Rupture of the anterior cruciate ligament (ACL) is a major clinical problem, leading to instability of the knee joint. This is especially unfortunate, as ACL failure is most commonly encountered in sports, where it affects healthy, younger people who wish to pursue an active life-style. Due to the frequency and potential severity of injuries, a need still exists for information on the biomechanical properties of ligaments under loading conditions, which occur at the time of trauma. The aims of this study were to examine the effect of different loading conditions on the mechanical properties and the appearance of the ruptured ligaments when viewed by scanning electron microscopy. Examining the appearance of collagen fibres at these surfaces should help us understand more about what actually happens during and after the fracture process. This study represents a combination of the two fields of tissue mechanics and fracture morphology for understanding the failure of biological tissues. (Abstract shortened by UMI.)t.

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to determine the efficacy of Genesen Acutouch pointers in the treatment of osteoarthritis of the knee. This was a prospective, randomized clinical trial consisting of sixty patients who volunteered from the general population of Durban. The patients, diagnosed as having osteoarthritis of the knee, were randomly divided into two different treatment groups. Each group consisted of thirty patients between the ages of eighteen and eighty five years. One group received active Genesen Acutouch Therapy, while the second group received placebo Genesen Acutouch Therapy. Data capturing took place for both groups on the first, fifth and ninth consultations. Subjective data was collected using the Numerical Pain Rating Scale-l Ol, the Visual Analogue Scale and the Patient Specific Functional Scale. Objective data was gathered from goniometer and algometer readings. For statistical analysis, only parametric tests were used in all hypothesis tests due to the large sample size. All readings were considered to be continuous variables. The twosample (unpaired) two-tailed t-test was used to compare two independent samples. The two-sample paired t-test was used to compare results from related samples. All tests were conducted at a = 0.05 level of significance / M

M.Tech.

M.Tech.

There is no published research available that evaluates the outcome of TKA in South African public hospitals. Prior to this project, there was no South African published research on the role of physiotherapy in patients post TKA. There are also no clinical practice guidelines in South Africa for rehabilitation post TKA. International guidelines may not be appropriate within a South African public hospital context. One of the issues raised in the literature pertaining to CPG development is that they lack practical detail and clarity of how decisions are made. In the current context, these problems may be compounded due to the lack of published research in the field in South Africa. The report that is presented is an attempt to combat these issues when a CPG for physiotherapy post TKA in a South African public hospital is developed. The aim of this study was to draft a report that could inform a comprehensive physiotherapy intervention (in the form of a clinical practice guideline) for patients undergoing a TKA in a tertiary care public hospital in urban South Africa. This was achieved through a series of four studies. The first study involved translating and establishing reliability of the Oxford Knee Score. The second study was a survey of current physiotherapy practice in the management of patients post TKA in South Africa. The third study was a prospective cohort study to establish the effect of an in-patient treatment protocol for use in the final study. The final study was an observational study to explore the outcome of patients post TKA and identify those who may be at risk for poor outcome. The English and translated versions of the Oxford Knee Score was shown to be reliable in this sample. This provided an outcome measure that can be used in the validation and evaluation phases of CPG development. The survey of current practice highlighted the high rate of staff turnover and the relative inexperience of physiotherapists working with patients post TKA in the public sector. It identifies the junior physiotherapists as potential stakeholders in the CPG. The trial of the in-patient physiotherapy protocol rendered similar findings to other similar studies in that a specific physiotherapy intervention did not have any effect on short term outcomes. It puts forward clear clinical questions to facilitate the development of the CPG, particularly relating to scheduling and delivery of weekend and out-patient therapy. The final study provided a demographic profile of the patients within the study context, who are potential stakeholders in the CPG development process. In addition it revealed that level of education, the presence of a caregiver at home, marital status and lack of previous exposure to physiotherapy form part of the profile of an ‘at risk’ patient. When the contribution that this thesis has made thus far to the CPG development process, is appraised using the AGREE tool, it shows that the thesis has contributed to 11 out of 23 of the criteria on the AGREE tool. It has therefore resulted in a report that informs the development of a clinical practice guideline for the physiotherapy management of patients post total knee arthroplasty in a tertiary care public hospital in Gauteng, South Africa.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy. / The purpose of this retrospective study was to assess the Subjective, objective and functional results of intra-articular anterior cruciate ligament (ACL) reconstructions using the patellar tendon. The subjects of one orthopaedic surgeon were assessed to eliminate surgical variability. Twenty active males, aged 20 - 35 were assessed twelve to fortyeight months post-operatively. Each subject completed a questionnaire and underwent various functional and subjective tests. Eighteen subjects (90 %) were satisfied with the outcome of their operation. Fourteen (70%) complained of intermittent pain or cdscomfort. Six (30%) complained of some form of post-operative giving way. Nineteen (95 %) had returned to sporting activity but most modified their sport or level of participation. Knee stability was restored post-operatively. Nineteen (95%) had a side-to-side difference of three rnillimetres (mm) or less on Lachman testing and eighteen (90 %) a side-to-side difference of 3mm or less on anterior drawer testing. Thirteen (65 %) had a 3mm or less side-to-side difference on KT1000 testing at 20 pounds (lbs) and 14 (70%) a side-to-side difference of 3mm or less on manual maximum testing. Isokinetic muscle testing revealed persistent quadriceps deficits greater than 20 % in seven subjects (35%) and three (15%) had similar hamstring deficits. Various factors may affect post-operative function. These include the length of rehabilitation, pain, residual quadriceps weakness and restoration of stability. / AC 2018

