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Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / Purpose. Patellofemoral pain syndrome (PFPS) refers to a syndrome associated with the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof (Wood 1998). The purpose of this investigation was to evaluate whether spinal manipulation, as an adjunct to patella mobilization, contributed significantly to the improvement of patients diagnosed with PFPS. A prospective trial using convenient sampling was implemented using the first 60 volunteers that met the requirements. These were randomly divided into two groups. Participants in group 2 received combined patella mobilization and spinal manipulative therapy, while those in group 1 received patella mobilization only. Each patient selected for the study was required to complete an informed consent form. The selected patients underwent a general medical case history, lower back and knee orthopaedic regional examinations. 8 clinical experiments were done: pain threshold (ALGI), pain tolerance (ALG2), the mean least pain experienced (NRS 1), the mean worst pain experienced (NRS2), the mean pain experienced (NRS3), pain quality (McGill), patellofemoral joint evaluation scale (PFJE) and a patient specific functional scale (PSFS). All were continuous variables except McGill, which was a categorical variable. For each clinical experiment, readings were taken 3 times, i.e. at the first, third and sixth consultations / M

The patellofemoral joint (PFJ) is a common source of problems in Orthopaedics and is the source of poorly defined pain and poor function in both normal and replaced knees. Before problems of the PFJ can be fully comprehended a better understanding of the basic form and function of the PFJ is required. The aim of this thesis therefore is to investigate the shape and kinematics of the PFJ and their inter-relations in both normal and replaced knees. The first part of this thesis was concerned with the shape (or form) of the PFJ. Species from the human ancestry over the previous 400 million years were assembled and measurements taken from three dimensional, CT reconstructions, allowing the descriptions of evolutionary changes in the shape, and orientation of the patellofemoral joint in relation to the tibiofemoral compartments. The study chronicled the dramatic changes that occurred in relation to the adoption of the erect bipedal hominin stance which has resulted in varied anatomy at the PFJ, predisposing it to a wide range of pathologies. The articular surface geometry of normal human patellofemoral joints (bone and cartilage) were compared with those of total knee replacements, and patellofemoral joint replacements. Mapping of the trajectory of the apex of the trochlea groove revealed significant differences between native and replaced knees, with the trajectory being orientated laterally in normal knees and either centrally or medially in replaced knees. The second part of this work was concerned with the kinematics (or function) of the PFJ. With current technology it is impossible to measure coronal plane PFJ kinematics with any accuracy in both native and replaced knees. A novel method was developed combining Motion Analysis and UltraSound (MAUS). Validation experiments were undertaken that demonstrated acceptable error (1.8 mm). The MAUS technique was used to show statistically significant differences between the coronal plane kinematics of the patella in normal and replaced knees. In particular in some arthroplasty patients, the patella tracked in the opposite direction to that in normal subjects. The abnormal kinematics were a manifestation of non-anatomical joint replacements. This demonstrates that form and function are closely related. The interaction between form and function in the knee was further investigated using patients with anterior knee pain. Assessment was made of the relationship between patellar subluxation and multiple bony, cartilaginous and soft-tissue factors potentially predisposing to subluxation. The percentage of engagement of the patella in the trochlear groove in knee extension showed the strongest relationship with subluxation, with subjects less than 30% engaged tending to subluxate. This suggests that the most important factor in preventing subluxation is patellar engagement. A clinical study is now required to assess the effect of surgery aimed at improving engagement. The detailed insights into the variability of form and function in the PFJ obtained throughout this thesis will help address pathology in the native knee and guide decisions for new designs of knee replacements. A novel technology has been developed here for measuring patella kinematics which has great potential for future research. The MAUS technique will provide a clinical investigative tool and allow investigation into kinematic abnormalities in other joints.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of the investigation was to evaluate the presence and extent of Quadriceps Femoris weakness in subjects with patellofemoral pain syndrome by the use of an isokinetic dynamometer. / M

Introduction There is little known about the acute status of TKA patients, as many studies have focused on the long-term outcomes (Aarons et al., 1996). Knowing the acute status can aid physiotherapists in planning postoperative treatment protocols and help with discharge planning. This research examines the postoperative status of total knee arthroplasty (TKA) patients on discharge from an acute setting. The objectives of the study were to establish pain, ROM of the operated knee, functional level, socio-demographic factors, clinical data and the relationship between identified factors and postoperative functional status of TKA patients in the acute setting. Materials and Methods This study is classified as a quantitative, cross-sectional design. Sociodemographic and clinical data, pain, range of movement (ROM) and function of TKA patients were collected on day three post operation. A selfdesigned data capture sheet, the goniometer, VAS (Visual Analogue Scale) and ILOA (Iowa Level of Assistance) were used to measure data. Results Forty-four patients were assessed. There were 41% males and 59% females. The average age was 67 years and BMI was 30kg/m2. All patients had decreased ROM and 82% had poor quadriceps strength. Pain on walking was 5.8 on the VAS and correlated with the ILOA score. Pain on rest was 3.3 and when climbing stairs was 2.4. Sixty-one percent of subjects performed supine to sit, 59% performed sit to stand and 43% performed ambulation independently. Men performed better with an ILOA score of 24. Females had an ILOA score of 31. Length of stay (LOS) was 5.7 days. Females, older subjects and those with no medical conditions were more likely to stay in hospital for longer. Conclusion Knowledge of these factors will help to give patients a likely prognosis following a TKA and target future rehabilitation. Patients should receive adequate pain control to improve their functional ability. More attention should be given to female patients as they perform worse than men. Patients in this population should be referred for outpatient physiotherapy post-discharge, as their status on day three post operation reflected poor ROM, quadriceps muscle strength and function which may affect their rehabilitation outcome.

Thesis (Ph. D.)--University of Oregon, 2006. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 102-109). Also available for download via the World Wide Web; free to University of Oregon users.

Graduation date: 1992