properties of SCI people, but less research has focused on the benefits of passive cycling in the management of spasticity and improving ROM of lower limbs in individuals with SCI. Aims: To evaluate the effect of electrical passive cycling on passive range of movement spasticity and electrodiagnostic parameters in SCI veterans. Methods: Sixty-four SCI veterans referred to two clinical and research center in Tehran were recruited in this prospective clinical trial. The subjects were divided into two groups according to electrical passive cycling usage: (1) patients who did not use pedal exercise (control group), (2) patients used Electrical passive cycling up to optimal level (intervention group). Main outcome measures included hip, knee, and ankle range of motion, spasticity scale, and electrodiagnostic parameters including F-Wave Consistency, F-Wave Amplitude, H/M Ratio, F/M Ratio, H-Reflex Onset Latency, and H-Reflex Amplitude. Data were recorded at the time of receiving and 1 year after pedal exercise usage. Results: Sixty-four SCI patients including 95.3% male, 4.7% female with mean age 43 years old were included in this study. All patients except one suffered from complete SCI. The involved spinal levels were cervical (17.2%), upper thoracic (34.4%), lower thoracic (45.3%), and lumbar (3.1%). Spasticity scale decreased significantly after passive cycling in group 2. Also hip, knee, and ankle ROM in group 2 were significantly improved after pedal exercise. There was a significant difference in H max/M max (RT<) and F/M ratio after versus before electric passive cycling system in group 2. Conclusion: These findings suggest that passive rhythmic leg exercise can lead to decrease in spasticity, increase in passive ROM of lower limbs and improvement in electrodiagnostic parameters of spasticity in patients with SCI.

기능적 발목 불안정성 선수들의 드롭랜딩 시 재활 기간이 하지 관절의 운동역학적 특성에 미치는 영향

The purpose of this study was to analyze the changes in kinematic and kinetic parameters of lower extremity joint according to rehabilitation period. Fourteen collegiate male athletes(age: <TEX>$22.1{\pm}1.35$</TEX> years, height: <TEX>$182.46{\pm}9.45cm$</TEX>, weight: <TEX>$88.63{\pm}9.25kg$</TEX>) and fourteen collegiate athletes on functional ankle instability(age: <TEX>$21.5{\pm}1.35$</TEX> years, height: <TEX>$184.45{\pm}9.42cm$</TEX>, weight: <TEX>$92.85{\pm}10.85kg$</TEX>) with the right leg as dominant were chosen. The subjects performed drop landing. The date were collected by using VICON with 8 camera to analyze kinematic variables and force platform to analyze kinetic variables. There are two approaches of this study, one is to compare between groups, the other is to find changes of lower extremity joint after rehabilitation. In comparison to the control group, FAI group showed more increased PF & Inversion at IC and decreased full ROM when drop landing. Regarding the peak force and loading rate, it resulted in higher PVGRF and loading. FAI group used more increased knee and hip ROM because of decreased ankle ROM to absorb the shock. And it used sagittal movement to stabilize. In terms of rehabilitation period, FAI group showed that landing patterns were changed and it increased total ankle excursion and used all lower extremity joint close to normal ankle. Regarding the peak force and loading rate, FAI group decreased PVGRF and loading rate. and also showed shock absorption using increased ankle movement. And COP variable showed that proprioception training increased stability during 8 weeks. The results of this study suggest that 8 weeks rehabilitation period is worthwhile to be considered as a way to improve neuromuscular control and to prevent sports injuries.

