Cervical spine segmental vertebral motion in healthy volunteers feigning restriction of neck flexion and extension

The purpose of this study was to obtain comparative data concerning the percentage contribution of segmental cervical vertebral motion to the cervical range of motion (ROM) in healthy volunteers under two conditions: (1) normal, voluntary neck flexion and extension and (2) feigned restriction of neck flexion and extension. Each healthy subject’s angular motion over forward cervical flexion and extension was measured first by X-ray analysis during normal, voluntary motion. Then the subjects were asked to pretend that they had a 50% restricted neck range due to pain or stiffness and thus to move in both flexion and extension only as far as about 50% of their normal range. A total of 26 healthy subjects (ten males and sixteen females, age 28.7±7.7 years) participated. The total angular motion from C2 to C7 was normal in the unrestricted condition and was significantly reduced in the feigned restriction condition (p<0.001). The percentage contribution of each of the functional units C2–C3 to C6–C7 to this rotation was different between the normal unrestricted and the feigned restricted conditions. In the feigned restricted neck flexion and extension, a shift occurred in the pattern of how each segment contributes to the total angular range. A greater percentage contribution was made by C2–C3 and C3–C4 than under normal conditions (P<0.01), and the percentage contribution to total rotation made by C6–C7 became much less under the feigned restricted movements than under normal, unrestricted neck range (p<0.001). Thus, simulated or feigned restricted neck ROM affects the percentage contribution of the functional units C2–C3 to C6–C7 by showing a higher percentage contribution of the upper cervical segments and less contribution to the angular rotation by the lowest cervical segment. Feigners of restricted neck range thus produce a pattern different from nonfeigning subjects.     

The feasibility of a video-based motion analysis system in measuring the segmental movements between upper and lower cervical spine

The evaluation of the range of motion (ROM) and static posture in the cervical spine are important in physical examination. Despite offering dynamic assessment without radiation, the video-based motion analysis system has not yet been applied to measure the cervical segmental movements. The purposes of this study were to develop a neck model to differentiate the movements and posture between upper and lower cervical spine, and to examine the reliability of measuring cervical motion with surface markers and the aid of videofluoroscopy. Sixteen healthy adult subjects (eight males and eight females) participated in this study. Ten surface markers were used to estimate the discrepancies in cervical vertebral angles compared with corresponding bony landmarks throughout the ROM. The average intraclass correlation coefficients (ICCs) of the paired vertebral angles between surface markers and bony landmarks ranged from 0.844 to 0.975 and the mean absolute difference (MAD) averaged 2.96 degrees. Our results indicate high consistency between surface markers and bony landmarks throughout the cervical movements. The mean upper (C0-C2) and lower (C2-C7) cervical joint angles in the neutral position were 18.59+/-4.33 degrees and 23.98+/-6.15 degrees, respectively. Furthermore, the reliability of the digitizing procedure within raters (ICC=0.850-0.999; MAD=0.58-2.42 degrees) and between raters (ICC=0.759-0.988; MAD=0.59-2.66 degrees) suggests that the neck motion analysis model is a feasible method for investigating static neck posture or dynamic motion between upper and lower cervical spine.     

Functional diagnostics of the cervical spine using computer tomography

Summary 35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7°, and C1/C2 more than 54° could indicate segmental hypermobility, a rotation at the segment C1/C2 less than 29° to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patinets examined after cervical spine injury and with therapyresistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotatory instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast.Paper presented at the Meeting of the Cervical Spine Research Society, June 21–24, 1987, Pavia, Italy     

The increased range of cervical flexed motion detected by radiographs in Hirayama disease

Purpose

Cervical flexion movement is supposed to play an important role in the pathogenesis of Hirayama disease. But there is no report on the range of cervical flexed motion in this disease. The purpose of current study was to compare the range of cervical flexed motion in patients with Hirayama disease with the one in healthy controls using conventional lateral flexion radiographs of the cervical spine, and to investigate the diagnostic value of radiographs for Hirayama disease.

