Runner's Knee

A systematic approach to knee problems by anatomical location of symptoms helps the physician make a specific diagnosis. The aim is to keep the runner running, so treatment is conservative whenever possible.     

Responsiveness of the International Knee Documentation Committee Subjective Knee Form

Background and PURPOSE: The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patient's perception of change on the global rating of change scale. In addition, a receiver operating characteristic curve was plotted to determine the change in score that best distinguished patients who improved from those who did not. RESULTS: The overall standardized response mean was 0.94, which is considered large. With the exception of those who were slightly worse or unchanged, the mean change in the International Knee Documentation Committee Subjective Knee Form score compared to the patients' perceived global ratings of change was as expected (greatly worse, -15.1; somewhat worse, -8.4; slightly worse, 20.6; no change, 10.7; slightly better, 5.9; somewhat better, 18.1; greatly better, 38.7). The receiver operating characteristic curve analysis revealed that a change score of 11.5 points had the highest sensitivity, and a change score of 20.5 points had the highest specificity to distinguish between those who were or were not improved. CONCLUSION: The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.     

Acute Knee Injuries

An athlete who has an acute knee injury should be assessed rapidly on the field and then more thoroughly on the sideline or in the training room. On-the-field assessment includes questions about the mechanism of injury and any similar previous injuries, a visual check for knee deformities and skin injuries, a neurovascular exam, and, ideally, tests for flexion and hyperextension. On the sideline or in the training room, standard physical tests are likely to reveal any significant injuries. These include the patellar apprehension, Lachman, posterior sag, quadriceps active, posterior drawer, posterolateral drawer, valgus and varus stress, pivot-shift, and dial tests.     

Knee arthrography today

Three recent studies on intraarticular knee structures are considered-one on an advance in conventional knee arthrography and two on use of computed tomography in evaluating knee menisci. A resurgence of knee arthrography is predicted.     

The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data

BACKGROUND: The International Knee Documentation Committee Subjective Knee Evaluation Form may be used to measure symptoms, function, and sports activity for people with a variety of knee disorders, including ligamentous and meniscal injuries, osteoarthritis, and patellofemoral dysfunction. To date, normative data have not been established for this valid, reliable, and responsive outcomes instrument. PURPOSE: To provide clinicians and researchers with normative data to facilitate the interpretation of results on the International Knee Documentation Committee Subjective Knee Evaluation Form. STUDY DESIGN: Cross-sectional survey. METHODS: The Subjective Knee Evaluation Form was mailed to 600 people in each of 8 age/gender categories (18-24 years, 25-34 years, 35-50 years, and 51-65 years for both male subjects and female subjects). Participants were drawn from a panel of 550 000 households (1 300 000 subjects) representative of noninstitutionalized persons in the United States and were matched to data from the United States Census Bureau on geographical region, market size, income, and household size. RESULTS: Complete data were available for 5246 knees. Twenty-eight percent of respondents reported an injury, weakness, or other problem with one or both knees. Normative data were determined for respondents as a whole and for the subset of respondents with no history of knee problems. Mean scores were determined for men aged 18 to 24 years (89 +/- 18), 25 to 34 years (89 +/- 16), 35 to 50 years (85 +/- 19), and 51 to 55 years (77 +/- 23); mean scores were also determined for women aged 18 to 24 years (86 +/- 19), 25 to 34 years (86 +/- 19), 35 to 50 years (80 +/- 23), and 51 to 65 years (71 +/- 26). Scores were higher for the subset of respondents with no history of current or prior knee problems. CONCLUSION: Scores on the International Knee Documentation Committee Subjective Knee Evaluation Form vary by age, gender, and history of knee problems. The normative data collected in this article will allow clinicians to interpret how patients with knee injuries are functioning relative to their age- and gender-matched peers and will enable researchers to determine the clinical outcomes of treatment.     

Knee Injuries in Sailboarding

Sailboarding is an exciting sport, but it does involve some risk for injury. In this study of 21 knee injuries that occurred during sailboarding over a 2-year period, 12 were isolated medial collateral ligament (MCL) sprains, 4 were meniscus tears, and 5 involved joint instability. The MCL sprains were directly related to the use of the foot straps on the sailboard. Conservative treatment was successful for the MCL sprains; the meniscus tears were treated with arthroscopic surgery. Improved foot straps designed to release the foot more readily may help reduce knee injuries.     

Refining Knee Injection Techniques

‘Best of the Literature’ presents summaries of sports medicine-related articles culled from more 30 medical journals. Experts comment on what the new findings add to current medicai thinking and on the implications for practice.