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Knee Exam

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13601. The correlation between pes planus and anterior knee or intermittent low back pain. (Abstract)

The correlation between pes planus and anterior knee or intermittent low back pain. Anterior knee pain and intermittent low back pain are among the most common orthopedic complaints of adolescents. However, little is known about pes planus and its relative risk for these symptoms. The goal of the study was to track the prevalence of pes planus in adolescents, and examine its associated risk to anterior knee pain and intermittent low back pain, respectively.A retrospective study of 97,279 (...) military recruits presenting to recruitment centers was conducted. Pes planus was graded by an orthopedist as mild, moderate or severe according to the flattening of the plantar arch and its rigidity to standing on one's toes. Anterior knee pain was diagnosed when symptoms were attributed to the patellofemoral joint. Intermittent low back pain was diagnosed when there was pain but neither abnormal clinical nor radiographic findings.Pes planus was present in 15,698 (16%) individuals. 11,549 (74%), 3,341

2008 Foot & Ankle International

13602. Anthropometric measures, body composition, body fat distribution, and knee osteoarthritis in women. Full Text available with Trip Pro

Anthropometric measures, body composition, body fat distribution, and knee osteoarthritis in women. Increased BMI is a well-recognized risk factor for radiographic knee osteoarthritis (rKOA); however, the contributions of the components of body composition, body fat distribution, and height to this association are not clear.We examined 779 women > or = 45 years of age from the Johnston County Osteoarthritis Project. Body composition was assessed using DXA, and rKOA was defined as Kellgren (...) -Lawrence grade > or = 2. Logistic regression models examined the association between rKOA and the fourth compared with the first quartiles of anthropometric, body composition, and fat distribution measures adjusting for age, ethnicity, and prior knee injury.The adjusted odds ratios and 95% confidence interval of BMI and weight were 5.27 (3.05, 9.13) and 5.28 (3.05, 9.16), respectively. In separate models, higher odds of rKOA were also found for fat mass [4.54 (2.68, 7.69)], percent fat mass [3.84 (2.26

2006 Obesity

13603. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. Full Text available with Trip Pro

Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. The response of healthy and diseased cartilage of the knee to the mechanics of walking is examined, with the goal of providing insight into the relationship between the kinematics and kinetics of the knee during walking and the maintenance of cartilage health. The combination of information from three-dimensional thickness models of cartilage derived from magnetic resonance imaging and the analysis (...) of the interaction between load at the knee and kinematic changes during walking associated with loss of the anterior cruciate ligament demonstrated the importance of considering walking mechanics as an important factor in the initiation and progression of osteoarthritis. In particular, this material suggests that knee cartilage becomes conditioned to loading and to the large number of repetitive cycles of loading that occur during walking and that healthy cartilage homeostasis is maintained as long

2009 The Journal of Bone and Joint Surgery. American Volume

13604. Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture: an 8-year follow-up of 28 consecutive cases. (Abstract)

Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture: an 8-year follow-up of 28 consecutive cases. Chronic anterior knee pain is a common complication after intramedullary nailing of a tibial shaft fracture. The source of pain is often not known, although it correlates with a simultaneous decrease in thigh muscle strength. No long-term follow-up study has assessed whether weakness of the thigh muscles is associated with anterior knee pain after (...) the procedure in question.Prospective study.University Hospital of Tampere, University of Tampere.The muscular performance of 40 consecutive patients with a nailed tibial shaft fracture was tested isokinetically in a follow-up examination an average of 3.2 +/- 0.4 (SD) years after the initial surgery. An 8-year follow-up was possible in 28 of these cases.Isokinetic muscle strength measurements were made in 28 patients at an average 8.1 +/- 0.3 (SD) years after nail insertion and an average 6.6 +/- 0.3 (SD

2007 Journal of Orthopaedic Trauma

13605. 10-year review of knee dislocations: is arteriography always necessary? (Abstract)

10-year review of knee dislocations: is arteriography always necessary? Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations.We conducted an institutional review board-approved retrospective review of patients (...) admitted at a university-based Level I trauma center with knee dislocations from January 1, 1993, to December 31, 2002. Thirty-nine patients (28 male patients and 11 female patients; average age, 42.8 years) had 39 dislocations (27 left and 12 right, 26 posterior and 13 anterior). Most patients (n = 25) were involved in motor vehicle crashes. All patients underwent arteriography.Of the 20 normal arteriograms, all had normal PE. Of the 19 abnormal arteriograms, 8 had a normal PE and 11 were abnormal

