Thesis (MAppSc in Physiotherapy)--University of South Australia, 1996

The objective of this study was to investigate the accuracy of eleven prediction equations and one prediction table when estimating isoinertial knee extension and leg press one repetition maximum (1-RM) performance in subjects with knee injuries and knee osteoarthritis. Study Design: A descriptive quantitative research study was undertaken utilizing a cross-sectional design. Background: Traumatic injuries and osteoarthritis are common musculoskeletal pathologies that can disrupt normal function of the knee joint. A frequent sequela of these pathologies is quadriceps femoris muscle weakness. Such weakness can contribute to disability and diminished levels of functional and recreational activity. Therefore, safe and accurate methods of measuring maximal strength are required to identify and quantify quadriceps strength deficits. One option proposed in the literature is the use of 1-RM prediction equations which estimate 1-RM performance from the number of repetitions completed with sub-maximal loads. These equations have been investigated previously using healthy populations and subjects with calf muscle injuries. However, to date, no known study has investigated their accuracy in individuals with joint pathologies. Method: Machine-weight seated knee extension and seated leg press exercises were investigated in this study. Twenty subjects with knee injuries and 12 subjects with knee OA completed the testing procedures for the knee extension exercise. Nineteen subjects with knee injuries and 18 subjects with knee OA completed the testing procedures for the leg press exercise. All subjects attended the testing venue on three occasions. At the first visit a familiarization session was carried out. At the second and third visits each subject was randomly assigned to perform either actual or predicted 1-RM testing for both of the exercises. Twelve different prediction methods were used to estimate 1-RM performance from the results. The estimates of 1-RM strength were then compared to actual 1-RM performance to assess the level of conformity between these measures. Statistical procedures including Bland and Altman analyses, intraclass correlation coefficients, typical error and total error of measurement were used in the analyses of the results. In addition, paired t-tests were performed to determine whether actual 1-RM values were significantly different across the control and affected limbs and whether there were any significant differences in predictive accuracy for each equation across the control and affected limbs. Finally, the number of subjects with predicted 1-RM values within 5% or less of their actual 1-RM values was determined for each equation. Results: When the knee injury group performed the knee extension exercise, the Brown, Brzycki, Epley, Lander, Mayhew et al., Poliquin and Wathen prediction methods demonstrated the greatest levels of predictive accuracy. When two atypical subjects were identified and excluded from the analyses, the accuracy of these equations improved further. Following the removal of these two subjects, no significant differences in predictive accuracy were found for any of the equations across the affected and control limbs (p > 0.05). Typical errors and total errors were low for the more accurate prediction methods ranging from 2.4-2.8% and from 2.4-3.5%, respectively. Overall, the Poliquin table appeared to be the most accurate prediction method for this sample (affected limbs: bias 0.3 kg, 95% limits of agreement (LOA) -5.8 to 6.4 kg, typical error as a coefficient of variation (COV) 2.4%, total error of measurement (total error) 2.4%; control limbs: bias -1.3 kg, 95% LOA -9.0 to 6.3 kg, typical error as a COV 2.7%, total error 2.8%). When the knee OA group performed the knee extension exercise, the Brown, Brzycki, Epley, Lander, Mayhew et al., Poliquin and Wathen prediction methods demonstrated the greatest levels of predictive accuracy. No significant differences in predictive accuracy were found for any of the equations across the affected and control limbs (p > 0.05). When an atypical subject was identified and excluded from the analyses, the accuracy of the equations improved further. Typical errors as COVs and total errors for the more accurate prediction methods ranged from 2.5-2.7% and from 2.4-2.9%, respectively. Overall, the Poliquin table appeared to be the most accurate prediction method for this sample (affected limbs: bias 0.9 kg, 95% LOA -4.5 to 6.3 kg, typical error as a COV 2.5%, total error 2.5%; control limbs: bias -0.1 kg, 95% LOA -6.0 to 5.9 kg, typical error as a COV 2.5%, total error 2.4%). When the knee injury group performed the leg press, the Adams, Berger, Lombardi and O’Connor equations demonstrated the greatest levels of predictive accuracy. No significant differences in predictive accuracy were found for any of the equations across the affected and control limbs (p > 0.05). Typical errors as COVs and total errors for the more accurate equations ranged from 2.8-3.2% and from 2.9-3.3%, respectively. Overall, the Berger (affected limbs: bias -0.4 kg, 95% LOA -7.2 to 6.3 kg, typical error as a COV 3.2%, total error 3.2%; control limbs: bias 0.1 kg, 95% LOA -6.6 to 6.7 kg, typical error as a COV 3.1%, total error 3.0%) and O’Connor equations (affected limbs: bias -0.6 kg, 95% LOA-6.8 to 5.7 kg, typical error as a COV 2.9%, total error 3.0%; control limbs: bias -0.2 kg, 95% LOA -6.9 to 6.4 kg, typical error as a COV 2.9%, total error 2.9%) appeared to be the most accurate prediction methods for this sample. When the knee OA group performed the leg press, the Adams, Berger, KLW, Lombardi and O’Connor equations demonstrated the greatest levels of predictive accuracy. No significant differences in predictive accuracy were found for any of the equations across the affected and control limbs (p > 0.05). The typical errors as COVs and the total error values for the more accurate prediction methods were the highest observed in this study, ranging from 5.8-6.0% and from 5.7-6.2%, respectively. Overall, the Adams, Berger, KLW and O’Connor equations appeared to be the most accurate prediction methods for this sample. However, it is possible that the predicted leg press 1-RM values produced by the knee OA group might not have matched actual 1-RM values closely enough to be clinically acceptable for some purposes. Conclusion: The findings of the current study suggested that the Poliquin table produced the most accurate estimates of knee extension 1-RM performance for both the knee injury and knee OA groups. In contrast, the Berger and O’Connor equations produced the most accurate estimates of leg press 1-RM performance for the knee injury group, while the Adams, Berger, KLW and O’Connor equations produced the most accurate results for the knee OA group. However, the higher error values observed for the knee OA group suggested that predicted leg press 1-RM performance might not be accurate enough for some clinical purposes. Finally, it can be concluded that no single prediction equation was able to accurately estimate both knee extension and leg press 1-RM performance in subjects with knee injuries and knee OA.