노르딕 워킹과 일반 보행의 효율성 비교 분석

The purpose of this study were to analyze the changes in kinematic and kinetic parameters and to find biomechanical benefits of Nordic Walking and normal gait performed under the same velocity. Nine participants(age: <TEX>$26.73{\pm}3.28$</TEX> year, height: <TEX>$182.45{\pm}4.62\;cm$</TEX>, weight: <TEX>$76.59{\pm}6.84\;kg$</TEX>) was chosen. The velocity of gait was set by 5.75 km/h which was made by a Nordic Walking professional. The data were collected by using VICON with 8 cameras to analyze kinematic variables with 200 Hz and force platform to analyze kinetic variables with 2000 Hz. The results of this study were as follows. First, when compared with Normal gait, Nordic Walking group showed decreased Plantarflexion angle and ROM. Second, Nordic Walking group showed decreased knee flexion angle and ROM. Third, Nordic Walking group showed increased hip joint movement. Fourth, Nordic Walking group showed higher active GRF but decreased loading rate from delayed Peak Vertical GRF time and increased impulse. Fifth, Nordic Walking group showed longer ground contact time. Through this study, we found that Nordic Walking showed higher stability and efficiency during gait than normal gait and that Nordic Walking may help people who have walking difficulties.

Limb Lengthening and Deformity Correction by the Ilizarov Technique in Type III Fibular Hemimelia: An Alternative to Amputation

Fibular hemimelia is partial or total aplasia of the fibula; it represents the most frequent congenital defect of the long bones. It usually is associated with other anomalies of the tibia, femur, and foot. We reviewed 32 patients with Type III fibular hemimelia treated by successive lower limb lengthening and deformity correction using the Ilizarov method. We had three aims; first, to analyze complications, including the need for reoperation. The second was to assess knee and ankle function, specifically addressing knee ROM and stability and function of the foot and ankle. The third was assessment of overall patient satisfaction. Thirty-two patients underwent 56 tibia lengthenings and 14 ipsilateral femoral lengthenings. Their mean age and mean functional leg-length discrepancy at initial treatment were 6.7 years and 6.2 cm, respectively. Activity level, pain, patient satisfaction with function, pain, and cosmesis, complications, and residual length discrepancy were assessed at the end of treatment. The mean number of surgeries was six per case. The healing index was 44.9 days/cm. Although complications were observed during 60 lengthenings (82%), the highly versatile system overcame most of them. Nearly equal limb length and a plantigrade foot were achieved by 16 patients. For two patients, a Syme's amputation was performed. The outcome was considered satisfactory in 17 patients (53%) and relatively good in eight patients (25%). The Ilizarov technique has satisfactory results for treatment of Type III congenital fibular hemimelia and can be considered a good alternative to amputation. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Intertrochanteric fractures in elderly high risk patients treated with Ender nails and compression screw.

Background:Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures.Materials and Methods:76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years).Using the Evan’s system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years) with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head.Results:The mean follow-up was 14 months (range 9-19 months) Average time to fracture union was 10 weeks (range 6-16 weeks). The mean knee ROM was 130° (± 5°). There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally.Conclusions:The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.

Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

BackgroundArthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA.MethodsFunctional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use.ResultsForty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p < 0.05). Persons that underwent TKA were also significantly weaker, had lower self-reported function and had less knee extension than persons who did not undergo TKA. No differences between groups were seen for BMI, gender, knee flexion ROM and unilateral versus bilateral joint disease. Using backward regression, age, knee extension ROM and KOS-ADLS together significantly predicted whether or not a person would undergo TKA (p ≤ 0.001, R2 = 0.403).ConclusionsYounger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.

