by Lo Ming Yip. / "July 1998." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 208-247). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstract in Chinese.

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 121-122. / by Michael P. Shepley. / M.S.

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1981. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 91-92. / by Robert Gregory Clarke. / B.S.

Introdução: As alterações meniscais causadas por lesões degenerativas ou traumáticas podem levar a importantes alterações na estrutura dos mesmos. Pouco se sabe sobre o efeito direto da carga corpórea nos compartimentos femorotibiais sobre os diferentes graus de extrusão meniscal. Objetivos: Avaliar a extrusão meniscal no compartimento femorotibial medial, nas posições em decúbito e ortostática, por meio da ultrassonografia (US). Avaliar o desempenho da US na avaliação meniscal na posição em decúbito, usando a ressonância magnética (RM) como padrão de referência. Material e Métodos: 104 indivíduos com dor crônica no joelho realizaram exames de ultrassonografia e ressonância magnética. Dois radiologistas avaliaram a extrusão meniscal por US e RM e a graduaram:0 (< 2 mm), 1 (>= 2 mm and < 4 mm), and 2 (>= 4 mm).Um avaliador realizou a mensuração da extrusão meniscal dos indivíduos nas posições em decúbito dorsal e ortostática, e para avaliar os efeitos dessas medidas foi utilizada a correlação intraclasse (CIC) e teste pareado de Wilcoxon. Para comparar os resultados obtidos pela mensuração entre grupos com presença e ausência de lesão foi utilizado o teste T não pareado, com p <0,05 considerado como significativo. Resultados: Houve concordância substancial entre os examinadores quando comparadas a avaliação entre US e RM (CIC: 0,73 e 0,70). O US mostrou excelente sensibilidade (95% e 96%, cada examinador) e boa especificidade (82% e 70%, cada examinador). Houve diferença significativa dos valores médios de extrusão meniscal entre as posições em decúbito e ortostase (p = 0,0002). Todos os meniscos com extrusão >= 3 mm pela US apresentavam lesão meniscal confirmada pela RM (p< 0,0001). Conclusão: A avaliação de extrusão meniscal via US mostra excelente desempenho diagnóstico. Há variação na extrusão do menisco medial entre as posições decúbito e ortostase, com maior extrusão na posição ereta. / Background: Meniscal abnormalities related to degenerative or traumatic lesions may lead to significant changes in meniscal structure. There is lack knowledge about the direct effect of weight bearing in femorotibial compartments on the diverse meniscal extrusion levels. Objectives: To evaluate meniscal extrusion on medial femorotibialcompartmentby ultrasonography (US), both in dorsal decubitus and orthostatic positions. To evaluate US performance inassessment of meniscus in dorsal decubitus, using magnetic resonance (MR) as a standard method. Material andMethods: A total of 104 subjects with chronic pain on the knee underwent US and MR. Meniscal extrusion was assessed by two radiologists using US and RM, being graded as: 0 (< 2 mm), 1 (>= 2 mm and < 4 mm), and 2 (>= 4 mm). One radiologist performed measurements of meniscal extrusion of the participants in dorsal decubitus and orthostatic positions. Intra-class coefficient (ICC) and Wilcoxon paired t-test were used to analyze the effects of such measurements. To compare data from groups with and without lesions we used non-paired t-test was used, with values of p < 0,05considered to be significant. Results: There was substantial agreement between readers when US and MR evaluations were compared (ICC: 0,73 e 0,70). US showed excellent sensitivity (95% e 96%, each reader) and good specificity (82% e 70%, each reader). There was significant difference onmedium values of meniscal extrusion regarding dorsal decubitus and orthostatic positions (p = 0,0002). All subjects that presented meniscal extrusion >= 3 mm on US had meniscal lesion confirmed by RM (p < 0,0001). Conclusion: US has an excellent diagnostic performance in assessment of meniscal extrusion. Meniscal extrusion varies from dorsal decubitus and orthostatic positions, being higher while in upright position.

