Medial Knee Joint Line Research Articles

COMPARISON OF THE EFFECT OF ULTRASOUND VERSUS LASER ON PAIN AND FUNCTION IN SUBJECTS WITH OSTEOARTHRITIS KNEE

Background:Osteoarthritis(OA) is a degenerative joint disease which leads to loss of hyaline articular cartilage associated with underlying bony changes. Knee osteoarthritis(KOA) is associated with pain and functional impairment which negatively affects the patients quality of life. Ultrasound and LASER have been found effective in KOA but studies comparing the two are less. Method:An experimental study was conducted with 21 patients of unilateral KOA randomized into three groups. Each group had 7 patients. Group A- Ultrasound- 1MHz, Pulsed1:1, 0.8W/cm2, 10 min on medial knee joint line. Group B- LASER- 7.6J for 1 min and 30 sec for each trigger point. Group C-Conventional physiotherapy. All subjects received conventional physical therapy with hot packs and quadriceps exercise of affected knee. Outcome measures used were Numerical pain rating scale(NPRS), Sit to stand(STS) and Timed up and go test(TUG). Result:Using Wilcoxon test, mean difference in painin Group A(W=-2.414,p=0.016), GroupB(W=-2.460,p=0.014 ), GroupC(W=-2.392 ,p=0.017). Mean difference in STS in GroupA(W=-2.392,p=0.017 ), Group B(W=-2.392,p=0.017 ), Group C(W=-2.428,p=0.015). Mean difference in TUG, Group A(W=-2.366,p=0.018),GroupB(W=-2.371,p=0.018 ) Group C(W=-2.375 ,p=0.018 ). Applying Kruskal-Wallis test, mean difference between the groups, for pain(KW=6.612,p=0.037), STS(KW=3.020,p=0.221) and TUG(KW=7.822,p=0.020). Applying Bonferronis post hoc test mean difference in pain between groups Aand B was statistically significant(p=0.03), and mean difference in TUG between groups Band C was statistically significant(p=0.013). Conclusion:Ultrasound,LASER and conventional physiotherapy are effective in reducing pain, improving function and mobility in subjects with OA knee. LASER is more effective than ultrasound and conventional PT for pain and more effective than conventional PT for mobility.

8 Week Exercise Protocol and Minimalist Shoes Walking Effect on Lower Leg Muscle Size

Transitioning to minimalist shoes (MS) is desired by many runners. However, there are concerns about transitioning safely. Pre-transition exercises or low intensity training may facilitate this transition. PURPOSE: The purpose of this preliminary study was to investigate muscle size change after either 8 weeks of walking in MS or 8 weeks of following an exercise protocol. The muscles of interest in the lower leg were the tibialis anterior (TA), tibialis posterior (TP) and flexor digitorum longus (FDL). METHODS: 28 runners (22.6±2.6 yr, 174.4±10.3 cm, 70.0±13.0 kg) continued to run their usual weekly amount and were randomly assigned to a control group (n=7), MS walking group (n=7, progressively increase walking from 2500 steps in MS to 7000 steps/day at 8 weeks), or an exercise group (n=14, 8 weeks of progressive foot muscle exercises). Videos of the TA, TP and FDL were taken starting from a relaxed state to a contracted state and back to the relaxed state via B-mode ultrasound imaging using a 10 MHz linear probe (GE LogiqP6). Videos for the FDL were taken at a point 50% distal from the medial knee joint line to the inferior tip of the medial malleolus with the probe held perpendicular to the shaft of the leg. For the TP and TA the probe was held at a point 30% from the knee joint line to the inferior tip of the lateral malleolus. To obtain videos of the TA and TP, each participant was instructed to invert their foot. For the videos of the FDL, participants were instructed to flex their toes. Videos of the contraction cycle for the TA, TP, and FDL were recorded. 2 separate still-shots of the muscles at rest were saved from the recorded videos to make size measurements. Repeated measures ANCOVA with the respective baseline muscle size as covariate was run. RESULTS: There was a significant main effect for time for all muscles (p<0.02), and a significant group by time interaction (p<0.05) for the change in muscle size for the FDL and TP. The mean and SD for the muscles were TA: 2.5±0.3 cm, TP: 1.8±0.25 cm, FDL: 1.7±0.36 cm2. CONCLUSION: The data from this preliminary study appear to support the idea that walking in MS or performing foot intrinsic strengthening exercises may increase the size of some lower leg muscles. It is unknown if this increase in muscles size will alter the potential risks associated with a transition to minimalist shoe running.

