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Knee Exam

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61. Efficacy of low-load blood flow restricted resistance EXercise in patients with Knee osteoarthritis scheduled for total knee replacement (EXKnee): protocol for a multicentre randomised controlled trial. Full Text available with Trip Pro

Efficacy of low-load blood flow restricted resistance EXercise in patients with Knee osteoarthritis scheduled for total knee replacement (EXKnee): protocol for a multicentre randomised controlled trial. Up to 20% of patients undergoing total knee replacement (TKR) surgery report no or suboptimal pain relief after TKR. Moreover, despite chances of recovering to preoperative functional levels, patients receiving TKR have demonstrated persistent deficits in quadriceps strength and functional (...) performance compared with healthy age-matched adults. We intend to examine if low-load blood flow restricted exercise (BFRE) is an effective preoperative method to increase functional capacity, lower limb muscle strength and self-reported outcomes after TKR. In addition, the study aims to investigate to which extent preoperative BFRE will protect against surgery-related atrophy 3 months after TKR.In this multicentre, randomised controlled and assessor blinded trial, 84 patients scheduled for TKR

2020 BMJ open

62. Occupation and risk of knee osteoarthritis and knee replacement: A longitudinal, multiple-cohort study. Full Text available with Trip Pro

Occupation and risk of knee osteoarthritis and knee replacement: A longitudinal, multiple-cohort study. To examine the effect of occupation on knee osteoarthritis (OA) and total knee replacement (TKR) in working-aged adults.We used longitudinal data from the Chingford, Osteoarthritis Initiative (OAI) and Multicentre Osteoarthritis (MOST) studies. Participants with musculoskeletal disorders and/or a history of knee-related surgery were excluded. Participants were followed for up to 19-years (...) (Chingford), 96-months (OAI) and 60-months (MOST) for incident outcomes including radiographic knee OA (RKOA), symptomatic RKOA and TKR. In those with baseline RKOA, progression was defined as the time from RKOA incidence to primary TKR. Occupational job categories and work-place physical activities were assigned to levels of workload. Logistic regression was used to examine the relationship between workload and incident outcomes with survival analyses used to assess progression (reference group

2020 Seminars in arthritis and rheumatism

63. Do Knee Osteoarthritis Patterns Affect Patient-Reported Outcomes in Total Knee Arthroplasty? Results From an International Multicenter Prospective Study With 3-Year Follow-Up. (Abstract)

Do Knee Osteoarthritis Patterns Affect Patient-Reported Outcomes in Total Knee Arthroplasty? Results From an International Multicenter Prospective Study With 3-Year Follow-Up. The aim of this multicenter study is to answer (1) Does patellofemoral osteoarthritis (OA) affect preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) scores in total knee arthroplasty (TKA)? and (2) Do different OA patterns affect preoperative and postoperative KOOS scores in TKA?This international (...) , multicenter prospective study examined 384 TKA patients. Compartmental OA was divided into (1) medial, (2) medial + patellofemoral, (3) lateral, (4) lateral + patellofemoral, (5) medial + lateral (bicompartmental), and (6) medial + lateral + patellofemoral (tricompartmental), based on preoperative anterior-posterior and lateral ± skyline radiographs with Kellgren-Lawrence grade III-IV and joint space width <2.5 mm. KOOS was collected preoperatively, 1 year postoperatively, and 3 years postoperatively

2020 Journal of Arthroplasty

64. Greater Knee Soft Tissue Thickness Predisposes Patients to Subsequent Periprosthetic Joint Infection After Total Knee Arthroplasty. (Abstract)

Greater Knee Soft Tissue Thickness Predisposes Patients to Subsequent Periprosthetic Joint Infection After Total Knee Arthroplasty. Although obesity is a risk factor for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA), the role of soft tissue thickness (STT) at the surgical site has not been well studied. This study examined if increased STT in the medial and anterior aspects of the knee are independent risk factors for PJI.A retrospective study was conducted on 206 (...) patients who underwent 2-stage exchange arthroplasty for PJI from 2000 to 2015. They were matched 1:3 to a control group of primary, noninfected TKA patients with minimum 2 years infection-free survival by age, gender, age-adjusted Charlson Comorbidity Index, date of surgery, and body mass index (BMI). Two blinded orthopedic surgeons measured the medial STT from the medial aspect of the knee at the level of the joint line on an anteroposterior radiograph, and anterior STT 8 cm above the joint line

