Study Design: Methodological study. Objectives: To examine the agreement and validity of using observational risk screening guidelines to evaluate ACL injury risk factors. Background: Post-pubescent females have an increased risk of anterior cruciate ligament (ACL) injury compared with their male counterparts partly due to their high-risk landing and cutting strategies. There are currently no scientifically-tested methods to screen for these high risk strategies in the clinic or on the field. Methods and Measures: Three physiotherapists used observational risk screening guidelines to rate the neuromuscular characteristics of 40 adolescent female soccer players. Drop jumps were rated as high risk or low risk based on the degree of knee abduction. Side hops and side cuts were rated on the degree of lower limb 'reaching'. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. 3D motion analysis was used as a gold standard for determining the validity of ratings. Results: Acceptable intrarater and interrater agreement (k≥0.61) were attained for the drop jump and the side hop, with kappa coefficients ranging from 0.64 to 0.94. Acceptable sensitivity (≥0.80) was attained for the side hop and the side cut, with values ranging from 0.88 to 1.00. Acceptable specificity (≥0.50) was attained for the drop jump, with values ranging from 0.64 to 0.72. Conclusion: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Based on levels of agreement and sensitivity, the side hop appears to be a suitable screening task. Agreement was acceptable for the drop jump but its validity needs further investigation.

Pasaulyje operacijos minimaliai invazine metodika tampa vis labiau populiaresnės. Literatūroje galima rasti argumentų ,,už” ir ,,prieš” šia metodiką.. Minimalios invazijos šalininkai teigia, kad pagrindinis metodikos privalumas — greitesnė pacientų reabilitacija. Oponentų teigimu minimalios invazijos totalinis kelio sąnario endoprotezavimas nėra pranašesnis už įprastinį, netgi mano, jog tai padidina komponentų padėties klaidų tikimybę, bei komplikacijų riziką. 70 kelio sąnario artroze sergančių pacientų buvo įtraukta į atsitiktinių imčių tyrimą. 35 pacientai operuoti minimaliai invazine metodika, 35 įprastine. Mes tyrėme operacijos laiką, kelio sąnario judesius. Po 6 ir 12 savaičių kelio sąnario funkcija buvo vertinta pagal Kelio Sąnario draugijos skalę. Rentgenologiniam ištyrimui priekinę, šoninę kelio bei priekinę visos kojos rentgenogramas. Ligonių pasiskirstymas pagal, lytį amžių, kūno masės indeksą bei kelio sąnario pakitimus statistiškai reikšmingai tarp grupių nesiskyrė. Tyrimo metu nustatėme minimaliai invazinė metodika operuotų pacientų greitesnį kelio judesių atsistatymą, geresnius funkcinius rezultatus po 6 sav., bei ilgesnę operacijos trukmę. Po 12 savaičių skirtumo tarp grupių nenustatėme. Taip pat nenustatėme protezo komponentų padėties skirtumų tarp grupių. / Minimally invasive surgery is getting more interest in literature recently. However the reports regarding the effectiveness of this particular technique are controversial. There are reports in the literature that minimally invasive technique is associated with increased number of technical mistakes. Advantages of this technique are faster rehabilitation. In randomized controlled trial we analyzed 70 knee osteoarthritis patients admitted for elective total knee replacement. All patients were randomized to do surgery using minimally invasive or conventional technique. We analyzed operation time, range of motions 1-6 days after surgery. After 6 and 12 week we evaluated total knee replacement patiens according KSS score. For radiographic examination we performed anterior, lateral and long standing x-rays after the surgery. Preoperative data such as severity of osteoarthirtis, sex, age, and functional score did not differ within the groups. Minimally invasive group was associated with longer operation time, faster recovery of range of motions, better knee function 6 weeks after surgery. 12 week after total knee replacement we did not find any differences between the groups. Component position and leg axis deviation did not differ between the groups.

Key words: knee, anterior cruciate ligament, aquatic physiotherapy, adolescents. There are not so many information about efficiency of aquatic physiotherapy in adolescents after reconstruction of anterior cruciate ligament in the literature. Hypothesis. Because of specific effect of water, aquatic physiotherapy should faster improve range of knee joint motion and muscular strength than physiotherapy in gym. Purpose. The aim of this study was to evaluate efficiency of aquatic physiotherapy in patients who had reconstruction of anterior cruciate ligament. The tasks. 1. To evaluate dinamies of recovery of knee joint functions in patients who had physiotherapy in gym. 2. To evaluate dinamies of knee joint functions in patients who had aquatic physiotherapy and gym. 3. To compare recovery changes of knee joint functions in patients who had physiotherapy in gym with patients who had aquatic physiotherapy and gym. Subjects: 28 adolescents 16-18 years old. Research was accomplished in children’s rehabilitation center “Zibute” in Kacergine. Adolescents were grouped in to two groups for 14 in each group. Control group had physiotherapy in gym and experimental group – in gym and aquatic physiotherapy. Methods: 1. Measurement of knee joint motion. 2. Knee joint stability’s evaluation by Lysholm scale. 3. Knee joint function’s evaluation by Cincinnati scale. 4. Knee joint muscular strength‘s evaluation by Lovett test. 5. Statistic methods. Conclusions: 1. Physiotherapy in gym is... [to full text]