Preoperative determination of tibial nail length: An anthropometric study

ObjectiveTo assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers. MethodsSix anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale: medial knee joint line to ankle joint line (K-A), medial knee joint line to medial malleolus (K-MM), tibial tuberosity to ankle joint (TT-A), tibial tuberosity to medial malleolus (TT- MM), olecranon to 5th metacarpal head (O-MH) and body height (BH). Nail size predicted based upon TT-MM measurement was chosen as ideal nail size. A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size. A regression equation was applied to BH measurements. Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated. Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data. ResultsAdding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly. Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively. Adding 6 mm to O-MH distance had a poor accuracy of 51%. Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases. Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively. ConclusionTT-A, K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction. This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

A medial soft-tissue mass of the knee.

A 46-year-old man presented to a sports medicine clinic with medial left knee swelling that had begun 2 months earlier after a direct blow from a fall. The patient complained of stiffness and discomfort that occurred with immobilization and resolved with stretching and exercise. He reported no locking or instability. A physical examination showed marked swelling over the medial knee joint line; the area was firm, rubbery, and nontender. There was no suprapatellar effusion. The patient's knee had a full range of motion, and hamstring and quadriceps strength was normal. Magnetic resonance imaging (MRI) was ordered to exclude a soft-tissue tumor.

Ultrasound Video Recordings Enable Intra-rater Reliability of Muscle Size Measurements of the Toe Flexor Muscles

Ultrasound (US) imaging is being utilized in orthopedic, sport, and exercise research. It is a cost-effective way to assess cross-sectional area (CSA) and thickness of muscles in vivo; it can be used in research and clinical settings to monitor muscle changes. PURPOSE: To determine intra-rater reliability in measuring separate consecutive US still images obtained from video recordings of the lateral toe flexors: flexor digitorum longus (FDL), flexor digitorum brevis (FDB), and quadratus plantae (QP). METHODS: Videos were taken starting from a relaxed state to a contracted state and back to the relaxed state for the CSA of the FDL, FDB, and QP and thickness of the QP. A trained individual, using a 10 MHz linear probe (GE LogiqP6), recorded US videos of the FDL, FDB, and QP muscles of 12 feet. The videos for the FDL were taken at a point 50% distal from the medial knee joint line to the inferior tip of the medial malleolus with the probe held perpendicular to the shaft of the leg. For the videos of the FDB and QP, the probe was held perpendicular to the sole of the foot in line with the navicular tuberosity. Each participant was instructed to flex their toes and videos of the contraction cycle were recorded. The video recording was used in order to more easily differentiate the fascial borders of the muscles of interest at the time of measurement. Using the ultrasound machine’s internal software, 2 separate still-shots of the muscles at rest were saved from the recorded videos to make calculations of either the CSA or thickness. Each individual image was measured by the same rater and the rater was blinded to each measurement value. The measurements were made one right after the other. RESULTS: The ICC3,1 for the measurement reliability of CSA of the FDL was 0.985, CSA for the FDB was 0.996, and CSA QP was 0.978, while the ICC3,1 for QP thickness was 0.998. CONCLUSIONS: Excellent intra-rater reliability was achieved to assess muscle CSA and thickness when video recordings of the FDL, FDB, and QP during the contraction cycle were utilized to obtain more accurate estimates of the fascial borders than by using still images alone. The rater was also accurate at finding images within the video that represented the relaxed state.

Effect of Anterior tibiofemoral glides on knee extension after Anterior Cruciate Ligament Reconstruction

A 33 year old male patient presented to the department with the complains of pain and inability to bend and straighten the left knee since 1 month. The pain was present during Knee flexion and extension. Tenderness was present over medial knee joint line. Patient had a history of twisting his left leg and a third degree Anterior cruciate ligament tear for which he had underwent reconstruction surgery with autogenous bone-patellar tendon-bone graft after which he had been referred for Physiotherapy. During Physiotherapy treatment he was given Cryotherapy, Range of motion exercises, continuous passive movement exercises, followed by Anterior Tibiofemoral glides.strengthening exercises were given as home program.12 sessions of treatment were given and good reduction in pain and improvement in range of motion was observed in the last session. The purpose of this case report is to present the positive effects of mobilization techniques in the early post-op phases of rehabilitation on the subjects who underwent ACL reconstruction surgery.

