Bakgrund: Uppmärksamhetsfokus på omgivningen/externt fokus har återkommande visat förbättra motorisk färdighet, inlärning och prestation under flertalet olika motoriska uppgifter i jämförelse med fokus på egna kroppen/internt fokus. Instruktioner som uppmuntrar till internt fokus är mer förekommande vid rehabiliteringen av skador som ruptur av främre korsbandet, däremot har externt fokus visats påverka kinematiska variabler som kan minska risken för återskada. Uppmärksamhetsfokus inverkan på kinematiken under knäböj på vippbräda har dock inte studerats tidigare. Syfte: Syftet var att undersöka om instruktioner som uppmuntrar olika uppmärksamhetsfokus har en inverkan på uförande mätt som rörelseflyt, knästabilitet och balans under ett knäböj på vippbräda samt om det fanns skillnader i utförande mellan personer utan knäskada och personer med främre korsbandsrekonstruktion (ACLr). Metod: Sexton deltagare (11 icke-skadade, 5 ACLr) genomförde sex knäböj på en vippbräda under tre omgångar med instruktioner som uppmuntrade till antingen inget särskilt fokus (neutralt), externt fokus (på vippbrädan) eller internt fokus (på fötterna). Alla knäböj registrerades med ett tredimensionellt kamerasystem. Neutralt fokus utfördes först följt av externt eller internt fokus i randomiserad ordning. Utfallsvariabeln rörelseflyt mättes som avvikelser i knäböjets hastighetskurva, knästabilitet som adduktion/abduktion av underbenet och balans som brädans avvikande lutning i horisontalplan. Resultat: Internt fokus ledde till signifikant mindre knäadduktion (gruppmedian skillnad 1.9°) under flexionsfasen när man slog ihop alla 16 deltagare jämfört med neutralt fokus. Inga andra signifikanta resultat noterades mellan uppmärksamhetsfokus eller mellan grupperna utifrån utfallsvariablerna.   Slutsats: Uppmärksamhetsfokus hade ingen konsekvent inverkan på rörelseflyt, balans och knästabilitet bland våra deltagare. Fler studier med högre deltagarantal vid liknande komplexa uppgifter behövs.

No / Anterior cruciate ligament (ACL) injuries are a major problem among female athletes. Screening for the risk of ACL injuries tends to focus on landing tasks, which may be limited in sports where changing direction is the main action involved in noncontact ACL injuries such as soccer. To investigate whether there is a relationship between single-legged landing (SLL), cutting (90° cuts), and pivoting (180° turns) in terms of the characteristics of dynamic valgus. Study Design: Controlled laboratory study. Methods: Twenty female soccer players (mean ± SD: age, 21.0 ± 3.9 years; height, 1.65 ± 0.08 m; mass, 58.4 ± 6.4 kg) performed a minimum of 6 trials of SLL from a 0.3-m drop height and cutting and pivoting all on the right leg. Kinematics and kinetics were calculated from 3-dimensional motion analysis. Results: Strong correlations were found for peak knee abduction angles between tasks (R = 0.63-0.86, P < .01), whereas only moderate correlations between SLL and cutting (R = 0.46, P < .05), cutting and pivoting (R = 0.56, P < .05), and SLL and pivoting (R = 0.43, P > .05) were found between tasks for peak knee abduction moments. Conclusion: The results suggest that female athletes who exhibit poor SLL mechanics perform the same during various changing direction tasks. Clinical Relevance: The results support the use of existing screening tests that involve landing tasks to identify at-risk athletes for noncontact ACL injuries.

No / Context: Two-dimensional (2D) video analysis of frontal-plane dynamic knee valgus during common athletic screening tasks has been purported to identify individuals who may be at high risk of suffering knee injuries such as anterior cruciate ligament tear or patellofemoral pain syndrome. Although the validity of 2D video analysis has been studied, the associated reliability and measurement error have not. To assess the reliability and associated measurement error of a 2D video analysis of lower limb dynamic valgus. Design: Reliability study. Participants: 20 recreationally active university students (10 women age 21.5 ± 2.3 y, height 170.1 ± 6.1 cm, weight 66.2 ± 10.2 kg, and 10 men age 22.6 ± 3.1 y, height 177.9 ± 6.0 cm, weight 75.8 ± 7.9 kg). Main Outcome Measurement: Within-day and between-days reliability and measurement-error values of 2D frontal-plane projection angle (FPPA) during common screening tasks. Interventions: Participants performed single-leg squat and drop jump and single-leg landings from a standard 28-cm step with standard 2D digital video camera assessment. Results: Women demonstrated significantly higher FPPA in all tests except the left single-leg squat. Within-day ICCs showed good reliability and ranged from .59 to .88, and between-days ICCs were good to excellent, ranging from .72 to .91. Standard error of measurement and smallest detectable difference values ranged from 2.72° to 3.01° and 7.54° to 8.93°, respectively. Conclusions: 2D FPPA has previously been shown to be valid and has now also been shown to be a reliable measure of lower extremity dynamic knee valgus. Using the measurement error values presented along with previously published normative data, clinicians can now make informed judgments about individual performance and changes in performance resulting from interventions.

