Patellofemoral pain (PFP) is believed to be associated with deficits in coordination between the different heads of the quadriceps muscle; however, considerable debate exists in the literature regarding the presence of such a deficit. Discrepancies between studies may be explained by differences in experimental tasks, such as whether the task is performed with open (OKC) or closed kinetic chain (CKC), or whether the activity is voluntary or triggered. Particular interest has been directed toward the function of the vastus medialis obliquus (VMO), which is a short muscle with limited ability to exert torque across the knee joint, but probably has a particular role in controlling patellofemoral joint position. Another short muscle that may influence knee joint position control is popliteus (POP), which is located in the back of the knee. This thesis investigates task specific activity of quadriceps in CKC versus OKC and studies the relative activity between the four heads of the quadriceps in PFP subjects compared to controls without knee pain in voluntary activity (CKC and OKC) and postural responses to balance perturbations. In addition, this thesis investigates the presumed function of POP for control of joint position in postural tasks in healthy individuals. All subjects were of normal weight and height and between 18 and 40 years. Quadriceps activity was tested for isometric with identical joint configuration in CKC and OKC, and it was performed as a reaction time task. Balance perturbations were elicited by unpredictable anterior and posterior translations of the support surface. Function of POP was investigated in unpredictable support surface translations and in self induced provocations to balance by moving the arms. Muscle activity was recorded with electromyography (EMG). Optic kinematic analysis was used to obtain specific movement responses to perturbations of balance. The quadriceps muscles were activated differently in CKC and OKC. VMO was activated earlier and to a greater degree in CKC. Rectus femoris was activated earlier and to a greater degree in OKC. PFP subjects reacted slower in both CKC and OKC, but there was no difference between groups in the relative activity between the different heads of the quadriceps. In the unpredictable support surface translation in the anterior direction, PFP subjects responded with earlier onset of VMO and with greater trunk and hip flexion in the anterior translation. POP activation in response to support surface translations in both directions occurred before all other muscles measured. In the self-initiated provocations of balance, POP was activated after the initiation of the balance provocation. This thesis concludes that quadriceps activity was task specific. The lack of difference between groups in OKC and CKC, and the difference between groups in postural responses suggest that variations in motor behaviour may occur only in tasks habitually performed. Differences in muscle activation patterns may be related to compensatory strategies to unload the quadriceps muscles and the patellofemoral joint. Furthermore, this thesis suggests that POP muscle may have a particular role in active control of the knee joint.

Tyrimo tikslas: įvertinti skausmo sureikšminimo ir judesių baimės įtaką kelio sąnario funkcijai antruoju reabilitacijos etapu po kelio sąnario operacijų. Uždaviniai: 1. Įvertinti skausmo sureikšminimo ir judesių baimės lygį prieš ir po reabilitacijos; 2. Įvertinti kūno funkcijų ir veiklos sutrikimus prieš ir po reabilitacijos; 3. Įvertinti skausmo sureikšminimo įtaką kelio sąnario funkcijos atsigavimui; 4. Įvertinti judesių baimės įtaką kelio sąnario funkcijos atsigavimui; 5. Įvertinti kineziterapeutų požiūrį į psichologinių veiksnių vertinimą kineziterapeuto darbe. Tyrimo metodai: buvo atlikti du tyrimai. Pirmo tyrimo tikslas buvo įvertinti skausmo sureikšminimo ir judesių baimės įtaką kelio sąnario funkcijai antruoju reabilitacijos etapu po kelio sąnario operacijų. Tyrime dalyvavo 41 tiriamasis, 22 pacientai po priekinių kryžminių raiščių operacijos ir 19 pacientų po meniskų operacijos. Prieš ir po reabilitacijos buvo vertinami tiriamųjų skausmo sureikšminimo ir judesių baimės lygis, skausmo intensyvumas, judesių amplitudė, raumenų jėga ir kelio sąnario funkcinė būklė. Antro tyrimo tikslas buvo įvertinti kineziterapeutų požiūrį į psichologinių veiksnių vertinimą kineziterapeuto darbe. Buvo sudaryti klausimai ir atlikta anoniminė anketinė apklausa. Tyrime dalyvavo 98 kineziterapeutai, dirbantys pagal specialybę ir su suaugusiais žmonėmis. Išvados: 1. Pasibaigus reabilitacijai, pacientams po kelio sąnario operacijų skausmo sureikšminimo ir judesių baimės lygis sumažėjo (p<0,0... [toliau žr. visą tekstą] / The aim of research: to assess the association of pain catastrophizing and fear of movement with knee joint function after knee joint surgery during the second stage of rehabilitation. The tasks of research: 1. To assess the level of pain catastrophizing and fear of movement before and after rehabilitation. 2. To assess body function and activities limitations before and after rehabilitation. 3. To assess the association of pain catastrophizing with knee joint function recovery. 4. To assess the association of fear of movement with knee joint function recovery. 5. To assess physical therapists attitudes toward psychological factors assessment in physical therapist practise. The methods of the research: this research focuses on two studies. The aim of the first study – to assess the association of pain catastrophizing and fear of movement with knee joint function after knee joint surgery during the second stage of rehabilitation. The study involved 41 participants, 21 of them after anterior cruciate ligament reconstruction and 19 after meniscus surgery. Before and after rehabilitation participant‘s level of pain catastrophizing and fear of movement, pain intensity, range of motion, muscle strenght and subjective knee joint function were assessed. The aim of the second study – to assess physical therapists attitudes toward psychological factors assessment. The anonymous survey of physical therapists attitudes was conducted. The study involved 98 physical therapists, which are... [to full text]