Tyrimo problema: sergant kelio sąnario osteoartritu atsiranda skausmas, apsunkinama kasdieninė veikla, trinka pusiausvyra, padidėja griuvimo rizika. Siekiant pagerinti pusiausvyrą ir sumažinti griuvimų riziką, analizavome kaip įvairios kineziterapijos programos veikia pagyvenusių žmonių, sergančių kelio sąnario osteoartritu, šlaunies raumenų jėgą, statinę ir dinaminę pusiausvyrą bei skausmą. Tyrimo objektas: pusiausvyros, raumenų jėgos ir skausmo pokyčiai taikant skirtingas kineziterapijos programas. Tyrimo tikslas: nustatyti skirtingų kineziterapijos programų poveikį ligoniams sergantiems kelio sąnario osteoartritu. Tyrimo uždaviniai: 1. Nustatyti pusiausvyros kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 2. Nustatyti šlaunies raumenų jėgos kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 3. Nustatyti pusiausvyros kaitą taikant tik TENS ir fizinius pratimus. 4. Nustatyti šlaunies raumenų jėgos kaitą taikant tik TENS ir fizinius pratimus. 5. Įvertinti skirtingų kineziterapijos programų efektyvumą. Tyrimo hipotezė: manome, kad didžiausią teigiamą poveikį pusiausvyros, šlaunies raumenų jėgos ir skausmo kaitai turi ankstyvas sąnarių mobilizacijos, TENS bei fizinių pratimų taikymas. Taikant minėtus metodus atskirai, poveikis pusiausvyrai, šlaunies raumenų jėgai ir skausmui turėtų būti mažesnis arba visai nepasireikšti. Tyrimo metodai ir organizavimas: tyrimas atliktas VšĮ Kauno slaugos ligoninėje 2005-2007 metais. Tyrime dalyvavo asmenys, sergantys... [toliau žr. visą tekstą] / Problem of study: osteoarthritis of knee joint causes pain, aggravates everyday activities, disconcerts balance, and increases the risk of fall. Aiming to improve balance and to decrease the risk of falls, we analyzed how various programs of physiotherapy influence the strength of thigh muscles, static and dynamic balance, and pain of elderly with knee osteoarthritis. Object of study: changes of balance, muscle strength and pain after application of various programs of physiotherapy. Aim of study: to determine the impact of various physiotherapy programs to the patients with knee osteoarthritis. Goals of study: 1. To determine the change in balance, when the joint mobilization, TENS and physical exercises are applied. 2. To determine the change in the thigh muscles strength, when the joint mobilization, TENS and physical exercises are applied. 3. To determine the change in balance, when TENS and physical exercises alone are applied. 4. To determine the range of thigh muscles strength, when TENS and physical exercises alone are applied. 5. To evaluate effectiveness of various physiotherapy programs Hypothesis of study: we believe that the biggest positive impact on the change of balance, strength of thigh muscles and pain has the combination of early joint mobilization, TENS and physical exercises. While applying all those methods separately, the impact on the change of balance, strength of thigh muscles and pain is lesser or even doesn’t emerge. Methods and organization of... [to full text]

Obesity is a highly cited risk factor for knee osteoarthritis (OA) associated with increased risk of development of OA and accelerated disease progression. Rates of obesity are increasing internationally, and while obesity is well established as a risk factor, the precise role of obesity in knee OA pathogenesis and progression is not as clearly understood. Mechanical loading has been implicated as an important factor in knee OA initiation and progression. The purpose of this thesis was to further examine the roles of moderate knee OA disease presence and obesity on knee joint mechanics during gait, and to characterize their mechanical interaction. Two methods have been applied. First, principal component analysis has been applied to resultant waveforms from gait analysis and second, a sagittal plane joint contact force model has been applied. Using both methods, statistical differences in biomechanical loading has been associated with obesity, moderate knee OA, and their interaction.

Despite the existence of numerous knee-joint specific patient-reported outcome measures, the content contained within such instruments does not completely capture the spectrum of injury and impairments experienced by multi-ligament knee injured patients. Based on this shortcoming, the overall objective of the current study was to develop, and to test the reliability and validity of a novel disease-specific quality of life instrument for patients with multi-ligament knee injuries. The World Health Organization’s International Classification of Functioning, Disability, and Health was used to guide content development. Using a mixed methods approach (surveys, patient focus groups, expert interviews), the final Multi-ligament Quality of Life (MLQOL) instrument was comprised of 52 items distributed over 4 domains. This instrument demonstrated excellent content validity, test-retest reliability, and construct validity. Future work will evaluate the responsiveness of the MLQOL and will implement its use in randomized trials.