Introdução: O alongamento dos músculos isquiotibiais (ISQ) tem sido utilizado com frequência para a correção da contratura em flexão dos joelhos na paralisia cerebral (PC), porém o aumento da anteversão da pelve (AP) e a recidiva da deformidade podem ocorrer a longo prazo. Objetivos: O objetivo deste trabalho foi avaliar se a transferência do semitendíneo para o tubérculo dos adutores (TXST) está relacionada a uma menor taxa de recidiva e a um menor aumento da AP no período pós-operatório, quando comparada ao alongamento deste músculo. Métodos: Foi realizado um estudo tipo coorte retrospectivo. Pacientes com PC diparesia espástica, Gross Motor Function Classification System (GMFCS) I-III, sem cirurgias prévias nos joelhos, submetidos ao alongamento dos ISQ mediais ou à TXST, e com completa documentação no laboratório de marcha foram incluídos no estudo. Foram excluídos aqueles que receberam de forma concomitante a osteotomia extensora do fêmur distal e o encurtamento patelar. Trinta e nove pacientes preencheram os critérios de inclusão e foram divididos em dois grupos de acordo com os procedimentos cirúrgicos realizados: Grupo A (22 pacientes / 44 joelhos), composto por aqueles que receberam o alongamento dos ISQ mediais; Grupo B (17 pacientes / 34 joelhos), formado por aqueles que receberam a TXST ao invés do alongamento do semitendíneo (AST), em conjunto com o alongamento dos demais ISQ mediais. Parâmetros clínicos e de cinemática foram avaliados nos dois grupos antes e após as cirurgias. Resultados: Os grupos não exibiram diferença quanto à distribuição por gênero, idade na cirurgia e tempo de seguimento. A deformidade irredutível em flexão estava presente em 9,1% dos joelhos no Grupo A e em 50% no Grupo B (p < 0,001) antes do tratamento, e em 25% dos joelhos do Grupo A e 20,6% no Grupo B (p=0,647) após os procedimentos cirúrgicos. O número de joelhos com deformidade irredutível em flexão aumentou no Grupo A (p=0,047) e reduziu no Grupo B (p=0,011) após a intervenção. Houve redução significativa da deformidade média em flexão dos joelhos ao exame físico (de 7,3° para 4,4°, p= 0,04) e da flexão dos joelhos durante a fase de apoio da marcha (de 34,2° para 20,2°, p < 0,001) apenas no Grupo B. A AP aumentou nos Grupos A e B após a correção cirúrgica da deformidade em flexão dos joelhos. Conclusão: O aumento da AP foi observado nos dois grupos após o tratamento efetuado. A redução da deformidade em flexão dos joelhos ao exame físico e o aumento da extensão dos joelhos na fase de apoio foram observados apenas nos pacientes submetidos à TXST / Introduction: Hamstrings surgical lengthening has been frequently used for the correction of knee flexion contracture in cerebral palsy (CP), however the increase of anterior pelvic tilt and the recurrence of the deformity can occur in a long-term follow-up. The aim of this study was to evaluate if semitendinosus transfer to distal femur (STTX) is related to less increase of anterior pelvic tilt and less recurrence of knee flexion deformity after treatment than semitendinosus surgical lengthening (STL). Methods: A retrospective cohort study was conducted. Patients with diplegic spastic CP, GMFCS levels I to III, without previous surgical procedures at knee, undergone to bilateral medial hamstrings surgical lengthening or STTX, and with complete documentation at gait laboratory were included in this study. Patients with concomitant distal femur extension osteotomy and patellar tendon shortening were excluded. Thirty-nine patients matched the inclusion criteria and they were divided in two groups according surgical procedures at knees: Group A (22 patients / 44 knees), including patients who received medial hamstrings surgical lengthening as part of multilevel approach; Group B (17 patients / 34 knees), represented by patients who underwent orthopedic surgery including a STTX instead of STL. Clinical and kinematic parameters were evaluated at baseline and at follow-up for all groups. Results: The two groups matched at gender distribution, age at surgery and follow-up time. Fixed knee flexion deformity (FKFD) before surgery was observed at 9.1% of knees in Group A and at 50% in Group B (p < 0.001). At final follow-up, 25% of knees in Group A and 20.6% in Group B shown FKFD (p=0.647). FKFD increased in Group A (p=0.047) and decreased in Group B (p=0.011) after treatment. The reduction of mean FKFD (from 7.3° to 4.4°, p= 0.04) and of knee flexion during gait stance phase (from 34.2° to 20.2°, p< 0.001) were observed only in Group B after surgical procedures. The anterior pelvic tilt increased at both groups after treatment. Conclusion: The increase of anterior pelvic tilt occurred at both groups after correction of knee flexion deformity. Patients who received STTX exhibited less fixed knee flexion deformity and better knee extension during stance phase after surgical treatment than those whom undergone to STL