Knee Injury- Football

HISTORY: An 11 yo middle school football player presented with complaints of right knee pain while playing football. He reported difficulty running secondary to inability to extend his knee fully. PMH was significant for injury four months ago, when a motorcross bike landed on the front of his knee after falling off during a jump. The patient was transported to ED at time of injury. X-rays of right knee reported as unremarkable. The patient also seen by an orthopedic surgeon later that week then ordered an MRI. The MRI reported as normal. The patient wore a brace initially, but had not worn it over the last few months. Although he had swelling at time of injury, patient denied swelling. Since initial injury, patient reported he had never regained full ROM of knee. He denies any radiating symptoms or hip pain. Initial MRI was unavailable for review. PHYSICAL EXAMINATION: (Right knee) No effusion was appreciated. Patient had tenderness to palpation along lateral femoral condyle, LCL, and lateral joint line. Patient reported pain in the posterolateral corner with passive knee extension. Patient had a loss of approximately 30 degrees of knee extension. The right knee was stable with valgus and varus stress at 30 degrees. Anterior and posterior drawer test were negative. Patient demonstrated guarding with McMurray's and Lachman's test. Sensation was intact. 2+ dorsalis pedis and posterior tibial pulses were palpated. Patient had full PROM of right hip. DIFFERENTIAL DIAGNOSIS: Lateral meniscus tear Posterolateral corner injury Articular cartilage injury Occult fracture Hip abnormality TEST AND RESULTS: AP/LAT/Sunrise radiographs of right knee: - Small bony avulsion noted adjacent to lateral femoral condyle MRI right knee: - Avulsion of the popliteus tendon from popliteal hiatus. - ACL,PCL, MCL, and LCL ligaments are intact - Popliteal fibular ligament is intact. - Medial and lateral meniscus are intact - Articular cartilage is intact - No effusion is present Final/Working Diagnosis Isolated popliteus tendon avulsion Treatment and Outcomes Activities restricted ROM exercises with Physical therapy started at 4 months post injury Patient regained full, painless ROM after 1 month of physical therapy. Patient released for full activity and return to play. Patient doing well five months post injury with all sports.

Quality of Life, Knee Function, and Physical Activity in Japanese Elderly Women with Early-Stage Knee Osteoarthritis

To compare quality of life, knee function, and physical activity in 33 elderly women with or without early-stage knee osteoarthritis (OA). 33 Japanese elderly women (mean age, 66 years) with (n=18) or without (n=15) early-stage knee OA symptoms (knee pain and decreased range of motion [ROM]) were recruited. The height, weight, and body mass index, disease severity, quality of life (according to the Japanese Knee Osteoarthritis Measure [JKOM]), knee function (knee extension strength, ROM, 10-m gait time), and the amount of physical activity (net energy expenditure and step count) of the 2 groups were compared. The 2 patient groups did not differ significantly with respect to mean patient age, height, and body mass index, except for weight. Regarding knee function, mean knee extension strength, ROM (extension but not flexion), and 10-m gait speed (comfortable and maximum) were significantly inferior in patients with knee OA than in controls. Regarding the mean amount of physical activity undertaken, patients with knee OA did not differ significantly from controls with respect to net energy expenditure (179 vs. 212 Kcal/day) and step count (8016 vs. 9729 steps/day). Net energy expenditure (r= -0.65, p=0.04) and step count (r= -0.62, p=0.02) correlated negatively with JKOM scores in patients with knee OA but not in the controls. In Japanese elderly women with knee OA, quality of life (JKOM scores) correlated negatively with physical activity (net energy expenditure and step count). The 2 groups undertook similar amounts of physical activity, although those with knee OA exhibited less knee extension strength. Decreased knee extension strength coupled with high levels of physical activity may exacerbate the development of knee OA.

Effects of virtual reality training on gait biomechanics of individuals post-stroke

Objective To evaluate gait biomechanics after training with a virtual reality (VR) system and to elucidate underlying mechanisms that contributed to the observed functional improvement in gait speed and distance. Design A single blind randomized control study. Setting Gait analysis laboratory in a rehabilitation hospital and the community. Participants Fifteen men and three women with hemiparesis caused by stroke. Interventions Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation. Subjects were randomized to either a VR group ( n = 9) or non-VR group (NVR, n = 9). Training was performed three times a week for 4 weeks for approximately 1 h each visit. Main outcome measures Kinematic and kinetic gait parameters. Results Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p = 0.036). The VR group had greater change in ankle ROM post-training (19.5%) as compared to the NVR group (3.3%). Significant differences were found in knee ROM on the affected side during stance and swing, with greater change in the VR group. No significant changes were observed in kinematics or kinetics of the hip post-training. Conclusions These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis. It is likely that the effects of training included improved motor control at the ankle, which enabled the cascade of changes that produced the functional improvements seen after training.