This paper investigates the importance of electrical stimulation (E-Stim) treatment pre- exercise, during exercise, and post-exercise on knee pain management and exercise performance on individuals with knee injuries. Common problems from which individuals experience pain and injuries are arthritis, ACL tears, and osteoarthritis. One therapeutic approach to address the pain has been electrical stimulation. This is a non-invasive treatment that introduces electrical currents into the injured tissue or muscle. However, there are several modalities of electrical stimulation treatment that include Transcutaneous Electrical Nerve Stimulation (TENS), Neuromuscular Electrical Stimulation (NMES), and Patterned Electrical Neuromuscular Stimulation (PENS). These treatments have the same goal: to provide a non-invasive method to stimulate the muscles and nerves to aid the healing process. Throughout this research, the populations targeted were females and males with age ranging from adolescents to older adults. The subjects were 15 – 75 years of age and had experienced knee injuries. They included athletes, older adults with osteoarthritis, and those who required arthroplasty. Between January 2023 and April 2024, the review of literature was conducted using UCF Libraries, PubMed, (MedLine), and SPORTDiscus (EBSCOhost). Keywords used included “TENS (Transcutaneous Electrical Nerve Stimulation) *”, “NMES (Neuromuscular Electrical Stimulation) *”, “osteoarthritis (OA)*”, Electrical Stimulation (E- Stim) *”, “knee injuries*”, “pain management*”, “before exercise*”, “after exercise*” and “during exercise*”. The results from these studies suggested that the application of e-stim was favored either during or after exercise.

Background: Knee osteoarthritis is a degenerative disease characterized by damaged joint tissues (e.g., cartilage) that leads to joint pain, and reduced mobility and quality of life. Various factors are involved in disease progression, including biomechanical, patient-reported outcome and mobility measures. This thesis provides important longitudinal data on the role of these factors in disease progression, and the trajectory of biomechanical factors in persons with knee osteoarthritis. Objectives: (1) Determine the extent to which changes over 2.5 years in knee cartilage thickness and volume in persons with knee osteoarthritis were predicted by the knee adduction and flexion moment peaks, and knee adduction moment impulse and loading frequency. (2) Determine the extent to which changes over 2 years in walking and stair-climbing mobility in women with knee osteoarthritis were predicted by quadriceps strength and power, pain and self-efficacy. (3) Estimate the relative and absolute test-retest reliabilities of biomechanical risk factors for knee osteoarthritis progression. Methods: Data were collected at 3-month intervals during a longitudinal (3-year), observational study of persons with clinical knee osteoarthritis (n=64). Magnetic resonance imaging of the study knee was acquired at the first and last assessments, and used to determine cartilage thickness and volume. Accelerometry and dynamometry data were acquired every 3 months, and used to determine knee loading frequency and knee muscle strength and power, respectively. Walking and stair-climbing mobility, as well as pain and self-efficacy data, were also collected every 3 months. Gait analyses were performed every 6 months, and used to calculate lower-extremity kinematics and kinetics. Results: (1) The knee adduction moment peak and impulse each interacted with body mass index to predict loss of medial tibial cartilage volume over 2.5 years. These interactions suggested that larger joint loads in those with a higher body mass index were associated with greater loss of cartilage volume. (2) In women, lower baseline self-efficacy predicted decreased walking and stair ascent performances over 2 years. Higher baseline pain intensity/frequency also predicted decreased walking performance. Quadriceps strength and power each interacted with self-efficacy to predict worsening stair ascent times. These interactions suggested that the impact of lesser quadriceps strength and power on worsening stair ascent performance was more important among women with lower self-efficacy. (3) Relative reliabilities were high for the knee adduction moment peak and impulse, quadriceps strength and power, and body mass index (i.e., intraclass correlation coefficients >0.80). Absolute reliabilities were high for quadriceps strength and body mass index (standard errors of measurement <15% of the mean). Data supported the use of interventions effective in reducing the knee adduction moment and body mass index, and increasing quadriceps strength, in persons with knee osteoarthritis. Conclusion: Findings from this thesis suggest that biomechanical factors play a modest independent role in the progression of knee osteoarthritis. However, in the presence of other circumstances (e.g., obesity, low self-efficacy, high pain intensity/frequency), biomechanical factors can vastly worsen the disease. Strategies aiming to curb