2005 Journal of Trauma

13606. The effect of knee-spanning external fixation on compartment pressures in the leg. (Abstract)

. A threshold of less than 30 mm Hg differential from diastolic pressure in conjunction with clinical examination was set as an indication for 4-compartment fasciotomy.: Twenty-five patients with a mean age of 52 years (range, 21-69 years) were enrolled in the study. Injuries included proximal tibial fractures (Orthopaedic Trauma Association types, 41) in 21 patients; knee fracture-dislocation (Moore type II) in 2 patients, and knee (femoro-tibial) dislocations in 2 patients. Two fractures were open (...) The effect of knee-spanning external fixation on compartment pressures in the leg. External fixation is frequently used for provisional and/or definitive stabilization of open and closed fractures and dislocations involving the lower extremity. There is some concern, however, that application of an external fixator with subsequent reduction of the fractures with distraction may precipitate the development of compartment syndrome. The hypothesis of this study was that application of external

2008 Journal of Orthopaedic Trauma

13607. Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis. Full Text available with Trip Pro

Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis. To determine if the combination of body mass index (BMI) and waist circumference (WC) explains an additional component of arthritis and knee osteoarthritis risk than is accounted for by either anthropometric measure alone.Cross-sectional study.Participants were part of the Third National Health and Nutrition Examination Survey, a representative sample of Americans conducted from 1988 (...) to 1994. The arthritis analyses included 15 570 participants aged 18 years and older. The knee osteoarthritis analyses included 2323 participants aged 60 years and older. Body mass index and WC were measured in all participants and classified into sex-specific tertiles.Arthritis (determined by self-report) and knee osteoarthritis (determined by radiograph).Independent of sex, the likelihood of arthritis and knee osteoarthritis increased in a graded fashion when moving from the lowest to highest BMI

2006 International Journal of Obesity

13608. Anterior knee pain after intramedullary nailing of a tibial shaft fracture: an ultrasound study of the patellar tendons of 36 patients. (Abstract)

Anterior knee pain after intramedullary nailing of a tibial shaft fracture: an ultrasound study of the patellar tendons of 36 patients. Chronic anterior knee pain is a common complication following intramedullary nailing of a tibial shaft fracture. The etiology of pain is often not known. This study sonographically examined the patellar tendons of patients with a nailed tibial shaft fracture.Prospective study.University hospital.Fifty consecutive patients with a nailed tibial shaft fracture (...) were initially included in the study. Thirty-six of them could be measured at an average of 2.5 +/- 0.5 years after nail insertion (1.0 +/- 0.3 years after nail extraction).Reamed intramedullary nailing with 2 interlocking bolts at both ends of the nail (Grosse-Kempf-nail, Howmedica).The ultrasound investigation of the patellar tendons of the 36 patients.Twelve (33%) patients were painless and 24 (67%) patients had anterior knee pain at follow-up. With the reference to the mean difference

2005 Journal of Orthopaedic Trauma

13609. Radiographic identification of the primary medial knee structures. Full Text available with Trip Pro

of the posterior oblique and medial patellofemoral ligaments of eleven fresh-frozen, nonpaired cadaveric knee specimens. Both anteroposterior and lateral radiographs were made. Structures were assessed within quadrants formed by the intersection of reference lines projected on the lateral radiographs. Quantitative measurements were performed by three independent examiners. Intraobserver reproducibility and interobserver reliability were determined with use of intraclass correlation coefficients.The overall (...) 15.9 +/- 5.2 and 66.1 +/- 3.6 mm distal to the tibial inclination, respectively.The attachment locations of the main medial knee structures can be qualitatively and quantitatively correlated to osseous landmarks and projected radiographic lines, with close agreement among examiners.