Total knee replacement is the gold standard treatment for restoring mobility and relieving pain associated with osteoarthritis when other medical therapy has failed. Revision surgery is necessary when the replaced knee fails, which is often a result of implant damage (such as wear) or poor kinematics. Design optimization is a method for finding the best shape for a component using an optimization approach considering one or multiple performance metrics. The shape of a parametric candidate design can be manipulated by an optimization algorithm, which seeks to minimize an objective function subject to performance constraints and design space limitations. During multiobjective design optimization, multiple performance measures are minimized simultaneously, the relative importance of each determined using a weighted sum. This approach can also be used to derive a Pareto curve or frontier which graphically describes the relationships (or trade-offs) between the performance measures. It was hypothesized that a trade-off exists between wear and kinematics performance in total knee replacements. The objective of this research was to test this hypothesis by using multiobjective design optimization to describe this relationship with a Pareto curve. It was first necessary to develop and validate numerical frameworks for wear and kinematics simulations, using models constructed using a parametric modeller. The Pareto curve was then generated using a combination of single objective and multiobjective design optimizations considering these two performance measures. Single objective optimization for wear yielded a theoretical design with superior wear resistance when compared to a typical commercially available knee design. Single objective optimization for kinematics yielded a theoretical design capable of higher flexion, as well as more natural laxity characteristics. After performing multiobjective design optimization, the resulting Pareto curve showed that there is, in fact, a trade-off between wear and kinematics performance. When considering optimum designs, in order to improve the wear performance it was necessary to sacrifice kinematics performance, and vice-versa. This previously suspected but never verified nor quantified relationship can be used to improve total knee replacement designs, as well as help healthcare providers select the best implants for their patients. / Thesis (Ph.D, Mechanical and Materials Engineering) -- Queen's University, 2010-04-14 13:43:42.639

Total knee arthroplasty has been effective in reducing pain, but less so in restoring function, especially for activities requiring deep knee flexion. The philosophy of this dissertation was that more functionally effective and optimally designed artificial knees could be created for high flexion activities, if the knee joint kinematics and joint contact forces applied during finite element testing, knee simulator testing, and fatigue testing were more physiologically accurate. The objective of this work was to determine knee joint kinematics and contact forces that could be used in high flexion total knee replacement design and pre-clinical testing. Knee kinematics were determined during high flexion activities for total knee replacement patients and asymptomatic subjects by tracking the motion of skin-mounted sensors. In addition, a protocol was developed to determine the effect of soft tissue artefact on the accuracy of the skin-mounted sensor system in high flexion. The ranges of motion determined for the studied activities can be used as a benchmark to measure the functional success of high flexion total knee replacements. Tibiofemoral joint contact forces were estimated during high flexion activities of daily living using a simple, non-invasive, inverse dynamics based model. The accuracy of the joint contact force estimates was investigated by comparing the estimated forces to in vivo forces measured directly using implanted instrumented tibial components. The comparison showed that the model underestimates the measured axial joint contact force, most likely because the model neglects antagonistic muscle co-contraction. The measured and modeled joint contact forces and the measured knee kinematics could be used to form industry standards for knee simulator and fatigue testing to ensure that the implants are being tested physiologically. Healthy target populations can be studied using the methods outlined in this thesis to define testing standards for target populations: Kinematics can be determined as they were in this work for a group of Middle Eastern subjects, and the non-invasive inverse dynamics based model (with some consideration for the underestimation of forces) could be used to determine the tibiofemoral joint contact forces that the implant might be subjected to during activities of daily living. / Thesis (Ph.D, Mechanical and Materials Engineering) -- Queen's University, 2010-10-25 11:33:06.162

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Despite the existence of numerous knee-joint specific patient-reported outcome measures, the content contained within such instruments does not completely capture the spectrum of injury and impairments experienced by multi-ligament knee injured patients. Based on this shortcoming, the overall objective of the current study was to develop, and to test the reliability and validity of a novel disease-specific quality of life instrument for patients with multi-ligament knee injuries. The World Health Organization’s International Classification of Functioning, Disability, and Health was used to guide content development. Using a mixed methods approach (surveys, patient focus groups, expert interviews), the final Multi-ligament Quality of Life (MLQOL) instrument was comprised of 52 items distributed over 4 domains. This instrument demonstrated excellent content validity, test-retest reliability, and construct validity. Future work will evaluate the responsiveness of the MLQOL and will implement its use in randomized trials.