structural progression and improve clinical outcomes in knee osteoarthritis should target biomechanical and clinical outcomes simultaneously. / Thesis / Doctor of Philosophy (PhD) / Knee osteoarthritis is a multifactorial disease whose progression involves worsening joint structure, symptoms, and mobility. Various factors are linked to the progression of this disease, including biomechanical, patient-reported outcome and mobility measures. This thesis provides important information on how these factors, separately and collectively, are involved in worsening disease over time, as well as benchmarks that are useful to clinicians and researchers in interpreting results from interventional or longitudinal research. First, we examined how different elements of knee loading were associated with changes in knee cartilage quantity over time in persons with knee osteoarthritis. Second, we examined how different elements of knee muscle capacity and patient-reported outcomes were related to changes in mobility over time in persons with knee osteoarthritis. Third, we examined the stability over time of various biomechanical risk factors for the progression of knee osteoarthritis. Novel results from this thesis showed that: (1) larger knee loads predicted cartilage loss over 2.5 years in obese individuals with knee osteoarthritis but not in persons of normal weight or overweight; (2) among women with knee osteoarthritis with lower self-efficacy (or confidence), lesser knee muscle capacity (strength, power) was an important predictor of declining stair-climbing performance over 2 years; and (3) clinical interventions that can positively alter knee biomechanics include weight loss, knee muscle strengthening, as well as specific knee surgery and alterations during walking to reduce knee loads. Interventions for knee osteoarthritis should target biomechanical and clinical outcomes simultaneously.

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Motion palpation is used to assess the functional status of a joint and is defined as “The manual palpation of bony structures and soft tissues, through pressure applied in various directions of joint motion to ascertain areas of joint hypomobility and hypermobility.” Motion palpation is a collection of manual examination procedures, used to identify the site and characteristics of altered joint motion and which has been an important part of chiropractic since its inception. One of the most important goals for any clinical instrument is for it to have good reliability and reproducibility, this is because the clinical value of a test must be demonstrated before the results are considered valid. The extent to which a repeated test will produce the same result when evaluating an unchanged characteristic is its reliability. Reliability is evaluated by multiple blinded measurements performed on a sample of subjects. Inter-examiner reliability evaluates the consistency of different examiners and is determined through repeated assessment by two or more raters. Objective The aim of this study was to determine the inter-examiner reliability of motion palpation of knee joints with patellofemoral pain syndrome and asymptomatic knee joints, and to compare the inter-examiner reliability of motion palpation between the two groups. Method This quantitative, inter-examiner, clinical reliability study, included 30 patients each with one knee with patellofemoral pain syndrome and one asymptomatic knee. Each patient had both of their knees motion palpated by three independent examiners blinded to which was the symptomatic knee. The examiners were senior student interns at the DUT Chiropractic Clinic. The motion palpation findings were recorded and statistically analyzed through the SPSS statistical package. Fleiss Kappa statistic was used to give a Kappa score for each direction of motion palpation and these scores evaluated the inter-examiner reliability of motion palpation in the symptomatic and the asymptomatic knee. A comparison of the inter-examiner reliability of motion palpation between the two groups was performed using a paired Wilcoxin signed ranks test. Results The Kappa scores for motion palpation ranged from -0.2081 to 0.1802 for the symptomatic knee joint and -0.2836 to 0.0339 for the asymptomatic knee. This shows poor agreement in both cases. There was no significant difference in Kappa values (p= 0.609) for the two groups for the Wilcoxin signed ranks test and the number of positive and negative ranks were similar. This indicates that the reliability of motion palpation in both groups was similar. Conclusion It was concluded that inter-examiner reliability of motion palpation of the knee joint was poor in knees with patellofemoral pain syndrome and in knees that were asymptomatic. Motion palpation was found to be equally reliable in both groups, indicating that motion palpation of a symptomatic joint does not improve its reliability. This research suggests that motion palpation should be used together with other diagnostic tests to identify patellofemoral pain syndrome as it is not a reliable tool when used in isolation.