A generally accepted goal in orthopaedic surgery today is to maximize conservation of tissue and reduce tissue damage. Bone-conserving implants have bone-mating surfaces that reproduce the natural curvature of bone structures, requiring less bone removal. No small, reliable, inexpensive and universal bone sculpting technique currently exists, however, that can both create and accurately align such complex surfaces. The goal of this thesis was to develop a haptic hard surface emulation mechanism that could be applied to curvilinear bone sculpting using a surgical robot. A novel dynamic physical constraint concept was developed that is able to emulate realistic hard constraints, smooth surface following, and realistic surface rigidity, while allowing complete freedom of motion away from the constraints. The concept was verified through the construction of a two-link manipulator prototype. Tests were run on nine users that involved each user tracing out five different virtual surfaces on a drawing surface using the prototype. The primary purposes of prototype testing were to obtain subjective data on how effectively the dynamic physical constraint concept simulates simple surfaces, to assess how it reacts to typical user interactions and to identify any unexpected behaviour. Users were 100% satisfied with the prototype’s ability to emulate realistic and stiff hard surfaces and with its ease of manipulation. The amount of incursion into each of the virtual surfaces by all the users was measured to assess the precision of the system with the goal of deciding whether this new haptic concept should be further developed specifically for precision applications such as surgery. For curvilinear surfaces, 90% of the cumulative distribution of the measured data was less than 2mm, while for linear surfaces it was less than 6mm. Four behavioural effects were noticed: lateral deflection, reverse ‘stickiness’, hysteresis and instability in certain areas. These effects were studied in detail to determine how to either eliminate them or to minimize them through system design optimization. A computer simulation was also used to model the behaviour of the prototype and to gain further understanding of these effects. These analyses showed that the concept can be successfully used in curvilinear bone sculpting.

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.

No description available.

The purpose of this investigation was to assess the efficacy of a multifaceted gait analysis approach using a group of twenty osteosarcoma patients who underwent limb salvage surgery. Mean age at time of surgery was 16.1 years (range: 7-29), mean age at time of evaluation was 23.55 years (range: 11-43). Nine patients were treated with a Stryker Howmedica Modular Resection System (Stryker Kalamazoo, USA) and eleven patients were treated with a Stanmore custom made prosthesis (Stanmore implants worldwide Ltd, Stanmore, UK). Ten control participants with a mean age of 24.9 (range: 14-36) were recruited for the study. Ethical approval was gained through The University of Queensland Ethics Committee and The Royal Children’s Hospital and Health Service district Ethics Committee. Investigations included subjective, kinematic, kinetic, electromyographic and bioenergetic assessments. The subjective assessment incorporated results from the Musculoskeletal Tumour Society Rating Scale (MSTS) and the Toronto Extremity Salvage Score (TESS). Overall impairment was found to be 83.33% according to results of the MSTS and overall disability was found to be 86.00% according to results of the TESS. Kinematic findings showed that limb salvage participants walked with reduced velocity (p < 0.01) and increased step asymmetry (p < 0.01). Patients exhibited an increase in plantarflexion during the loading response (p < 0.001) and during terminal stance (p < 0.05), and an increase in dorsiflexion during mid-stance (p < 0.001). Knee kinematics revealed reduced extension during the loading response (p < 0.001) and increased frontal plane excursion throughout the gait cycle (p < 0.01). Patients exhibited increased lateral lean during loading response at the trunk (p < 0.05). Kinetic findings revealed a reduction in the magnitude of vertical ground reaction force during the loading response (p < 0.001) and a reduction in the magnitude of the anterior/posterior ground reaction shear force during terminal stance (p = 0.01). Furthermore, the internal ankle plantarflexor moment in terminal stance was reduced (p < 0.001), all sagittal plane knee moments were reduced (p < 0.05) and the internal hip adductor moment in terminal stance was reduced (p < 0.01). Electromyographic findings found that the limb salvage participants activated their rectus femoris for a significantly prolonged period (p < 0.5) and exhibited increased bilateral co-contraction of their rectus femoris and medial hamstring muscles (p < 0.05) compared with control participants. Bioenergetic findings revealed that the limb salvage participants exhibited an increased energetic cost (p < 0.01) and consumption rate (p < 0.01). Moderate correlations were observed between electromyographic and bioenergetic findings. Multivariate methods suggested that muscle removal, knee extension strength and knee flexion range of motion were all significant predictors of locomotor function. Length of bone resection and time from surgery were not predictive of post-operative function. The findings supported the efficacy of a multifaceted gait analysis approach for the assessment of pathological function under research conditions. The combined approach, using multiple measurements, allowed determination of functional status following musculoskeletal alteration. This enabled identification of primary and secondary compensations and allowed recommendations for improved treatment and rehabilitation.