2009 The Journal of Bone and Joint Surgery. American Volume

13610. Evaluation of posterolateral rotatory knee instability using the dial test according to tibial positioning. (Abstract)

Evaluation of posterolateral rotatory knee instability using the dial test according to tibial positioning. This study examined the effect of the anteroposterior (AP) direction force on the tibial external rotation of a posterior cruciate ligament (PCL)/posterolateral corner (PLC)-deficient knee in a clinical setting.Between December 2006 and December 2007, 21 patients with a PCL-PLC injury were assessed using a dial test. The thigh-foot angle (TFA) and patella-tubercle angle (PTA) were (...) measured with an external rotation stress applied to the tibia at both 30 degrees and 90 degrees of knee flexion in 2 different positions (reduced and posterior subluxed). The test was performed with the patient in the supine position and with an AP force applied to the tibia by an assistant. To reduce intra- and interobserver bias, the measurements were taken twice by 2 orthopaedic surgeons for all patients.In the subluxed position, the mean side-to-side differences in the TFA at 30 degrees and 90

2009 Arthroscopy

13611. Neighborhoods matter: use of hospitals with worse outcomes following total knee replacement by patients from vulnerable populations. Full Text available with Trip Pro

Neighborhoods matter: use of hospitals with worse outcomes following total knee replacement by patients from vulnerable populations. Neighborhood sociodemographic characteristics are associated with health care utilization across many conditions. There has been little study of whether total knee replacement (TKR) recipients from vulnerable populations, including racial and ethnic minorities, the poor, the elderly, and the less well educated, are more likely to use low-volume hospitals (LVHs).We (...) used Medicare claims and census data to identify a national cohort of Medicare beneficiaries who had elective TKR. We defined an LVH as a center performing fewer than 26 TKRs per year, and we used geocoding to identify "bypassers" (patients who had a high-volume hospital closer to their residence than the one where they had TKR). We used multivariate logistic regression to examine the association of patient and neighborhood characteristics with utilization of LVHs and bypassing. We derived

2007 Archives of Internal Medicine

13612. Residual varicose veins below the knee after varicose vein surgery are not related to incompetent perforating veins. Full Text available with Trip Pro

limbs) with untreated primary varicose veins, a preoperative clinical examination and preoperative color flow duplex imaging were performed. Re-evaluation (clinical examination and color flow duplex imaging) was performed 6 months after surgery. Dissection of the saphenofemoral junction and short-stripping of the GSV from the groin to just below the knee level was performed without additional stab avulsions on the lower leg. The association between postoperative reflux in the three GSV branches (...) Residual varicose veins below the knee after varicose vein surgery are not related to incompetent perforating veins. The objectives of this study were to investigate the occurrence of residual varicose veins (visible and ultrasonic) at the below-knee level after short-stripping the great saphenous vein (GSV) and to investigate the possible role of preoperative incompetent perforating veins (IPVs) on the persistence of these varicose veins.In this prospective study in 59 consecutive patients (74

2006 Journal of Vascular Surgery

13613. Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation. (Abstract)

Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation. Anterior cruciate ligaments (ACLs) and posterior cruciate ligaments (PCLs) from 45 osteoarthritic knees were histologically examined to evaluate the frequency and grade the severity of degenerative changes, which were correlated with radiologic grade of arthritis and severity of deformity at the knee. Immunohistochemical staining was used to identify neurofilaments in 10 knees. A histologic score (...) was generated for both cruciates based on changes found on light microscopy. The ACL was severely degenerated, absent, or disrupted in knees with radiologic arthritis higher than grade 3 and varus deformity exceeding 15 degrees . The PCL was moderately degenerated in most knees irrespective of the grade of arthritis and severity of deformity. Neurofilaments were present in all 10 PCLs and absent in 4 ACLs.

2008 Journal of Arthroplasty

13614. Non-Hodgkin lymphoma as an unexpected diagnosis after elective total knee arthroplasty. (Abstract)

Non-Hodgkin lymphoma as an unexpected diagnosis after elective total knee arthroplasty. Total knee arthroplasty is routinely performed for osteoarthritis of the knee joint. We report a case of non-Hodgkin lymphoma as an unexpected diagnosis after pathologic examination of unusual-looking femoral condyle bone block harvested during total knee arthroplasty in an asymptomatic patient.

2008 Journal of Arthroplasty

13615. Tibial post failures in a condylar posterior cruciate substituting total knee arthroplasty. (Abstract)

Tibial post failures in a condylar posterior cruciate substituting total knee arthroplasty. In posterior-stabilized total knee arthroplasties, a femoral cam and polyethylene tibial post are commonly used to restore posterior stability after sacrifice of the posterior cruciate ligament. This article reports a high incidence of early tibial post failures in one design of prosthesis and examines the variables that may have contributed to such. Five hundred sixty-four consecutive posterior (...) -stabilized total knees were implanted in 512 patients, using a total knee prosthesis with a polyethylene tibial post and femoral cam. Clinical and radiographic outcomes were measured at a mean follow-up of 40 months after surgery (range, 24-83 months). At follow-up, 70 knees in 62 patients (12%) had undergone revision surgery because of symptoms related to catastrophic failure of the tibial post.