BACKGROUND:Anticoagulation with vitamin K antagonists such as warfarin has historically been used for the long term management of patients with thromboembolic disease. However, these agents have a slow onset of action which requires bridging therapy with heparin and its analogues, which are available only in parenteral route. To overcome these limitations, new oral anticoagulants such as factor Xa inhibitors and direct thrombin inhibitors have been developed. The aim of this article is to systematically review the phase 3 clinical trials of new oral anticoagulants in common medical conditions.METHODS:We searched PubMed (Medline) from January 2007 to February 2013 using "Oral anticoagulants", "New oral anticoagulants", "Randomized controlled trial", "Novel anticoagulants", "Apixaban", "Rivaroxaban", "Edoxaban", "Dabigatran etexilate", "Dabigatran" and a combination of the above terms. The available evidence from the phase 3 RCTs was summarized on the basis of individual drug and the medical conditions categorized into "atrial fibrillation", "acute coronary syndrome", "orthopedic surgery", "venous thromboembolism" and "medically ill patients".RESULTS:Apixaban, rivaroxaban and dabigatran have been found to be either non-inferior or superior to enoxaparin in prophylaxis of venous thromboembolism in knee and hip replacement with similar bleeding risk, superior to warfarin for stroke prevention in atrial fibrillation with significant reduction in the risk of major bleeding, non-inferior to aspirin for reducing cardiovascular death and stroke in acute coronary syndrome with significant increase in the risk of major bleed. Rivaroxaban and dabigatran are also superior to the conventional agents in the management of symptomatic venous thromboembolism. However, compared to enoxaparin, apixaban and rivaroxaban use lead to significantly increased bleeding risk in medically ill patients. Additional studies evaluating the specific reversal agents of these new drugs for the management of life-threatening bleeding or other adverse effects are necessary.CONCLUSION:Considering their pharmacological properties, their efficacy and bleeding complications, the new oral agents offer a net favourable clinical profile in orthopedic surgery, atrial fibrillation, acute coronary syndrome and increase the risk of bleeding in critically ill patients. Further studies are necessary to determine the long term safety and to identify the specific reversal agents of these new drugs.

Thesis (MScEng)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The shape of the knee’s trochlear groove is a very important factor in the overall stability of the knee. However, a quantitative description of the normal three-dimensional geometry of the trochlea is not available in the literature. This is also reflected in the poor outcomes of patellofemoral arthroplasty (PFA). In this study, a standardised method for femoral parameter measurements on three-dimensional femur models was established. Using software tools, virtual femur models were aligned with the mechanical and the posterior condylar planes and this framework was used to measure the femoral parameters in a repeatable way. An artificial neural network (ANN), incorporating the femoral parameter measurements and classifications done by experienced surgeons, was used to classify knees into normal and abnormal categories. As a result, 15 knees in the database were classified by the ANN as being normal. Furthermore, the geometry of the normal knees was analysed by fitting B-spline curves and circular arcs on their sagittal surface curves to prove and reconfirm that the groove has a circular shape on a sagittal plane. Self-organising maps (SOM), which is a type of ANN, was trained with the acquired data of the normal knees and in this way the normal trochlear geometry could be predicted. The prediction of the anterior-posterior (AP) distance and the trochlear heights showed an average agreement of 97 % between the actual and the predicted normal geometries. A case study was conducted on four types of trochlear dysplasia to determine a normal geometry for these knees, and a virtual surface reconstruction was performed on them. The study showed that the trochlea was deepened after the surface reconstruction, having an average trochlea depth of 5.5 mm compared to the original average value of 2.9 mm. In summary, this research proposed a quantitative method for describing and predicting the normal geometry of a knee by making use of ANN and the femoral parameters that are unaffected by trochlear dysplasia. / AFRIKAANSE OPSOMMING: Die vorm van die trogleêre keep is ’n belangrike faktor in patella-stabiliteit. Tog is ’n kwantitatiewe beskrywing van die normale driedimensionele geometrie van die troglea nog nie beskikbaar nie, wat duidelik blyk uit die swak uitkomste van patellofemorale artroplastie (PFA). In hierdie studie is ’n gestandaardiseerde metode vir die meting van femorale parameters op grond van driedimensionele femurmodelle ontwikkel. Die femurmodel is in lyn gebring met die meganiese en posterior kondilêre vlak, welke raamwerk gebruik is om die femorale parameters op ’n herhaalbare wyse te meet. Die normale knieë is