Preoperative estimation of tibial nail length—Because size does matter

IntroductionSelecting the correct tibial nail length is essential for satisfactory outcomes. Nails that are inserted and are found to be of inappropriate length should be removed. Accurate preoperative nail estimation has the potential to reduce intra-operative errors, operative time and radiation exposure. MethodsWe compared the most commonly used radiological, anthropometric and intra-operative techniques to determine ideal nail lengths for 16 paired cadaveric tibiae. Five different anthropometric measurements were taken from each intact cadaver including: knee joint line to ankle joint line distance (JJD), medial knee joint line to medial malleolus distance (MMD), tibial tuberosity to medial malleolus distance (TMD), olecranon to 5th metacarpal head distance (OMD) and body height (BHR). Each tibia also underwent antero–posterior (AP) and lateral scanograms. Computerised tomography was used to determine the ideal nail length for each tibia. Each anthropometric and radiological measurement was recorded by two orthopaedic surgeons independently. An expert tibial nail was then inserted after nail length estimation was performed using a guidewire technique and an intra-operative radiographic ruler. ResultsThe AP scanogram was found to be 100% accurate in selecting ideal nail length. The lateral scanogram was also found to be reasonably accurate but in 19% (3/16) of cases it led to a nail being too long. The intra-operative radiographic ruler was found to give a good indication of the ideal nail size, as did the guidewire technique, with only 6% (1/16) of cases producing an incorrect nail size. In general, the anatomical measurements gave a poor indication of ideal nail size compared with the other techniques. The following accuracies were noted: JJD 56%, MMD 50%, TMD 38%, BHR 13% and OMD 56%. ConclusionsWe found that radiological methods such as using an AP radiograph with known magnification and intra-operative radiographic ruler were able to predict nail length very accurately and we suggest that these measurements should be performed routinely. The guidewire technique was also effective but we recommend that it not be used in isolation as errors can occur. We found that anatomical measurements are not accurate for predicting tibial nail length.

Knee Cooling Alters Dynamic Neuromuscular Control and Decreases Joint Laxity

PURPOSE: To determine whether focal knee cooling attenuates dynamic postural stability or decreases knee laxity and hamstring flexibility as compared to a room temperature trial. METHODS: Single-group, pretest-posttest control session design. Setting: University exercise physiology laboratory. Participants: Fourteen healthy college students (24 ± 3 years old). Intervention: Twenty-minute 5°C cooling pad application to the knee vs. room temperature (no cooling). Main Outcome Measures: Postural stability, anterior knee laxity and hamstring flexibility were measured before, immediately after and 20 minutes after either no cooling or a cooling pad application for 20 minutes. Skin temperature (lateral knee joint line) and subcutaneous temperature (medial knee joint line) were recorded every 5 minutes for the entire 20-minute treatment and for the 20-minute period following application. RESULTS: Mean medial-lateral deflection (frontal plane position) measurement of postural stability increased immediately following cooling from.60 ±.59 to.93 ±.80. Anterior knee laxity decreased immediately following cooling from 8.40 ±.79 to 7.48 ±.78 mm. These differences were no longer evident following 20 minutes of rewarming at room temperature. Hamstring flexibility did not change with cooling. Skin temperatures decreased with cooling from 30.34 ±.89 to 18.26 ± 2.28°C and remained lower (24.99 ±.93°C) following 20 minutes of rewarming. Subcutaneous temperatures decreased with cooling from 28.40 ± 1.41 to 16.13 ± 2.59°C and remained lower (21.94 ± 1.38°C) following 20 minutes of rewarming. CONCLUSIONS: Application of a cooling pad to the knee attenuates or alters dynamic neuromuscular control in the frontal plane and decreases knee compliance immediately following the application. Cold treatment is commonly used following acute injury in sport and exercise. Alterations in the dynamic joint stability and biomechanic properties of the knee with cooling may increase the risk of injury if exercise or sport is resumed immediately following cold treatment.

Is there an alternative to the full‐leg radiograph for determining knee joint alignment in osteoarthritis?

To assess the concurrent validity of alternative measures of frontal plane knee alignment, namely the radiographic anatomic axis and 5 clinical measures, in medial compartment knee osteoarthritis (OA) as compared with the mechanical axis on radiograph. Forty individuals (mean +/- SD age 64.7 +/- 9.4 years) with symptomatic medial knee OA participated. Knee alignment was measured according to the following methods: lower-limb mechanical axis on radiograph, lower-limb anatomic axis on radiograph, visual observation, distance between medial knee joint lines or medial malleoli using a caliper, distance between a plumb line and medial knee joint line or malleolus using a caliper, tibial alignment using a gravity inclinometer, and lower-limb alignment using a goniometer. Data were analyzed using Pearson's correlation coefficient or Spearman's rho correlation coefficient and simple linear regression. The anatomic axis best correlated with the mechanical axis (r = 0.88), followed closely by the inclinometer method (r = 0.80). Other clinical measures of alignment that were significantly associated with the mechanical axis were the caliper method, the plumb-line method, and visual observation (r = 0.76, 0.71, and -0.52, respectively). However, the goniometer method failed to correlate. The anatomic axis on radiograph and the inclinometer method appear to be valid alternatives to the mechanical axis on full-leg radiograph for determining frontal plane knee alignment in medial knee OA. These alternative methods of measuring knee alignment may increase the assessment of this parameter by clinicians and researchers alike, given that malalignment is an important indicator of disease progression and treatment outcome.