ABSTRACT The purpose of this study was to determine if there is a relationship between knee integrity and function in patients who have had a total knee replacement. Twenty-two patients were selected at the arthroplasty clinics at the Johannesburg Hospital and Chris Hani Baragwaneth Hospital. This occurred at six weeks following a primary total knee replacement. Twenty-two subjects who participated in the study underwent two tests. The first test measured the patients’ functional ability using the Iowa Level of Assistance (ILOA) Scale. Knee integrity was measured using the Knee Society Knee Score. The two examiners were blinded to each other’s results. The results indicate that there is no relationship between knee integrity measured using the Knee Society Knee Score and function measured using the ILOA Scale (p= 0.19).

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy. / The purpose of this retrospective study was to assess the Subjective, objective and functional results of intra-articular anterior cruciate ligament (ACL) reconstructions using the patellar tendon. The subjects of one orthopaedic surgeon were assessed to eliminate surgical variability. Twenty active males, aged 20 - 35 were assessed twelve to forty eight months post-operatively. Each subject completed a questionnaire and underwent various functional and subjective tests. Eighteen subjects (90 %) were satisfied with the outcome of their operation. Fourteen (70%) complained of intermittent pain or discomfort. Six (30%) complained of some form of post-operative giving way. Nineteen (95 %) had returned to sporting activity but most modified their sport or level of participation. Knee stability was restored post-operatively. Nineteen (95%) had a side-to-side difference of three rnillimetres (mm) or less on Lachman testing and eighteen (90 %) a side-to-side difference of 3mm or less on anterior drawer testing. Thirteen (65 %) had a 3mm or less side-to-side difference on KT1000 testing at 20 pounds (lbs) and 14 (70%) a side-to-side difference of 3mm or less on manual maximum testing. Isokinetic muscle testing revealed persistent quadriceps deficits greater than 20 % in seven subjects (35%) and three (15%) had similar hamstring deficits. Various factors may affect post-operative function. These include the length of rehabilitation, pain, residual quadriceps weakness and restoration of stability. / AC2018

Fachry Ambia Tandjung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 150-166.

Knee joint osteoarthritis is recognised as a significant subset of osteoarthritis. Little work has examined muscle changes that occur with knee joint osteoarthritis. Much of this work has centred on strength deficits, while little work has examined the effect of joint pathologies, such as osteoarthritis, on the fatigue resistance of the muscles associated with an affected joint. The purpose of this study was to investigate the relative fatigue-resistance characteristics of the vastus medialis in subjects with and without knee joint osteoarthritis, as well as the ability to predict endurance times in these groups, using high spatial resolution electromyography and a sub-maximal isometric endurance test. Twenty-six subjects with unilateral knee osteoarthritis and seventeen subjects with no known knee pathology were evaluated. All subjects performed initial tests to evaluate maximum voluntary contraction (MVC), voluntary activation levels, and true maximum force (TMF). Endurance time was assessed during an isometric quadriceps contraction at 50% of the true maximum force. Surface electromyography (sEMG) data was collected from the vastus medialis muscle of the quadriceps group during the endurance test. MVC tests showed that the affected leg of the group with osteoarthritis was significantly weaker (p < 0.05) than the unaffected leg. Voluntary activation data showed that subjects with osteoarthritis presented with significant bilateral deficits (p < 0.05). TMF data showed a significantly lower (p < 0.05) true potential for force generation in the affected compared to the unaffected leg of the osteoarthritis group. Endurance time data showed no significant difference between groups. Electromyography data showed significant differences (p < 0.05) between the affected and unaffected legs in initial values of Median Frequency (MDF), Mean Power Frequency (MPF) and Conduction Velocity (CV), the percentage change in CV and the relative rate of change in the frequency band between 5 and 30Hz (FB1). Finally, significant correlations were seen between endurance time and the relative rate of change of MDF, MPF and CV calculated over the initial thirty seconds of the endurance test. There were no significant correlations from either leg of the group with knee joint osteoarthritis.It can be concluded from this study that there are differences in strength measures, and in the sEMG signal collected from the vastus medialis muscle of the affected and unaffected legs of subjects with knee osteoarthritis. It appears likely that the differences observed in the sEMG signals were related to a decrease in the representation of type-2 muscle fibres in the vastus medialis of the affected leg. Furthermore, these changes in the behaviour of the signal appear to indicate an improvement in the relative fatigue resistance of the affected leg in relation to the unaffected leg of the group with knee osteoarthritis.Moderate success was seen with the prediction of endurance time in control subjects in the current work using a short duration (30-second) endurance test. This relationship was not seen in either the affected or unaffected leg of the subjects with knee osteoarthritis. Further investigation utilising different sEMG collection and analysis techniques in this area may improve prediction of endurance time in unaffected and affected subjects.