INTRODUÇÃO: As osteotomias são formas reconhecidas de tratamento da osteoartrose de joelho em pacientes jovens com desvio do eixo mecânico. A navegação tem sido estudada nos últimos anos como um auxiliar importante nas cirurgias ortopédicas, principalmente artroplastias e oesteotomias. OBJETIVO: Objetivo deste trabalho é comparar, em curto prazo, os resultados radiográficos e clínicos da osteotomia femoral varizante em cunha de adição pelo método convencional e por navegação. MÉTODOS: Avaliamos 25 pacientes no Ambulatório de Especialidades do Hospital Geral de Pedreira, 12 submetidos à osteotomia femoral com navegação e 13 pela técnica convencional. RESULTADOS: Observamos para o grupo da osteotomia com navegação 73, 69 m de tempo de cirurgia com 12, 53 de desvio padrão; 59 m de tempo de garroteamento. Com relação ao alinhamento mecânico, no pré-operatório a média absoluta foi de 13,84 para cirurgia convencional e 14,4 para a técnica com navegação (p= 0.7432; IC95% 12,8 -15,4), No pós-operatório o alinhamento final mecânico variou de -2 a 3 e, não foi diferente entre as técnicas aplicadas (p= 0.1316; IC95% 0,08-1,24). Porém, obtivemos uma alta correlação (p= -0,68) para o grupo com navegação e uma baixa correlação (p= -0,07) para o grupo Resumo Sérgio Ricardo da Costa convencional. CONCLUSÃO: Observamos diferença estatística nos parâmetros: tempo de garroteamento e tempo de cirurgia. Não observamos diferença estatística nos parâmetros: alinhamento mecânico pré e pós; e no escore do HSS / INTRODUCTION: Osteotomies are recognized forms of treatment of knee osteoarthrosis in young patients with mechanical axis deviation. Navigation has been studied in recent years as an important aid in orthopedic surgeries, mainly in arthroplasty and osteotomies. OBJECTIVE: Objective of this study is to compare short-term clinical and radiographic results of femoral varus osteotomy wedge performed by conventional method and by navigation. METHODS: We evaluated 25 patients in Hospital Geral de Pedreira 12 underwent femoral osteotomy with navigation and 13 by conventional technique. RESULTS: As a result, time of surgery was statistically different between techniques (p = 0.0046) with a mean (standard deviation) of 73.69 m (12.53) for the conventional technique and 92.75 m (16.49) technique with navigation. Regarding to mechanical alignment, preoperative mean was 13.84 for conventional surgery and 14.4 for navigation technique (p = 0.7432, 95% CI 12.8 -15.4) Postoperatively final mechanic alignment ranged from -2 to 3, and was not different between the techniques applied (p = 0.1316, 95% CI 0.08 to 1.24). However, we obtained a high correlation (p = -0.68) for the group with navigation and a low correlation (p = -0.07) for the conventional group. CONCLUSION: There were statistical differences in the parameters: time of surgery and tourniquet time. No statistical difference in the parameters: mechanical alignment before and after, and the HSS score

Osteoarthritis (OA) of the knee is a disease that deteriorates the bones and surrounding soft tissue of the affected joint. Categorisation of the disease into grades of severity is subject to errors of measurement and poor observer agreement. There is an urgent need for automated methods to measure radiographic features and remove, as far as possible, the element of subjectivity in assessment. This project creates a fully automated system to analyse all aspects of the knee in radiographs. The methods evaluate explicit and implicit features of: overall shape, trabecular structure, osteophytes, tibial spines and intercondylar notch, and joint space shape. The project develops the first fully automated osteophyte detection algorithms, improved trabeculae features using raw pixel intensities, and a better analysis of joint space using shape models. This project is the first to combine explicit and implicit features across the whole of the knee, and applies these features to classify radiographs using four main outcomes: current OA, current pain, later onset OA, and later onset pain. The results find a strong current OA classification rate, with an Area Under the ROC Curve (AUC) of 0.904 and weighted kappa of 0.49 (0.48-0.51). The remaining later onset and pain experiments report weaker results; these results suggest that radiographic features in Posterior-Anterior (PA) view radiographs have a weak association with clinical and later onset OA.

