Thesis (M.S.)--University of British Columbia, 2003. / Includes bibliographical references (leaves 94-97).

Thesis (M.S.)--Montana State University, 2002. / Includes bibliographical references (leaves 69-72).

Thesis (M.S.)--University of Delaware, 2007. / Principal faculty advisor: Todd D. Royer, Dept. of Health, Nutrition, and Exercise Sciences. Includes bibliographical references.

Thesis (Ph. D.)--University of North Carolina at Greensboro, 2007. / Title from PDF title page screen. Advisor: Sandra J. Shultz, David H. Perrin; submitted to the School of Health & Human Performance. Includes bibliographical references (p. 124-140).

Thesis (Ph. D.)--Ohio State University, 1985. / Includes vita. Includes bibliographical references (leaves 129-132). Available online via OhioLINK's ETD Center.

Thesis (Ph. D.)--Oregon State University, 2007. / Includes bibliographical references (leaves 113-116). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (Ph. D.)--Oregon State University, 2007. / Includes bibliographical references (leaves 113-116).

<b>Background and objectives.</b> Knee osteoarthritis (KOA) is a leading cause of disability in the developed world. Additionally, it is possibly linked with premature mortality. Low-grade inflammation is associated with a high risk of non-traumatic KOA incidence but also with metabolic syndrome. Knee injury is a major risk factor for KOA and is associated with an inflammatory response. Heterogeneity of both the symptoms and progression makes early identification of individuals at risk difficult. The aim of this thesis was to examine the diagnostic value of selected biomarkers to identify microscopic synovitis, examine their predictive value for KOA development and any association with excess premature mortality. <b>Methods.</b> Four serum biomarkers, COMP, resistin, C3M and CRPM, all linked with both knee pain and synovial or systemic inflammation, were selected and an additional sonographic marker was tested. Data from two cohorts has been utilised for the purpose of this thesis: the Oxford Knee Injury Cohort, a prospective study of NHS patients with recent ACL and/or meniscal injuries, and the Chingford women's study, a community-based prospective cohort with over 23 years of follow-up. <b>Results.</b> Cross-sectionally, sonographic markers correspond well with microscopically defined post-traumatic synovitis. Two biomarkers, COMP and resistin, were associated with development of incident radiographic KOA (RKOA), while two others, C3M and CRPM, predicted development of painful RKOA independently to age and BMI. High C3M levels and presence of painful RKOA were associated with premature mortality. Knee pain alone, especially in presence of RKOA was an independent predictor of mortality, but RKOA without pain was not. <b>Conclusion.</b> These results support the use of the studied biomarkers in complex predictive models for development of KOA and associated premature mortality. Taking the competing risk of death into account is an important consideration in this field.

Background: Knee injuries have a considerable impact on both the person’s psychological and physical health. We currently have tools to address each of these aspects but they are often considered independent of each other. Little work has been done to consolidate the subjective and objective functional ability of anterior cruciate ligament (ACL) injured individuals, which can be detrimental when implementing a return-to-play decision-making scheme. The lack of understanding concerning the relationship of these two measures may account for the high incidence of re-injury rates and lower quality of life exhibited by so many of these patients. Purpose: The purpose of this doctoral thesis is to investigate the relationship between subjective and objective measures of functional ability in ACL deficient and ACL reconstructed conditions through biomechanical and neuromusculoskeletal modelling approaches. Methods: This thesis is comprised of five studies based on a single in vivo data collection protocol, medical imaging and in silico data analyses. The in vivo data collection was of test-retest design where ACL deficient patients participated prior to their operation and approximately ten months post-reconstruction. This experimental group was matched to a healthy, uninjured control group, which was tested a single time. The first study of this thesis involved a descriptive analysis of spatiotemporal, neuromuscular, and biomechanical patterns during hopping and side cut tasks in addition to subjective functional ability questionnaires. Then, two novel measures of dynamic knee joint control were developed and applied along with a third measure to determine if changes in joint control exist between the three groups (Study 2). The relationships of these objective measures of functional ability to subjective measures were then examined through correlation and regression models (Study 3). Following this, a method of including magnetic resonance imaging to construct patient-specific models was developed and implemented to determine realistic kinematic and ligament lengthening profiles (Study 4). These patient-specific models were then applied to quantify knee joint loading in the form of contact and ligament forces, which were correlated to subjective measures of functional ability (Study 5). Results: Even though no major differences in neuromuscular patterns were observed between all three groups, it was found that subjective patient-reported outcome measures scores and biomechanical measures in the form of knee flexion angles and extensor moments were lower in the ACL deficient group compared to healthy controls. These differences continued to exist 10 months post-operation as the ACL reconstructed group had not fully recovered to patterns observed in the healthy controls. The current findings also suggest a possible hierarchy in the relationships between objective and subjective measures of functional ability. Basic kinematic objective measures such as knee flexion angle show small to moderate correlations, while more comprehensive measures such as stiffness and joint compressive force show moderate to strong correlations to subjective questionnaires. Finally, this thesis developed patient-specific OpenSim models that were used to produce appropriate kinematics and ligament lengthening with the reduction in soft tissue artefact. Conclusion: This thesis demonstrated that patients who are high-functioning in the ACL deficient state show greater improvements in subjective outcome scores after ACL reconstruction compared to objective measures. Biomechanical and neuromusculoskeletal modelling approaches identified important differences between the healthy and ACL deficient groups that were not resolved post-operatively. Our results also demonstrate that certain subjective and objective measures of functional ability are strongly correlated. The knowledge gained from this test-retest design and novel patient-specific in silico models aids clinicians in managing their expectations regarding the effectiveness of reconstruction and the respective long-term sequelae.