Real-time gait event detection using wearable sensors

Real-time gait event detection is a requirement for functional electrical stimulation and gait biofeedback. This gait event detection should ideally be achieved using an ambulatory system of durable, lightweight, low-cost sensors. Previous research has reported issues with durability in footswitch systems. Therefore, this study describes the development and assessment of novel detection algorithms using footswitch and accelerometer sensors on 12 healthy individuals. Subjects were equipped with one force sensitive resistor on the heel, one accelerometer at the foot, and one accelerometer at the knee. Subjects performed 10, 8-m walking trials in each of three conditions: normal, slow, and altered (reduced knee ROM) walking. Data from a subset of four subjects were used to develop prediction algorithms for initial contact (IC). Subsequently, these algorithms were tested on the remaining eight subjects against standard forceplate IC data (threshold of 5 N on a rising edge). The footswitch force threshold algorithm was most accurate for IC detection (mean absolute error of 2.4 ± 2.1 ms) and was significantly more accurate ( p < 0.001) than the optimal accelerometer algorithm (mean absolute error of 9.5 ± 9.0 ms). The optimal accelerometer algorithm used data from both accelerometers, with IC determined from the second derivative of foot fore-aft acceleration. The error results for footswitch and accelerometer algorithms are lower (∼60%) than in previous research on ambulatory real-time gait event detection systems. Currently, footswitch systems must be recommended over accelerometer systems for accurate detection of IC, however, further research into accelerometer algorithms is merited due to its advantages as a durable, low-cost sensor.

Poster 177: Ultrasound Evaluation of Vastus Intermedius (VI) as Outcome Measure for Knee ROM in Postoperative Knee Contractures: A Case Series

PM&RVolume 1, Issue 9S p. S181-S181 Poster Presentation Poster 177: Ultrasound Evaluation of Vastus Intermedius (VI) as Outcome Measure for Knee ROM in Postoperative Knee Contractures: A Case Series Michael K. Yoshida MD PhD, Michael K. Yoshida MD PhD Kansai Medical University, Hirakata-shi, JapanSearch for more papers by this author Michael K. Yoshida MD PhD, Michael K. Yoshida MD PhD Kansai Medical University, Hirakata-shi, JapanSearch for more papers by this author First published: 25 September 2009 https://doi.org/10.1016/j.pmrj.2009.08.197Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue9SSeptember 2009Pages S181-S181 RelatedInformation

Mid- and long-term surgical effect of tibial plateau fractures.

Objective To analyze the mid- and long-term surgical effect of tibial plateau fractures, and to explore the factor that affected the curative effect. Methods The clinical data of 43 with tibial plateau fractures (from May 1995 to November 2004) was retrospectively reviewed. All fractures were classified according to the Schatzker classification. There were 25 men and 18 women, with the mean age of 47.8 years (26 to 73 years). Thirty six had isolated fractures and seven had multiple fractures. After 57.4 months follow-up was done in all 43 patients. Functional Results of these were graded with self-evaluation of the Macnab scores and the Lysholm scores. Radiologic Results were graded with the Rasmussen score and Resnick-Niwoyama score to evaluate the reduction of fracture and the degradation of the knee. The joint space, and depressed height of articular surface were measured. Statistical analysis was performed by means of the sofeware SPSS11.5. Results According to the MacNab score, the with tibial plateau fractures average degree of satisfaction was 60%, and along with a mean knee ROM from 0° to 113°. Func-tional Results showed a mean Lysholm score of 83.1 points (range, 17-98 points). According to the stepwise multiple regression analysis, in the monoeondylar fractures of the tibial plateau, the Lyshoha scores was connection with the joint space and depressed height of articular surface, and the relationship was negative correlation. The Lyshoha score was negative correlation with depressed height of articular surface and articu-lar gaps. Monoeondylar fractures showed statistically significant better functional Results compared to bi-condylar fractures. In Radiologic result of mean Rasmussen score was 14 points (10-18 points). In 81.4% (35/43 cases)of the patients injuried knees arise secondary osteoarthritis, and 23.3%(10/43 cases) uninjured side happened osteoarithritis. Conclusion Mid and long-term Results after open reduction and internal fixa-tion for tibial plateau fractures are effeeted by depressed height, articular gaps and age. At the same time monocondylar fractures will get better recovery than bicondylar fractures. Key words: Tibial fractures; Fracture fixation, internal; Treatment outcome