Q-angle: an invaluable parameter for evaluation of anterior knee pain. (1/95)

BACKGROUND: Patellofemoral pain syndrome is a descriptive term applied to patients with nonspecific anterior knee pain, and is the most common knee problem. The pain in most patellofemoral disorders is generalized to the anterior part of the knee. One important concept in patellofemoral joint function is the quadriceps angle (Q-angle). Theoretically, a higher Q-angle increases the lateral pull of the quadriceps femoris muscle on the patella and potentiates patellofemoral disorders. This study was undertaken to evaluate the relationship between the anterior knee pain and Q-angle. METHODS: This prospective study was performed on two groups; the case group consisted of 100 outpatients (44 men, and 56 women) aged between 15 and 35 years, with anterior knee pain. The control group consisted of 100 outpatients (50 men, and 50 women) with the same age distribution, who presented with different problems in the upper extremities and no knee problems. The Q-angle of each knee was measured in all participants, using a universal goniometer. RESULTS: The mean Q-angle for men, women, and all participants in the case group was 15.2, 20.1, and 18.0 degrees, respectively. In the normal control group the angles were 12.1, 16.7, and 14.9 degrees, respectively. All these differences were statistically significant (P < 0.001). CONCLUSION: These results substantiate the fact that patients with anterior knee pain have larger Q-angles than healthy individuals.  (+info)

Anterior cruciate ligament tear: reliability of MR imaging to predict stability after conservative treatment. (2/95)

OBJECTIVE: The aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity. MATERIALS AND METHODS: Twenty patients with 20 knee injuries (13 males and 7 females; age range, 20-54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05). RESULTS: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups. CONCLUSION: MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.  (+info)

Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. (3/95)

BACKGROUND: The objective of the present study was to assess interobserver reproducibility (in terms of reliability and agreement) of active and passive measurements of knee RoM using a long arm goniometer, performed by trained physical therapists in a clinical setting in total knee arthroplasty patients, within the first four days after surgery. METHODS: Test-retest analysis. SETTING: University hospital departments of orthopaedics and physical therapy. PARTICIPANTS: Two experienced physical therapists assessed 30 patients, three days after total knee arthroplasty. MAIN OUTCOME MEASURE: RoM measurement using a long-arm (50 cm) goniometer. Agreement was calculated as the mean difference between observers +/- 95% CI of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on two-way random effects analysis of variance. RESULTS: The lowest level of agreement was that for measurement of passive flexion with the patient in supine position (mean difference 1.4 degrees ; limits of agreement 16.2 degrees to 19 degrees for the difference between the two observers. The highest levels of agreement were found for measurement of passive flexion with the patient in sitting position and for measurement of passive extension (mean difference 2.7 degrees ; limits of agreement -6.7 to 12.1 and mean difference 2.2 degrees ; limits of agreement -6.2 to 10.6 degrees, respectively). The ability to differentiate between subjects ranged from 0.62 for measurement of passive extension to 0.89 for measurements of active flexion (ICC values). CONCLUSION: Interobserver agreement for flexion as well as extension was only fair. When two different observers assess the same patients in the acute phase after total knee arthroplasty using a long arm goniometer, differences in RoM of less than eight degrees cannot be distinguished from measurement error. Reliability was found to be acceptable for comparison on group level, but poor for individual comparisons over time.  (+info)

Posterior cruciate ligament balancing in total knee replacement: the quantitative relationship between tightness of the flexion gap and tibial translation. (4/95)

We have examined the relationship between the size of the flexion gap and the anterior translation of the tibia in flexion during implantation of a posterior cruciate ligament (PCL)-retaining BalanSys total knee replacement (TKR). In 91 knees, the flexion gap and anterior tibial translation were measured intra-operatively using a custom-made, flexible tensor-spacer device. The results showed that for each increase of 1 mm in the flexion gap in the tensed knee a mean anterior tibial translation of 1.25 mm (SD 0.79, 95% confidence interval 1.13 to 1.37) was produced. When implanting a PCL-retaining TKR the surgeon should be aware that the tibiofemoral contact point is related to the choice of thickness of the polyethylene insert. An additional thickness of polyethylene insert of 2 mm results in an approximate increase in tibial anterior translation of 2.5 mm while the flexed knee is distracted with a force of between 100 N and 200 N.  (+info)