背景：膝痹因勞損或年高，膝失精血充養，經氣不利等原因所導致並以膝部長期固定疼痛，活動時關節內有聲響等為主要表現的肢體屏病類疾病。多發於老年人, 西醫的膝骨性關節炎、退行性膝關節病、膝關節滑膜炎，髏骨軟他症等屬於該疾病的範疇。該疾病所導致的疼痛以及活動障礙嚴重影響了人們的生活質量，亦極大地增加了家庭以及社會負擔。中醫學認為膝痹是因為肝腎虧虛，精血不足，筋骨失養，風、寒、濕、熱等邪氣趁虛而人，阻滯經脈氣血所致。 目的：通過對近十二年文獻的研究，分析溫針治療膝痹的臨床療效，作用機制，以及評價當前文獻質量，反映國內外溫針治療膝痹的研究現狀，為進一步的研究提供思路和依據。 方法：採用計算機檢索國內外相關臨床研究文獻。中文文獻檢索數據庫為： 中國 期刊全文資料庫（ CNKI ），檢索主題詞為“溫針，’ ，“針灸療法，’，"溫針療法 ,“溫針灸， "膝"，“膝關節 。英文文獻檢索數據庫為PubMed ，檢索主題詞為 “ acupuncture and moxibustion ,“warm needling’,“warm acupuncture,“warming needle moxibustion , “arthralgia syndrome’,“ knee arthralgia,“knee osteoarthritis,“osteoarthritis of the knee",“osteoarthritis of knee join t , “degenerative arthritis of the knee" , 九enile knee osteoarthri ti s 。檢索年限為2005 至2016 年。 將篩選後的文獻進行樣本量，診斷標準，隨機方法，臨床分期，療效評價方法，幹預措施，幹預週期及遠期隨訪，不良反應及脫失率，文獻評價等方面的統計與比較。 結果： 多數文獻認為溫針治療膝屏有較好的療效，但日前國內溫針治療膝痹的文獻質量普遍不高，通過對近十二年來溫針治療膝蟬的臨床研究進行回顧，發現國內臨床研究在樣本量估算，隨機方法，分級、分期進行治療，診斷標準和療效評價標準’遠期療效隨訪，不良反應和脫失率，隨機對照試驗質量等方面存在一定問題。且在單一療法的評價方面尚缺乏較強的說服力。本次研究通過Meta 分析雖然可得出溫針較口服西藥與單純針刺的療效為佳，但由於納入研究的試驗數量有限, 文獻質量亦參差不齊，故所得出的結論有一定的侷限性。 結論：由於文獻質量存在一定的問題，故而單一療法的評價方面尚缺乏較強的說服力。為了進一步證明溫針治療膝痹的療效，需要開展更多的設計合理，執行嚴格的大樣本、多中心、高質量的隨機對照試驗，並且在試驗中應進行遠期療效觀察，詳細描述研究過程中的不良反應以及脫失率， J,,j、期提供更加全面可靠的臨床依據。溫針治療膝痹的機制研究方面尚未完善對溫針治療的影響因素如灸量選擇，針刺深度選擇等方面亦未達成共識，這些方面亦可以作為未來研究的發展方向。