Ng Chau Wah Stephen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 120-135). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.viii / Publications --- p.ix / Abbreviations --- p.x / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Traditional Chinese Medicine --- p.1 / Chapter 1.2 --- Danshen --- p.7 / Chapter 1.2.1 --- Chemical constituents of Danshen --- p.7 / Chapter 1.2.2 --- Pharmacology of Danshen --- p.10 / Chapter 1.3 --- Vascular system --- p.13 / Chapter 1.3.1 --- Physiology of blood vessels --- p.13 / Chapter 1.3.2 --- Vascular smooth muscle contraction --- p.14 / Chapter 1.3.3 --- Mechanism of vascular smooth muscle contraction --- p.15 / Chapter 1.3.3.1 --- Adrenoceptor in vascular system --- p.19 / Chapter 1.3.3.2 --- Muscarinic receptor in vascular system --- p.20 / Chapter 1.3.3.3 --- Synthesis and release of Nitric Oxide (NO)in vascular system --- p.22 / Chapter 1.3.3.4 --- Synthesis and release of postanoidsin vascular system --- p.25 / Chapter 1.3.3.5 --- Synthesis and release of histaminein vascular system --- p.28 / Chapter 1.3.3.6 --- Synthesis and release of Calcitonin gene-related peptide in vascular system --- p.29 / Chapter 1.4 --- Aims of the studies --- p.33 / Chapter Chapter 2 --- Materials and methods / Chapter 2.1 --- Materials --- p.35 / Chapter 2.2 --- Methods - General procedures --- p.35 / Chapter 2.2.1 --- Preparations of drug solutions --- p.35 / Chapter 2.2.2 --- Animals used and anaesthetization --- p.36 / Chapter 2.2.3 --- Cannulation of carotid artery and jugular vein --- p.37 / Chapter 2.2.4 --- Blood pressure measurement --- p.37 / Chapter 2.2.5 --- Knee joint denervation --- p.38 / Chapter 2.2.6 --- Knee joint blood flow measurement --- p.39 / Chapter 2.3 --- Methods - Specific procedures --- p.41 / Chapter 2.3.1 --- Validation of Laser Doppler Imaging (LDI) measurements --- p.41 / Chapter 2.3.2 --- Actions of topical administration of Danshen --- p.42 / Chapter 2.3.2.1 --- Studies of the mechanism(s) of action of Danshen --- p.43 / Chapter 2.3.2.2 --- Investigation for α-adrenoceptor antagonist activity --- p.44 / Chapter 2.3.2.3 --- Investigation for neural involvement --- p.44 / Chapter 2.3.3 --- Actions of intravenous administration of Danshen --- p.45 / Chapter 2.3.4 --- Data analysis --- p.45 / Chapter Chapter 3 --- Results / Chapter 3.1 --- Validation of LDI measurement --- p.47 / Chapter 3.2 --- Actions of intravenous administration of Danshen --- p.53 / Chapter 3.3 --- Actions of topical administration of Danshen --- p.53 / Chapter 3.4 --- Muscarinic receptor antagonist on Danshen --- p.61 / Chapter 3.5 --- β-adrenoceptor antagonist on Danshen --- p.67 / Chapter 3.6 --- Danshen on α-adrenoceptor agonist-induced vasoconstriction --- p.74 / Chapter 3.7 --- Nitric oxide synthase inhibitor on Danshen --- p.79 / Chapter 3.8 --- Cyclo-oxygenase (COX) inhibitor on Danshen --- p.83 / Chapter 3.9 --- Histamine receptor antagonists on Danshen --- p.87 / Chapter 3.10 --- CGRP receptor antagonist on Danshen --- p.92 / Chapter 3.11 --- Effect of denervation on Danshen --- p.92 / Chapter Chapter 4 --- Discussion --- p.100 / Reference --- p.120

L’objectif de ce travail de thèse était d’évaluer les bénéfices thérapeutiques d’un entraînement par imagerie motrice chez les patients ayant subi une prothèse totale de genou unilatérale. Combiner l’imagerie motrice avec la physiothérapie classique a permis de diminuer la douleur et d’augmenter la force du quadriceps durant la phase aiguë, au 1er mois postopératoire. Durant la phase chronique, au 6ème mois postopératoire, l’imagerie motrice permettrait de corriger l’asymétrie de la marche, d’une part en augmentant la force du quadriceps ipsilatéral et, par conséquent, en accentuant la charge sur le genou opéré, et d’autre part en augmentant la flexion maximale du genou durant la phase oscillante. L’imagerie motrice pourrait également aider les personnes âgées après la prothèse totale du genou à monter les escaliers plus rapidement, en toute sécurité. Cela peut atténuer le risque de chute dans les escaliers et, par conséquent, diminuer la fréquence des blessures graves. En conclusion, intégrer l’imagerie motrice dans les programmes de rééducation après prothèse totale du genou primaire unilatérale est pertinent et prometteur / The primary aim of the present work was to determine the therapeutic benefits of a specific motor imagery training. Combining motor imagery with classical physical therapy was found to be effective in reducing pain and increasing quadriceps strength after total knee arthroplasty during the acute phase at the first month postoperatively. During the chronic phase, at the 6th month postoperatively, motor imagery might contribute to correct the asymmetry of gait by increasing the strength of the ipsilateral quadriceps and, consequently accentuating the weight loading on the operated knee, as well as by improving knee proprioception through an increase in the maximum knee flexion during the swing phase. MI might also help elderly people after total knee arthroplasty to climb stairs more quickly, easily, and safely. This could attenuate the risk of falls on stairs, and consequently decrease the frequency of major injuries. In summary, the integration of motor imagery in clinical rehabilitation programs after primary unilateral total knee arthroplasty is relevant and promising