Materials and methods

This prospective study was approved by a local institutional review board and written informed consent was obtained. From August 2007 to March 2009, conventional flexion cervical radiographs and flexion cervical MRI were performed on 31 Hirayama disease patients (all men, age range, 16-24 years, mean age, 19.52 ± 2.29 years) and 40 control subjects (all men, age range, 16-25 years, mean age, 23.10 ± 2.20 years). The segmental and overall range of cervical flexed motion was quantitatively measured. Receiver operating characteristic curve was calculated and the diagnostic accuracy was qualified by using the area under the curve Az.

Results

Both the segmental and overall range of cervical flexed motion of patients determined by flexion cervical radiographs was greater than that of controls. The Az value was 0.90, indicating a moderate to good ability of conventional flexion radiographs in the diagnosis of Hirayama disease.

Conclusion

Hirayama disease patients have an increased flexed motion range of cervical spine which would contribute to the pathophysiological change and determine its treatment. Conventional flexion radiographs might be suitable to be used as first line radiographic examination, followed by MRI in cases of suspected Hirayama disease.     

Comparison of 3D spinal motions during stair-climbing between individuals with and without low back pain

In spite of the importance of stair-climbing (SC) as an activity of daily living, 3D spinal motion during SC has not been investigated in association with low back pain (LBP). The purpose of this research is to investigate the differences of the spinal motions during SC between an LBP group and a healthy control group, in order to provide insight into the LBP effect on the spinal motions. During two types of SC tests (single and double step SCs), we measured 3D angular motions (flexion/extension, lateral bending, and twist) of the pelvis, lumbar spine and thoracic spine using an inertial sensing-based, portable spinal motion measurement system. For the nine motion variables (i.e. three anatomical planes × three segments), range of motions (ROM) and movement patterns were compared to determine the differences between the two groups. It was found that the only variable having the p-value of a t-test lower than 0.05 was the flexion/extension of the lumbar spine in both SCs (i.e. the LBP group's ROM < the control group's ROM). Although the strength of this finding is limited due to the small number of subjects (i.e. 10 subjects for each group) and the small ROM differences between the groups, the comparison result of the t-test along with the motion pattern shows that the effect of LBP during SC may be localized to the lumbar spinal flexion/extension, making it an important measure to be considered in the rehabilitation and treatment of LBP patients.     

Hip passive range of motion and frequency of radiographic hip osteoarthritis in former elite handball players

Objective

To establish the relation between handball playing, passive hip range of motion (ROM), and the development of radiological hip osteoarthritis (OA) in former elite handball players. Two related issues are addressed: (a) the relation between long term elite handball playing and the incidence of hip OA; (b) the relations between hip ROM, OA, and pain.

Methods

Data on 20 former elite handball players and 39 control subjects were collected. A questionnaire yielded personal details, loading patterns during physical activity, and previous lower limb joint injury. Bilateral radiographs were analysed to diagnose and classify hip OA. Passive hip ROM was measured bilaterally with a goniometer.

Results

A close relation was found between long term elite handball practice and the incidence of hip OA: 60% of the handball players were diagnosed with OA in at least one of the hip joints compared with 13% of the control subjects. Passive ROM measured in the handball players was significantly lower for hip flexion and medial rotation and higher for abduction, extension, and lateral rotation than the control values. The handball players with OA reported less pain in the hip joints during daily activities than the control subjects with OA.

Conclusion

The risk of developing premature hip OA seems high for retired handball players and significantly greater than for the general population. Pain and discomfort represent two difficult diagnostic challenges to the sports physician, as the repetitive nature of movements that are specific to handball can lead to alterations that are rarely seen in the general population.     

Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome

Hypermobility syndrome (HMS) is characterised by generalised joint laxity and musculoskeletal complaints. Gait abnormalities have been reported in children with HMS but have not been empirically investigated. The extent of passive knee joint range of motion (ROM) has also not been well reported in children with HMS. This study evaluated gait kinematics and passive knee joint ROM in children diagnosed with HMS and healthy controls. Thirty-seven healthy children (mean age±SD=11.5±2.6 years) and 29 children with HMS (mean age±SD=11.9±1.8 years) participated. Sagittal knee motion and gait speed were evaluated using a VICON 3D motion analysis system. Passive knee ROM was measured with a manual goniometer. Independent t-tests compared the values of sagittal knee motion and gait speed between the two groups. Mann-Whitney U tests compared passive knee ROM between groups. Passive ROM (extension and flexion) was significantly higher (both p<0.001) in children with HMS than the healthy controls. Peak knee flexion (during loading response and swing phase) during walking was significantly lower (both p<0.001) in children with HMS. Knee extension in mid stance during walking was significantly increased (p<0.001) in children with HMS. However, gait speed was not statistically (p=0.496) different between the two groups. Children with HMS had higher passive knee ROM than healthy children and also demonstrated abnormal knee motion during gait. Gait re-education and joint stability exercise programmes may be of value to children with HMS.     

A soluble factor (EMMPRIN) in exudate influences knee motion after total arthroplasty

Few studies have been conducted to investigate biological factors that affect postoperative knee motion after total knee arthroplasty (TKA). The purpose of this study is to test the hypothesis that range of knee motion (ROM) at 4 weeks after TKA is correlated with the concentration of extracellular matrix metalloproteinase inducer (EMMPRIN) and transforming growth factor (TGF)-beta1 in the exudative fluid harvested from the joint after surgery. A prospective measurement study was conducted with 20 osteoarthritis patients who underwent TKA. At 48 h after surgery, the exudate was harvested from a closed drainage system. Enzyme-linked immunosorbent assay was performed to measure the concentration of TGF-beta1, EMMPRIN, MMP-1, 2, 9, tissue inhibitor of metalloproteinase-1, and Hyalunonan. Knee flexion angle was measured before and at 4 weeks after surgery. There was a significant correlation between the EMMPRIN levels and knee flexion angle (r = 0.557, p = 0.0148). Western blot analysis of the exudate showed a prominent band for EMMPRIN at 27 kDa. On the other hand, there was no correlation between the TGF-beta1 levels and the knee flexion angle. This study showed that EMMPRIN levels after TKA affect the postoperative ROM. As to clinical relevance, EMMPRIN in the exudate after TKA is a promising biological indicator to predict difficulty in restoring postoperative ROM.     

The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance

The aim of the present study was to investigate the reliability of different methods used for isokinetic testing of calf muscle strength and endurance. The detailed evaluation of test-retest reliability serves the purpose of establishing reliable research tools when evaluating patients who have sustained an Achilles tendon rupture. The test-retest reliability of isokinetic measurements at the ankle for eccentric and concentric muscle action was calculated in ten healthy male volunteers using intra-class correlation (ICC) and coefficient of variation (CV). Three different positions were compared at the angular velocities of 30°/s and 180°/s for right and left ankles. The ICC for plantar flexion was 0.37–0.95, whilst it was 0.00–0.96 for dorsiflexion. The corresponding CVs were 4.0–19.9 and 2.4–19.8 respectively. The test-retest reliability of standardised heel-raises, Achilles tendon width, calf circumference and ankle range of motion revealed ICC values of 0.71–0.98 and CVs of 0.67–19.1. The test-retest interval was 5 to 7 days. We conclude that all three positions studied for the isokinetic evaluation of calf muscle function are equally reliable concerning plantar flexion at the ankle joint. The same level of reliability was also found in the evaluation of the standing heel-raise test and the isokinetic dorsiflexion test, except for dorsiflexion in the supine position. The reliability of the investigated methods was only fair despite the use of a detailed and standardised test protocol.     

Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program

Purpose

Preoperative range of motion (ROM) is the most important variable to determine final flexion after total knee arthroplasty (TKA). The purpose of this study was to determine whether a preoperative home exercise program could improve ROM in the arthritic knee and whether this influenced ROM and functional recovery following primary TKA.

Methods

During the period between 2005 and 2006, one hundred and twenty-two patients with gonarthrosis were included in a prospective study and randomly allocated to either the control or the treatment group. The sixty-one subjects in the treatment group underwent a 6-week home-based exercise program before TKA surgery. All one hundred and twenty-two patients were assessed before and after this exercise intervention. Postoperative assessments were at 6 weeks, 6 months and 1 year. Each evaluation included knee ROM and the Knee Society Clinical Rating System. Length of hospital stay and postoperative duration before achieving 90° of knee flexion were also recorded.

Results

Exercise program improves knee motion in the presence of gonarthrosis. After TKA, the patients in the exercise group achieved 90° of knee flexion faster and had a shorter hospital stay. There is no prolonged effect on knee motion or patient function between 6 weeks and 1 year postoperatively.

Conclusion

Preoperative exercise of the arthritic knee facilitates immediate postoperative recovery following primary TKA.

Levels of evidence

Therapeutic study, Level I.     

Pitfalls of magnetic resonance imaging of alar ligament

An observational study of variations in the appearance of the alar ligament on magnetic resonance imaging (MRI) and the normal range of lateral flexion and rotation of the atlas was performed to validate some of the premises underlying the use of MRI for the detection of injuries to the alar ligament. Fifteen healthy volunteers were included. Three sets of coronal proton-density images, and axial T2-weighted images of the craniovertebral junction, were obtained at 0.5 T with the neck in neutral position and laterally flexed (coronal proton density) or rotated (axial T2). Five of the subjects also underwent imaging at 1.5 T. The scans were independently examined twice by two radiologists. The presence of alar ligaments was recorded and a three-point scale used to grade the extent of hyperintensity exhibited by the structures: the ligament were graded as 2 and 3 if, respectively, less or more of its cross-section was hyperintense, whereas grade 1 represented a hypointense ligament. The effect of lateral flexion on image quality was assessed. Concordance analysis of the data were performed before and after dichotomising the data on grading. The atlanto-axial angle and rotation of the atlas were measured. The magnitude of movement to right was normalised to that to the left to give, respectively, the flexion index and the rotation index. The alar ligaments were most reliably seen on coronal proton-density scans, with a Maxwells RE of 0.96 as compared with 0.46 for sagittal images. Flexion of the neck improved definition of the ligaments in only rare instances. Inter-observer disagreement was marked with respect to grading of the ligament on both coronal [composite proportion of agreement (p₀)=0.44; 95% confidence intervals: 0.26, 0.64)] and sagittal scans [p₀=0.40 (0.19, 0.63)]. Dichotomising the data did not appreciably improve reliability [Maxwells RE: –0.11 (coronal scans), –0.20 (sagittal scans)]: for ligaments which demonstrated hypertensive areas (grades 2 and 3) there was complete lack of agreement for both coronal [p₂=0 (0, 0.25)] and sagittal scans [p2=0 (0–0.30)]. A large response bias was found in the reports of both readers albeit in opposite directions. There was poor concordance between scans obtained at different field strengths [RE (coronal images)=0.25; RE (sagittal images)=0.14). Mean flexion index and mean rotation index were 1.00 (SD 0.03) and 1.01 (SD 0.06), respectively. The MR imaging may not be the investigation of choice for the investigation of subtle injuries to the alar ligament. Whether it can be substituted by kinematic assessment of the occipito-atlanto-axial complex with MRI warrants investigation.     

An evaluation of differences in hip external rotation strength and range of motion between female dancers and non-dancers

Objectives: To evaluate the differences in hip external rotation (ER) strength and inner, outer, and total hip ER range of motion (ROM) between dancers and non-dancers and between left and right sides in each group.

