The knee is one of the most complex joints in the body, relying entirely on ligaments and muscles for stabilization. With the rise in people participating in sports, including a significant increase in female athletes, the prevalence of anterior cruciate ligament (ACL) injuries is very evident. With recent research showing that ACL injuries lead to osteoarthritis 10-20 years after the injury, determining the cause of these injuries to be able to prevent them is crucial. To date, both in-vivo and in-vitro techniques have been used to analyze the influences of the ACL injury including neuromuscular, anatomical, and kinematic. In-vivo techniques used to investigate knee kinematics is limited by the inability to take real ACL strain measurements while in-vitro techniques used to investigate anatomical considerations is limited by the inability to apply true muscular and kinematic forces. The purpose of the present thesis is to show the design and validation of a dynamic knee injury simulator. The simulator puts a cadaver knee, original ligaments and patellar tendon still attached, through motions which put the ACL at a high-risk of injury with realistic influence of muscles. The muscular influences are applied with actuators pulling the same force pro les as natural muscles. To get realistic muscle pro files, Anybody Software is used. Anybody Software is a modeling software which puts a skeletal system through prescribed motions and using an optimization algorithm calculates the muscle force pro file. The motion of the knee in the sagittal plane is simulated with actuators. The simulator consists of four actuators which are used in force control mode to add the muscle influence to the knee. Another two belt actuators are used for the joint motions, one each for the hip and ankle. The hip will move along the resultant Z motion and the ankle will move along the resultant Y motion. Simple gait is used for initial validation, the actuators chosen have speed and force capabilities for high-risk motions. The gait was successfully simulated and muscle force versus time profi le tracked the input well. The regression coeffcient study shows very good comparison. The hamstring muscle group is the only one which does not show very good comparison however this is only due to the jumpy nature of the hamstring profi le. The ACL strain fell within a similar range to published gait ACL strain data. The validation was successful, and with greater available force and speeds in the actuators, showing the use of this simulator during high-risk motions is possible.

One of the most poorly understood co-morbidities associated with obesity is the pathway to osteoarthritis of the knee. To implement appropriate preventative strategies, it is important to explore how obesity is a causal factor for osteoarthritis. The present research compared the kinematics and kinetics of a group of young obese, but otherwise healthy, adults to a group of young, healthy-weight adults, in an attempt to identify mechanical abnormalities at the knee during walking that may predispose the obese to osteoarthritis of the knee. Optotrak motion capture (Northern Digital Inc. Waterloo, Ontario) and a forceplate (AMTI OR6-7, Advanced Mechanical Technology Inc, Watertown, MA) were used to measure ground reaction forces and moments of 16 participants – 8 obese and 8 sex-, age- and height-matched healthy-weight – to analyze knee joint kinematics and kinetics at three walking speeds. Participants wore an accelerometer (ActiGraph GT3X, Fort Walton Beach, USA) for seven days to measure daily steps counts. Dependent t-tests were performed to determine group differences in ground reaction forces, knee angles and knee moments, as well as knee adduction moment impulse and cumulative knee adductor load (CKAL). The obese group walked at a significantly slower self-selected speed (p=0.013). While not statistically significant, the obese group did present with a more valgus mean dynamic knee alignment than the health-weight group. A significantly greater maximum abduction angle (p=0.009) and smaller minimum knee flexion angle at heel contact (p=0.001) was found in the obese group. A significant difference was found in the peak medial rotation moment in the transverse plane (p=0.003). A greater stance duration lead to a significantly greater knee adduction moment impulse (p=0.049) in the obese group. While significant group differences were not found in the steps per day, the obese group had a significantly greater CKAL (p=0.025). Obese young adults with healthy knees demonstrated a gait pattern of reduced medial knee joint compartment loading through greater knee abduction, medial knee rotation and a slower walking speed compared to matched controls. The ramifications of gait modifications on long-term musculoskeletal health remain unknown, but compensations may lead to increased risk of osteoarthritis of the knee.