geklassifiseer met ’n kunsmatige neurale netwerk (ANN), wat die femorale parameter-mate sowel as die chirurgiese klassifikasie ingesluit het, en 15 knieë is gevolglik as normaal aangewys. Die normaleknie-geometrie is ontleed deur B-latkrommes en sirkelboë op die sagittale oppervlak-kurwes aan te bring om te bewys en te herbevestig dat die keep uit ’n sirkelvorm op ’n sagittale vlak bestaan. Die ingesamelde data van die normale knieë is ingevoer by selfreëlende kaarte (SOM), synde ’n soort ANN, wat die navorser in staat gestel het om die normale trogleêre geometrie te voorspel. Die voorspelling van die anterior-posterior (AP) afstand en die trogleêre hoogtes toon ’n gemiddelde ooreenkoms van meer as 97 % tussen die werklike en voorspelde normale geometrie. ’n Gevallestudie is op vier soorte trogleêre displasie uitgevoer om die normale geometrie te voorspel en ’n oppervlakrekonstruksie daarop uit te voer. Hierdie studie het getoon dat die troglea ná oppervlakrekonstruksie verdiep was, met ’n gemiddelde trogleadiepte van 5.5 mm in vergelyking met die aanvanklike gemiddelde waarde van 2.9 mm. Hierdie navorsing het dus ’n metode aan die hand gedoen vir die kwantitatiewe beskrywing en voorspelling van normale geometrie met behulp van ANN sowel as met die femorale parameters wat nie deur die trogleêre displasie geraak word nie.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2010. / Patients’ knowledge about the effectiveness of interventions is now recognized as an important facilitator of the implementation of evidence in practice. Evidence-based, patient education programs aim to impart knowledge about the efficacy and effectiveness about interventions to individuals. However, there is currently a lack of structured evidence-based educational programs to educate patients about the evidence-base for interventions prescribed by the health professionals in the field of orthopaedics. OBJECTIVE: The main objective of this study was to develop and validate an Arabic version of an evidence-based educational program for patients who are scheduled to undergo ACL reconstruction surgery in UAE, based on available evidence collated through a systematic review process. METHODS: A systematic review was conducted to generate clinical recommendations which were used to develop the evidence-based educational program. The evidence-based information was derived from secondary research to determine which rehabilitation strategies were most effective in improving outcome measurements following ACL reconstruction surgery. A pre-final draft of the evidence-based educational program was prepared and forward and back translated from English into the Arabic language. Feedback groups of ACL patients and physiotherapists were used to determine the content and face validity of the program. The final draft was validated in a group of 40 ACL patients waiting to undergo ACL reconstruction surgery at Zayed Military hospital and Abu Dhabi Knee and Sports Medicine Centre in the UAE, using checklists. RESULTS: A total of 40 patients undergoing ACL reconstruction surgery consented to participate in this study. All the subjects were male. The age range was between 18 to 38 years old with mean age of 28.5 years (SD 5.75). Most of the patients (65%) underwent ACL reconstruction surgery to the right knee. Of the total sample (n=40), the majority of the subjects who participated in this study (90 %), had ACL surgery for the first time. Most of the responses to the evidence-based educational program checklist were positive. iv CONCLUSION: It can be recommended that the newly-developed evidence-based educational program is a valid tool which can be given to ACL patients prior to ACL reconstruction to prepare them for the rehabilitation postoperatively. By informing patients of their condition, the expected outcomes of their condition and the effect of doing exercises to improve their condition, the patients will be more encouraged to partake in rehabilitation, as they know it is for their own good. This will ultimately improve overall patient care and improve management of ACL patients.

Die vorliegende retrospektive Analyse zeigt große Unterschiede zwischen frühem (≤ 36 Monate) und spätem (>36 Monate) Knieendoprothesenversagen. Die Indikation für einen Prothesenwechsel in der Gruppe der Frühversager besteht am häufigsten aufgrund einer Malrotation / Malposition der Prothesenkomponenten. Ein Versagen unabhängig von der Standzeit ist meist auf aseptische Prothesenlockerungen zurückzuführen.  Mehrfach operierte Patienten erzielen ein schlechteres Revisonsergebnis und müssen im Mittel nach 34 Monaten einem erneuten Eingriff unterzogen werden. Dies spiegelt sich in schlechteren Befragungsresultaten dieser Patientengruppe wider. Als signifikant erweisen sich die Unterschiede in der körperlichen Aktivität (p=0,041) und im Gesamtscore des WOMAC (p=0,030). Auch Frauen und Patienten mit einem höheren BMI bewerten ihre Situation schlechter, hier zeigen sich signifikante Unterschiede in der Gelenksteifigkeit. Ein höheres Patientenalter wirkt sich dagegen positiv auf das Resultat nach Revisionsoperation aus. Insgesamt bewerten 78% der Befragten ihren Revisionsentscheid im Nachhinein als positiv.