A análise da cinemática articular do joelho apresenta-se como fator fundamental na compreensão da função musculoesquelética e mecânica articular. No âmbito clínico, a avaliação do padrão normal de parâmetros biomecânicos, permite a obtenção de valores de referência para comparações com diferentes grupos de indivíduos lesados ou submetidos à cirurgia. Dessa forma, o presente estudo tem como objetivo mapear a normalidade de parâmetros biomecânicos da articulação do joelho, obtidos no plano sagital, durante a extensão do joelho em cadeia cinética aberta, sem carga, utilizando videofluoroscopia. Especificamente, pretende estimar o comportamento do centro de rotação tibiofemoral e patelofemoral, distância perpendicular do ligamento patelar e efetiva dos extensores de joelho, torque de resistência do segmento perna-pé, força do ligamento patelar, força do músculo quadríceps e força de contato patelofemoral, razão entre a força do ligamento patelar e a força do músculo quadríceps, razão entre a força de contato patelofemoral e a força do músculo quadríceps, pressão patelofemoral e tilt patelar ântero-posterior. Para a determinação dos parâmetros biomecânicos foram obtidas imagens radiográficas dinâmicas, por meio de videofluoroscopia, a partir da análise da articulação do joelho no plano sagital, de vinte e cinco indivíduos, executando três repetições do exercício de extensão de joelho em cadeia cinética aberta, sem carga externa aplicada à tíbia. As imagens obtidas foram reproduzidas e digitalizadas utilizando uma placa de captura da marca Silicon Graphics 320. Foram desenvolvidas rotinas computacionais utilizando o software Matlab para processamento e análise dos dados. Os dados obtidos foram analisados estatisticamente utilizando-se o pacote estatístico SPSS, versão 13.0. Foram plotados os valores obtidos para cada parâmetro em função do ângulo de flexão do joelho, para todos os indivíduos da amostra, e realizada uma análise de regressão entre as variáveis interpoladas, obtendo-se respectivo intervalo de confiança e coeficiente de determinação (r2). A partir dos resultados obtidos, foram verificadas correlações muito forte, forte e regular entre os parâmetros do estudo e o ângulo de flexão do joelho, indicando a possibilidade de mapear a normalidade dos parâmetros cinemáticos e cinéticos da articulação do joelho. / The kinetic and kinematics analysis of the knee joint is considered to be of prime importance in the understanding of the musculoskeletal function and joint mechanics. In the clinical scope, the biomechanics evaluation of the normal standard of biomechanics parameters, allow the attainment of indexes of reference for compare different groups of injured individuals or submitted to surgery. On this way, the present study has as the main goal estimate the normality of biomechanics parameters of the knee joint, gotten in the sagittal plane, during the knee extension in open kinetic chain, without load, by means of videofluoroscopy. Specifically, it intends to estimate how the tibiofemoral and patellofemoral rotation center behave, the patellar ligament moment arm and the effective moment arm of the knee extensors muscle group, the resistance torque of the segment leg-foot, patellar ligament force, quadriceps muscle force and patellofemoral joint contact force, the ratio between the patellar ligament force and quadriceps muscle force, the ratio between patellofemoral joint contact force and quadriceps muscle force, patellofemoral pressure and the anteroposterior patellar tilt. For the determination of these biomechanics parameters, dynamic radiographic images had been gotten, by means of videofluoroscopy. From the analysis of the knee joint in the sagittal plane, from twenty-five individuals, performing three repetitions of the knee extension exercise in open kinetic chain, without applied external load to the tibia. The gotten images had been reproduced and digitalized using a capture plate - Silicon Graphics 320. There been developed specific computational routines using Matlab software for processing and analysis of the data. The gotten data had been analyzed statistically using the statistical package SPSS, version 13.0. The gotten values for each parameter related to the knee angle of flexion had been plotted, for all the individuals of the sample, and carried through an regression analysis between the interpolated variables, getting respective reliable interval and coefficient of determination (r2). In the light of these findings, correlations had been verified to be strong, very strong and also very regular among the parameters of the present study and the angle of knee flexion, indicating the possibility of estimate the normality of the kinematic and kinetic parameters of the knee joint.