Research suggests acupuncture is potentially an effective treatment for osteoarthritis (OA) of the hip or knee. Essential for the evaluation of Chinese acupuncture treatment is the availability of a reliable and valid measurement. However, currently there is no appropriate measurement instrument validated within traditional Chinese medicine (TCM) concepts and frameworks. Objective is to develop and validate a TCM questionnaire as a health status instrument for TCM assessment in patients with OA of the hip and knee. Methods The TCM questionnaire was developed from TCM theory and clinical experience. The questionnaire was examined by experts, for content and faces validity and pre-tested on a volunteer sample of three subjects. The developed questionnaire was validated on a convenience sample of ten subjects from six different clinical settings in Auckland region. The practitioner or receptionist from the selected clinical sites handed out the questionnaire package to their patients who fulfilled the study criteria. Each patient (subject) completed the questionnaire on their arrival and the re-testing questionnaire at a two-week interval. The reliability of the questionnaire was estimated by examining the internal consistency reliability (Cronbach's alpha statistic) and test-retest reliability (Intra-class correlation coefficients). The content validity of the questionnaire was examined by literature review, interviews with patients, and experts' judgement. The construct validity was estimated by the methods of known groups, correlations between scales, and correlations with the SF-36 health survey. The success of the grouping or scaling of the questionnaire was estimated by examining the item (i.e. question) internal consistency and item (i.e. question) discriminant validity. Results The TCM questionnaire scales corresponded to the "eight principal syndromes", "ten questions", and "eight patterns of OA" within TCM concepts and frameworks. Internal consistency reliability (Cronbach's alpha) was above .70 for all scales on both occasions of the first test and the second test. Test-retest reliability (intra-class correlation coefficient) for each scale was also above .70 for all scales, except the exterior (EXT) scale, which was .44. Moderate associations were found between the age of subjects and the scores of the interior (INT) scale and summary (SUM) scale. There was a significant difference between the groups of use and non-use of on-going medication in the EXT scale scores on the first test, p = .012. However, this significant difference was not found on the second test. As expected, strong or moderate associations were found between the TCM questionnaire and SF-36 comparable scales. Conclusions The TCM questionnaire was developed within TCM concepts and frameworks. The questionnaire contains 23 items with two main scales (the EXT scale and the INT scale) and one additional scale (the SUM scale). It takes approximately five minutes to complete and is entirely self-administered. Results from this pilot study indicate that this TCM questionnaire might have adequate reliability and validity. Therefore, the questionnaire has potential usage as an outcome measurement instrument for the assessment of TCM in the patients with OA of the hip or knee. For this application to be possible, the questionnaire needs further development and validation with a larger sample of patients who have a variety of OA conditions.

[Truncated abstract] Previous research has found that full recovery of knee function following arthroscopic partial meniscectomy (APM) is often not achieved, and in the long-term, over 50% of these patients will develop knee osteoarthritis (OA). Mechanical factors are believed to contribute largely to the development of knee OA. High frequency loading has been shown to lead to degenerative joint changes in animal models. In human gait, the knee adduction moment during stance phase, which tends to load the medial articular surface of the tibiofemoral joint, has been associated with the presence, severity and progression of knee OA. Quadriceps weakness, which is common in people with knee pathology, has been associated with abnormal sagittal plane knee moments during gait, yet no studies have investigated the effect of knee strength on frontal plane kinetics. This work aimed to investigate gait mechanics in a post-APM population, determine the influence of neuromuscular factors on gait, and assess recovery of function over 12 months while examining factors associated with recovery. One hundred and six APM subjects were examined between one and three months postsurgery. Data were compared to an age-matched control group of 49 healthy adults. Subjects were aged 20 to 50 years and had been screened for: clinical and radiographic evidence of knee OA; previous or current knee joint disease or injury (other than the current meniscus pathology); or any other previous or existing disease or injury that may have an effect on gait, or predispose to joint disease. Three-dimensional gait analysis was performed at a freely-chosen walking velocity, using a 50 Hz VICON three-dimensional motion analysis system, instrumented with two force platforms and 10-channel electromyography system. Subjects also underwent knee strength testing on a Biodex isokinetic dynamometer. Information was collected regarding subject’s physical activity levels, general health and knee function, as well as patient’s surgery specifics and rehabilitation regime.

Thesis (M.CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaves 55-64).

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.