Thesis (DHSc) -- AUT University, 2008. / Includes bibliographical references. Also held in print (xvii, 177 leaves : ill. (some col.) ; 30 cm.) in the Archive at the City Campus (T 616.7223062 REI)

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (M.S.)--West Virginia University, 2000. / Title from document title page. Document formatted into pages; contains vii, 57 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 50-51).

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis (M.S.)--University of British Columbia, 2002. / Includes bibliographical references (leaves 34-37).

Thesis (MTech (Sports Science Radiology))--Cape Peninsula University of Technology, 2006 / The knee is one ofthe most complicated joints in the body. The deep infrapatellar bursa being only a small water-pocket and forming a small part of the knee. The deep infrapatellar bursa can get inflamed and cause great discomfort, especially to professional sportsmen and -women. If such a inflammation is present, a common treament option are to inject a cortisone solution into the bursa for quick relieve and healing. This study was performed to investigate the specific ultrasound features of a normal deep infrapatellar bursa. Thus enableing more specific and accurate diagnosis of deep infrapatellar bursitis or not, which in turn leads to quicker recovery ofthe patients. A total of280 males and females from various population groups were recruited for the study. Subjects were categorized into different subgroups depending on their gender, ethnicity, competitiveness in sport, sport type practised and previous knee problems. These subgroups enabled a more individual specific DIB measurement. A high frequency ultrasound examination ofboth knees ofall recruits were performed. The deep infrapatellar bursa was located by slightly flexing the knee and applying not to much pressure with the probe whilst scanning. Three measurements, antero-posterio (AP), cranio-caudal (CC) and width measurements, were recorded ofeach individuals left and right deep infrapatellar bursa (DIB). The results ofthe DIB measurements were compared to results from a ultrasound study perfonned in Gennany and a favourable comparison could be made. MRI studies of the DIB performed in Turkey and Switzerland differed greatly from those of this study and Germany. This study could serve as a valuable source ofreference to sonographer, radiologist and orthopaedic surgeons when investigating the deep infrapatellar bursa. A statistical significant difference was shown for males having a larger DIB than female, for competitive sports people having a larger Dill than non-competitive sports people and also inactive people; and rugby players (as a sport type) have larger DIBs than cricketers, runners, soccer players and cyclists. Another surprising factor was the amazing ultrasound detection rate of the deep infrapatellar bursa, which allows for future easy and confident assessing of the DIB by ultrasound.

Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2006. / The knee is one of the most complicated joints in the body. The deep infrapatellar bursa being only a small water-pocket and forming a small part of the knee. The deep infrapatellar bursa can get inflamed and cause great discomfort, especially to professional sportsmen and -women. If such a inflammation is present, a common treament option are to inject a cortisone solution into the bursa for quick relieve and healing. This study was performed to investigate the specific ultrasound features of a normal deep infrapatellar bursa. Thus enableing more specific and accurate diagnosis of deep infrapatellar bursitis or not, which in turn leads to quicker recovery of the patients.

It has been noticed that the need for total knee replacement surgery is increasing for Asian region. A total knee replacement is a permanent surgical solution for a patient having debilitating pain in knee joint suffering from arthritis. In this surgery, knee joint is replaced with components made up of bio-compatible materials after which the patient can resume the normal day to day activities. Western population has bigger build compared to Asian population. Most of the total knee replacement prosthesis are designed for western population. When these total knee prosthesis are used for Asian population, they cause a mismatch leading to various clinical complications such as reduced range of motion and pain. The studies have been limited to clinical complications caused by the mismatch. To address this limitation, current study is aimed to find the mechanical implications such as stress distribution, maximum stresses, maximum displacements etc., caused by mismatch of total knee replacement components with knee. A surgeon selects total knee components for a patient based on some critical dimensions of femur and tibia bone of knee. In addition, a method to accurately calculate these dimensions of the femur and tibia bone of a real knee was developed in the current study. This method calculated the points of curvature greater than a threshold (decided based on the radius of the curvature) found out using the formula of curvature. Further, the highest point was calculated based on maximum height from a line drawn between initial and final point within the captured points, also the extreme points were calculated based on the sign change in slope of points within the captured points, giving multiple points on the boundary of bones extracted in an MRI image of a patient. The distance between two selected farthest points, out of these points, in specific direction was the basis for selection of the TKR components. Total knee replacement components were modeled in Geomatics Studio 12 software, bones were modeled in Rhinoceros 5 software, assembly of bones and total knee replacements components was done in Solid works 2013 software, the finite element model of the assembly was developed in Hyper mesh 11 software and, the stress analysis and post processing was done in ABAQUS 6.13 software. A static, implicit non linear analysis was performed. Simulations were performed for two conditions: at standing (0o of flexion) and at hyper-flexed (120o of flexion). In order to figure out if there were any mechanical implications of mismatch, the full model of assembly consisting of femur, tibia and fibula bones assembled with total knee replacement components, and the reduced model consisting of only total knee replacement components were simulated separately, results of which have been discussed in the current thesis. In this work, the effect of change of length of ligaments at 120o of flexion in detail was also studied. This study brought out various outcomes of contact mechanics and kinematics between the components of total knee replacement prosthesis.