2020 Journal of Arthroplasty

65. Over 20 years of chronic patellar ligament rupture with severe knee osteoarthritis for Total knee Arthroplasty: a case report. Full Text available with Trip Pro

patient suffered from patellar ligament rupture due to trauma more than 20 years ago and did not undergo any formal treatment. Physical examination revealed a small amount of fluid and extension lag, and the patella was displaced upward by approximately 5.5 cm. The quadriceps were atrophic and weak. There was significant tenderness on the medial side of the left knee joint. Passive motion of the left knee joint ranged from full extension to 120° of flexion with discomfort during excessive flexion (...) Over 20 years of chronic patellar ligament rupture with severe knee osteoarthritis for Total knee Arthroplasty: a case report. Extensor apparatus rupture is a severe complication after knee arthroplasty, but there have not been many reports on how to perform knee arthroplasty after chronic patellar ligament rupture. We reported a case of total knee arthroplasty (TKA) in a patient with severe osteoarthritis (OA) complicated by chronic patellar ligament rupture.In this case, a 67-year-old male

2020 BMC Musculoskeletal Disorders

66. Co-existing patterns of MRI lesions were differentially associated with knee pain at rest and on joint loading: a within-person knee-matched case-controls study. Full Text available with Trip Pro

morphology, bone marrow lesions, meniscus extrusion, meniscus morphology, Hoffa's synovitis and synovitis-effusion were assessed using the compartment-specific MRI Osteoarthritis Knee Score. We performed latent class analyses to identify subgroups of co-existing MRI lesions and fitted a conditional logistic regression model to examine their associations with knee pain.Among 130 eligible participants, we identified five subgroups of knees according to patterns of co-existing MRI lesions: I. minimal (...) Co-existing patterns of MRI lesions were differentially associated with knee pain at rest and on joint loading: a within-person knee-matched case-controls study. To assess the association of co-existing MRI lesions with knee pain at rest or on joint loading.We included participants from Osteoarthritis Initiative whose pain score, measured by WOMAC sub-scales, differed by ≥1 point at rest (in bed at night, sitting/lying down) or on joint loading (walking, stairs) between two knees. Cartilage

2020 BMC Musculoskeletal Disorders

67. Validation of the 7-item knee replacement patient education questionnaire (KR-PEQ-7), based on the 16-item knee osteoarthritis patient education questionnaire (KOPEQ). Full Text available with Trip Pro

Protocol that was tailored to the same patient educational material. Additionally, the revised questionnaire was correlated with both the Short Test of Functional Health Literacy and the Mini-Mental State Examination score.A relatively high internal consistency was found for the 7-item Knee Replacement Patient Education Questionnaire, with a Cronbach's alpha of 0.84 (SE: 0.036). Explanatory factor analysis showed no evidence against a one-factor model, with the first and second eigenvalues being 3.8 (...) Validation of the 7-item knee replacement patient education questionnaire (KR-PEQ-7), based on the 16-item knee osteoarthritis patient education questionnaire (KOPEQ). The aim of this study was to investigate the content validity including item reduction, construct validity and internal consistency of the existing 16-item Knee Osteoarthritis Patient Education Questionnaire. Former research had indicated that a reduction of items was necessary. Participants were patients with severe knee

2020 BMC Musculoskeletal Disorders

68. Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis. Full Text available with Trip Pro

Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis. To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models.A population-based cohort (n = 122) with knee pain, aged 40-79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion (...) ; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike's information criterion.Baseline depression model: sex (female

2020 BMC Musculoskeletal Disorders

69. Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery. Full Text available with Trip Pro

, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset.A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit (...) Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery. Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery.Retrospective analysis of data

2020 BMC Musculoskeletal Disorders

70. Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee. Full Text available with Trip Pro

treated by external fixation with the Ilizarov fixator between 2012 and 2017 were examined. Anti-TB drugs were administered preoperatively, intraoperatively, and postoperatively. Clinical and radiologic examinations were performed for comprehensive evaluations, and these include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), flexion and valgus angle of the knee, leg-length discrepancy, and Lysholm score.Twenty-four patients were followed up for an average of 5.8 years (2.2-7 years (...) Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee. With the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. This study aims to retrospectively determine the clinical and radiographic outcomes after use of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage knee TB.Twenty-six patients with end-stage knee TB