2008 Journal of Arthroplasty

13616. Weight and activity change in overweight and obese patients after primary total knee arthroplasty. Full Text available with Trip Pro

Weight and activity change in overweight and obese patients after primary total knee arthroplasty. Few studies have examined the effect of primary total knee arthroplasty on the weight and physical activity of overweight and obese patients in the United States. We conducted a prospective study of changes in mean weight, body mass index (BMI), and physical activity over 2 years in 188 consecutive overweight or obese patients. Weight, BMI, and physical activity, evaluated using the Lower

2008 Journal of Arthroplasty

13617. Results of total hip and total knee arthroplasties in patients with synovial chondromatosis. (Abstract)

Results of total hip and total knee arthroplasties in patients with synovial chondromatosis. This retrospective analysis examines the outcome of total joint arthroplasty for severe arthritis in patients with synovial chondromatosis. All 11 patients treated with total hip arthroplasty (n = 7) or total knee arthroplasty (n = 4) returned for follow-up at a mean of 10.8 years after surgery. Pain and functional scores improved significantly in all patients. Knee range of motion improved in all (...) patients. Synovial chondromatosis recurred in 1 knee (25%) and 1 hip (14%). Total joint arthroplasty is a valuable treatment option for these patients with predictable improvement in pain and function. Knee range of motion is likely to improve but may be less than expected for primary total knee arthroplasty. Patients remain at risk for recurrence.

2008 Journal of Arthroplasty

13618. Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty. (Abstract)

Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty. We aimed to identify the causes and predictors of patient's dissatisfaction after total knee arthroplasty (TKA). Patient's satisfaction was evaluated in 438 TKAs. Causes of patient dissatisfaction were identified using patient interview, physical examinations, laboratory and radiographic tests, and relevant medical consultations. Investigation of 33 dissatisfied knees identified knee-related symptoms (...) in 16 knees (48.5%) and the symptoms unrelated to the replaced knee in 17 knees (51.5%). Multivariate logistic regression analysis revealed that worse preoperative Western Ontario McMaster University Osteoarthritis Index scale pain score and postoperative decrease in range of motion were significantly associated with postoperative dissatisfaction (odds ratio, 7.6 and 2.1, respectively). This study demonstrates that residual symptoms or dysfunctions not directly associated with the replaced knee

2009 Journal of Arthroplasty

13619. The clinical effect of gender on outcome of total knee arthroplasty. (Abstract)

The clinical effect of gender on outcome of total knee arthroplasty. The purpose of this study was to quantify the effect of sex on the clinical outcome and survivorship of a total knee arthroplasty (TKA) with clinical and radiographic follow-up. Seven thousand three hundred twenty-six primary AGC (Biomet, Warsaw, Ind) cruciate-retaining TKAs were performed from 1987 to 2004. Of these, 59.5% were performed on women. We examined preoperative and postoperative Knee Society knee score, function (...) scores, pain scores, walking ability, stair-climbing ability, flexion, and implant survivorship based on sex. Female sex was associated with lower overall preoperative clinical scores for all parameters (P < .01). Improvement in Knee Society knee score and flexion was greater for women (P = .006), and there were equal pain relief and walking improvements for both sexes (P < .32). Stair and function score improvements were greater for men (P = .002). Implant survival was 98% for women and men at 15

2008 Journal of Arthroplasty

13620. Safety of Combined Use of Local Anesthetic Infiltration and Reinfusion Drains in Total Knee Arthroplasty. (Abstract)

Safety of Combined Use of Local Anesthetic Infiltration and Reinfusion Drains in Total Knee Arthroplasty. Injection of local anesthetic during total knee arthroplasty (TKA) has been shown to aid postoperative pain relief. Reinfusion drains have also proven useful in decreasing allogenic blood transfusion. Combined use carries the risk of reinfusion of local anesthetic from drainage bag. We examined plasma ropivacaine concentrations from 20 patients undergoing TKA, who were treated with these 2

2008 Journal of Arthroplasty

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