Hypergravity resistance exercise: the use of artificial gravity as potential countermeasure to microgravity. (5/95)

The aims of this study were to 1) determine if hypergravity (HG) squats can produce foot forces similar to those measured during 10-repetition maximum (10RM) squats using weights under normal 1-G(z) condition, and 2) compare the kinematics (duration and goniometry) and EMG activities of selected joints and muscles between 10RM and HG squats of similar total foot forces. Eight men and six women [27 yr (SD 4), 66 kg (SD 10)] completed ten 10RM [83 kg (SD 23)] and 10 HG squats (2.25-3.75 G(z)). HG squats were performed on a human-powered short-arm centrifuge. Foot forces were measured using insole force sensors. Hip, knee, and ankle angles were measured using electrogoniometers. EMG activities of the erector spinae, biceps femoris, rectus femoris, and gastrocnemius were also recorded during both squats. All subjects were able to achieve similar or higher average total foot forces during HG squats compared with those obtained during 10RM squats. There were no differences in total duration per set, average duration per repetition, and goniometry and EMG activities of the selected joints and muscles, respectively, between 10RM and HG squats. These results demonstrate that HG squats can produce very high foot forces that are comparable to those produced during 10RM squats at 1 G(z). In addition, the technique and muscle activation are similar between the two types of squats. This observation supports the view that HG resistance training may represent an important countermeasure to microgravity.  (+info)

Reliability of hip range of motion using goniometry in pediatric femur shaft fractures. (6/95)

INTRODUCTION: The purpose of this study was to determine the interrater reliability of the assessment of range of motion of the hip joint through goniometry. METHODS: We included children aged 4 to 10 years with a femoral shaft fracture, from 4 study sites, who had had either an early hip spica cast or an external fixator. An assessor blind to treatment received at each site measured range of hip joints motion, using a standardized goniometric technique at 15 and 24 months postfracture. RESULTS: The intraclass correlation coefficient (ICC) was used to quantify concordance or agreement. Most ICCs for the different aspects of hip range were between 0.2 and 0.5, indicating only slight agreement. The most reliable measure was hip flexion, with an ICC of 0.48 (95% confidence interval 0.29-0.63). CONCLUSION: Goniometric measurement, using standardized protocols for the hip, has low reliability. Only when differences in rotation exceed at least 30 degrees and in flexion-extension exceed 50 degrees should clinicians conclude that true change has occurred.  (+info)

Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. (7/95)

OBJECTIVE: To test the reproducibility of tests and criteria for generalized joint hypermobility (GJH) and benign joint hypermobility syndrome (BJHS). METHODS: A standardized protocol for clinical reproducibility studies was followed using a three-phase study (with a training, an overall agreement and a test phase). An overall agreement of at least 0.80 was required to proceed to the test phase. Phases 1, 2 and 3 used 14 patients (with varying degrees of hypermobility), 20 patients (50% cases) and 40 patients (50% cases), respectively. The inclusion criterion for cases was hypermobility (patients with Ehlers-Danlos Syndrome or BJHS) and for controls, non-hypermobility (patients with shoulder and/or back pain); patients were selected from patients' files (phases 1 and 2) or included consecutively from our outpatient clinic (phase 3). RESULTS: The overall agreement in phase 2 was 0.95 for GJH and 0.90 for BJHS. Reproducibility for diagnosing GJH and BJHS in phase 3 showed kappa values of 0.74 and 0.84, respectively. Kappa in the Beighton tests for diagnosing GJH (currently or historically) was generally above 0.80, except for the fifth fingers and elbows (> or = 0.60). In the Brighton tests for diagnosing BJHS, kappa was above 0.73, except for the skin signs (0.63). Lowest kappa was found in the Rotes-Querol tests, where it was > or = 0.57, except for the right shoulder (0.31). CONCLUSION: We found a good-to-excellent reproducibility of tests and criteria for GJH and BJHS. Future research on the validity of the tests and criteria for joint hypermobility is urgently needed.  (+info)

Relationships among severity of osteonecrosis, pain, range of motion, and functional mobility in children, adolescents, and young adults with acute lymphoblastic leukemia. (8/95)

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