Abstract Since Mar. 1995, the National Health Insurance begin in Taiwan, the payment of health insurance gradually increase each year. For controlling the increasing costs, case payment was the most important method. For each hospital, using clinical pathway to control costs of case payment was an effective tool. But, there were still less literatures to discuss the efficiency of clinical pathway in Taiwan. We used a retrospective study design, to examine the length of stay, total costs and quality including the complications, morbidity and readmissions for total knee replacement surgery. The data before clinical pathway was from June 2001 to May 2002, total 219 cases. After clinical pathway, the data was from Jan. 2003 to Dec. 2003, total 207 cases. The results showed decrease length of stay from 7.4 to 6.6 days (10.8%), decrease total cost from 125,324 NTS to 119,100 NTS (4.97%) and the quality of complications and readmissions did not increase. In conclusion, the clinical pathway can improve length of stay, total costs and quality. Key words: case payment, clinical pathway, total knee replacement

The knee joint is the most commonly injured joint in the body. Clinical methods used at present for the diagnosis of cartilage pathology in the knee are invasive in nature. Analysis of vibration signals emitted by the knee joint has the potential for the development of a non-invasive procedure for the diagnosis of knee pathology. By Short Time Fourier Transform (STFT) and calculating root mean square (RMS) value, via One Way ANOVA at last, to demonstrate whether the two analysis methods are valid in this work. The method was tested on 14 male volunteers from NSYSU (7 players of in-line skating and 7 normal schoolmates). By analyzing the signals extracted from the players, finding difference of them, and distinguishing whether they are healthy. In conclusion, if the knee joint ligament is unusual, the frequency of signal is higher than 50 Hz; if not, the frequency is lower than 10 Hz. On the other hand, the RMS value of signal has no distinct region among the testers, so could not be used to analyze the signals. The results should be able to take as the reference for the diagnosis of knee joint non-invasively in clinical medicine.

Thesis (M.S.)--Ohio State University, 2008. / Title from first page of PDF file. Includes bibliographical references.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Biomedical Engineering." Includes bibliographical references (p. 157-168).

Thesis (Ph.D.)--University of Delaware, 2009. / Principal faculty advisor: Lynn Snyder-Mackler, Dept. of Physical Therapy. Includes bibliographical references.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb 19, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Thesis advisor: Drs. Sheila Grant and James Cook. Includes bibliographical references.

Thesis (M.A.)--York University, 1999. Graduate Programme in Dance. / Typescript. Includes bibliographical references (leaves 152-159). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ56164.

With ageing population in Hong Kong, the prevalence of osteoarthritis is expected to be increasing. The most common type of osteoarthritis is osteoarthritis of knee. Osteoarthritis adversely affects physical activities, social activities and quality of life. It causes socioeconomic burdens and has become a more prominent public health issue in Hong Kong. Self-management of this irreversible health problem in the daily living is crucial to those elders suffering from osteoarthritis. However, no evidence-based guidelines on self-management education for elders with knee osteoarthritis have been formed. The objectives of this paper are to review literatures on the effectiveness of self-management program and to formulate evidence-based guidelines on self-management education for Chinese older adults with knee osteoarthritis. The literature review showed that self-management program was an effective measure to improve self-efficacy for self-management and to reduce pain among the elders with knee osteoarthritis. The assessment on the implementation potential of the self-management program showed that self-management program could be transferred to the community-dwelling Chinese elders with knee osteoarthritis and was found to be feasible for implementation in Elderly Health Centers in Hong Kong. The benefits of self-management program outweigh the costs for the implementation of such a program. The proposed self-management program would mainly provide the elders with the self-management skills, osteoarthritis related information and exercise practice in group sessions. There would also be follow-up telephone coaching. Guidelines for implementing the proposed self-management program are shown in this thesis. Implementation plan was formulated to propose communication strategies to initiate and sustain the implementation of the proposed self-management program. Pilot test was designed to test the feasibility of the program. Evaluation plan was developed to evaluate the effectiveness of the program in improving self-efficacy for self-management and reducing osteoarthritis pain for Chinese older adults with knee osteoarthritis. In sum, self-management program was found to be effective in improving self-efficacy for self-management and reducing pain among the elders with knee osteoarthritis. The guidelines on the proposed self-management program could support the evidence-based self-management education for Chinese older adults with knee osteoarthritis in Hong Kong. / published_or_final_version / Nursing Studies / Master / Master of Nursing