2020 BMC Musculoskeletal Disorders

71. Pain After Unilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Examining the Analgesic Effectiveness of a Combined Adductor Canal Peripheral Nerve Block with Periarticular Infiltration Versus Adductor Canal Nerve Block Alone Vers (Abstract)

Pain After Unilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Examining the Analgesic Effectiveness of a Combined Adductor Canal Peripheral Nerve Block with Periarticular Infiltration Versus Adductor Canal Nerve Block Alone Vers Total knee arthroplasty is a painful surgery that requires early mobilization for successful joint function. Multimodal analgesia, including spinal analgesia, nerve blocks, periarticular infiltration (PI), opioids, and coanalgesics, has been (...) shown to effectively manage postoperative pain. Both adductor canal (AC) and PI have been shown to manage pain without significantly impairing motor function. However, it is unclear which technique is most effective. This 3-arm trial examined the effect of AC block with PI (AC + PI) versus AC block only (AC) versus PI only (PI). The primary outcome was pain on walking at postoperative day (POD) 1.One hundred fifty-one patients undergoing unilateral total knee arthroplasty were included. Patients

2016 Anesthesia and Analgesia Controlled trial quality: predicted high

72. Physical examination findings and their relationship with performance-based function in adults with knee osteoarthritis. Full Text available with Trip Pro

Physical examination findings and their relationship with performance-based function in adults with knee osteoarthritis. Many physical examination (PE) maneuvers exist to assess knee function, none of which are specific to knee osteoarthritis (KOA). The Osteoarthritis Research Society International also recommends the use of six functional performance measures to assess function in adults with KOA. While earlier studies have examined the relationship between PE findings and self-reported (...) function or PE findings and select performance tests in adults with knee pain and KOA, few have examined the all three types of measures. This cross-sectional study specifically examines the relationships between results of PE findings, functional performance tests and self-reported function in adults with symptomatic KOA.We used baseline PE data from a prospective randomized controlled trial in 87 participants aged ≥40 years with symptomatic and radiographic KOA. The PE performed by three experienced

2016 BMC Musculoskeletal Disorders

73. The Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear among Middle-Age Subjects with Knee Pain. Full Text available with Trip Pro

The Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear among Middle-Age Subjects with Knee Pain. To evaluate the utility of clinical history, radiographic findings, and physical examination findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45 years, in whom concomitant osteoarthritis is prevalent.In a cross-sectional study of patients from 2 orthopedic surgeons' clinics, we assessed clinical history (...) , physical examination findings, and radiographic findings in patients age >45 years with knee pain. The orthopedic surgeons rated their confidence that subjects' symptoms were due to meniscal tear; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT, and we used the regression results to construct an index of the likelihood of SMT.In 174 participants, 6 findings were associated independently

2016 Arthritis care & research

74. Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? Full Text available with Trip Pro

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial.We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities (...) , 1.008-1.155; p = 0.033) and open injuries (OR, 3.366; 95% CI, 1.008-11.420; p = 0.048) were associated with vascular injury. No single physical examination maneuver had a 100% sensitivity for ruling out vascular injury. A normal physical examination (palpable pulses and ABI ≥ 0.9) had 100% sensitivity for ruling out vascular injury.Increased BMI and the presence of open dislocation are associated with a greater risk for vascular injury after knee dislocation. The combination of a palpable dorsalis

2016 Clinical Orthopaedics and Related Research

75. Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee Full Text available with Trip Pro

Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee The McKenzie System of Mechanical Diagnosis and Therapy (MDT) is a widely used method of classification and management of musculoskeletal problems. Although MDT has been investigated for its reliability and efficacy in the management of spinal pain, few studies have evaluated the system when applying it to musculoskeletal problems in the extremities, in particular the knee (...) . The purpose of this study was to investigate the inter-rater reliability of MDT when classifying clinical vignettes describing patients with musculoskeletal knee pain.This study was divided into two phases. First, 10 clinicians experienced in the use of MDT were recruited to write a total of 60 clinical vignettes based upon the initial assessment of their past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss

2016 The Journal of manual & manipulative therapy

76. Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint Full Text available with Trip Pro

Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape (...) of the meniscus and the risk of its extrusion.Knee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18-49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus

2016 PloS one

77. Examining Ankle-Joint Laxity Using 2 Knee Positions and With Simulated Muscle Guarding Full Text available with Trip Pro

Examining Ankle-Joint Laxity Using 2 Knee Positions and With Simulated Muscle Guarding Several factors affect the reliability of the anterior drawer and talar tilt tests, including the individual clinician's experience and skill, ankle and knee positioning, and muscle guarding.To compare gastrocnemius activity during the measurement of ankle-complex motion at different knee positions, and secondarily, to compare ankle-complex motion during a simulated trial of muscle guarding.Cross-sectional (...) ).In a relaxed state, the gastrocnemius muscle did not appear to affect anterior ankle laxity at the 2 most common knee positions for anterior drawer testing; however, talar tilt testing may be best performed with the knee in 0° of knee flexion. Finally, our outcomes from the simulated muscle-guarding condition suggest that clinicians should use caution and be aware of reduced perceived laxity when performing these clinical examination techniques immediately postinjury.

2016 Journal of athletic training

78. CORR Insights®: Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? Full Text available with Trip Pro

CORR Insights®: Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? 26979319 2017 04 24 2018 12 02 1528-1132 474 6 2016 06 Clinical orthopaedics and related research Clin. Orthop. Relat. Res. CORR Insights(®): Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? 1459-60 10.1007/s11999-016-4789-0 Beksaç Burak B Acıbadem University School of Medicine, Acıbadem Maslak Hospital, 40 Buyukdere Cad., Istanbul (...) , Sarıyer, 34457, Turkey. bbeksac@gmail.com. eng Journal Article Comment 2016 03 15 United States Clin Orthop Relat Res 0075674 0009-921X AIM IM Clin Orthop Relat Res. 2016 Jun;474(6):1453-8 26847454 Humans Knee Dislocation diagnosis Physical Examination Vascular System Injuries diagnosis 2016 02 26 2016 03 08 2016 3 17 6 0 2016 3 17 6 0 2017 4 25 6 0 ppublish 26979319 10.1007/s11999-016-4789-0 10.1007/s11999-016-4789-0 PMC4868148 J Vasc Surg. 2013 May;57(5):1196-203 23384491 Clin Orthop Relat Res. 2014

2016 Clinical Orthopaedics and Related Research

79. A New Physical Examination Technique for Evaluating Valgus Knee Deformity: Swing Test Full Text available with Trip Pro

A New Physical Examination Technique for Evaluating Valgus Knee Deformity: Swing Test 27958235 2017 03 13 2018 11 13 2542-5641 129 24 2016 12 20 Chinese medical journal Chin. Med. J. A New Physical Examination Technique for Evaluating Valgus Knee Deformity: Swing Test. 3004-3006 10.4103/0366-6999.195465 Zhou Yi-Xin YX Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Jishuitan Orthopaedic College of Tsinghua University (...) -6999 IM Adult Aged Arthroplasty, Replacement, Knee Female Humans Joint Deformities, Acquired physiopathology surgery Knee Joint Male Middle Aged Physical Examination methods Prospective Studies Young Adult There are no conflicts of interest. 2016 12 14 6 0 2016 12 14 6 0 2017 3 14 6 0 ppublish 27958235 ChinMedJ_2016_129_24_3004_195465 10.4103/0366-6999.195465 PMC5198538 Clin Orthop Relat Res. 1992 Jul;(280):48-64 1611764 J Bone Joint Surg Am. 2005 Sep;87 Suppl 1(Pt 2):271-84 16140800 Chin Med J

2016 Chinese medical journal

80. Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients' history elements and physical examination tests. Full Text available with Trip Pro

Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients' history elements and physical examination tests. To assess the diagnostic validity of clusters combining history elements and physical examination tests to diagnose partial or complete anterior cruciate ligament (ACL) tears.Prospective diagnostic study.Orthopaedic clinics (n = 2), family medicine clinics (n = 2) and community-dwelling.Consecutive patients with a knee complaint (n = 279) and consulting one (...) or complete ACL tears (LR-: 0.08; 95%CI: 0.03-0.24).Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of ACL tears compared to various knee disorders.

2018 PLoS ONE

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