Methods: Seventy one subjects (34 dancers and 37 non-dancers) volunteered for this study. The strength (truncated range average torque (TRAT), work, and angle specific torque (AST)) of the hip external rotator muscle group, through the full available active hip ER ROM, was evaluated using concentric isokinetic (30°/s) testing on a KinCom dynamometer. Adjustment for lean body mass (LBM) was made for comparison of strength between groups. A two way repeated analysis of covariance was used to compare strength between groups. A two way repeated analysis of variance was used to compare strength between sides and ROM between groups and sides. Bonferroni correction was made for multiple analyses, and significance was accepted at p0.05.

Results: AST at 0°, 20°, 30°, and 40° of hip ER was greater in the dancers than the non-dancers (p0.022). TRAT, work, AST_0°, AST_20°, and AST_30° of hip ER were all greater on the right side than the left (p = 0.007) in both groups. Dancers had greater inner ER ROM (p = 0.013) and less outer ER ROM than non-dancers (p0.001). There was no difference in total ER ROM between groups (p = 0.133). The right side had greater inner ER (p0.001) and total ER ROM (p0.001) than the left in both groups.

Conclusions: Ballet dancers have greater inner range, angle specific strength and inner range ER ROM, demonstrated by a shift in the dancers' strength curves. This shift in the strength curve towards the inner range of hip ER may be an adaptive training response.

     

Physiological coxa varus–genu valgus influences internal knee and ankle joint moments in females during crossover cutting

This study evaluated the ankle and knee electromyographic, kinematic, and kinetic differences of 20 nonimpaired females with either neutral (group 1) or coxa varus–genu valgus (group 2) alignment during crossover cutting stance phase. Two-way mixed model ANOVA (group, session) assessed mean differences (p<0.05) and correlation analysis further delineated relationships. During impact absorption, group 2 displayed earlier peak horizontal braking (anterior-posterior) ground reaction force timing, decreased and earlier peak internal knee extension moments (eccentric function), and earlier peak internal ankle dorsiflexion moment timing (eccentric function). During the pivot phase, group 2 displayed later and eccentrically-biased peak ankle plantar flexion moments, increased peak internal knee flexion moments (eccentric function), and later peak knee internal rotation timing. Correlation analysis revealed that during impact absorption, subjects with coxa varus–genu valgus alignment (group 2) displayed a stronger relationship between knee internal rotation velocity and peak internal ankle dorsiflexion moment onset timing (r=–0.64 vs r =–0.26) and between peak horizontal braking ground reaction forces and peak internal ankle dorsiflexion moment onset timing (r=0.61 vs r=0.24). During the pivot phase these subjects displayed a stronger relationship between peak horizontal braking ground reaction forces and peak internal ankle plantar flexion moment onset timing (r=–0.63 vs r=–0.09) and between peak horizontal braking forces and peak internal ankle plantar flexion moments (r=–0.72 vs r=–0.26). Group differences suggest that subjects with coxa varus–genu valgus frontal-plane alignment have an increased dependence on both ankle dorsiflexor and plantar flexor muscle group function during crossover cutting. Greater dependence on ankle muscle group function during the performance of a task that requires considerable 3D dynamic knee joint control suggests a greater need for frontal and transverse plane weight bearing tasks that facilitate eccentric ankle muscle group function to optimize injury prevention conditioning and post-surgical rehabilitation programs.     

Three-dimensional in vivo motion analysis of normal knees employing transepicondylar axis as an evaluation parameter

Purpose

The transepicondylar axis (TEA) has been used as a flexion axis of the knee and a reference of the rotational alignment of the femoral component. However, no study has showed dynamic normal knee kinematics employing TEA as the evaluation parameter throughout the full range of motion in vivo. The purpose of this study was to analyze dynamic kinematics of the normal knee through the full range of motion via the 3-dimensional to 2-dimensional registration technique employing TEA as the evaluation parameter.

Methods

Dynamic motion of the right knee was analyzed in 20 healthy volunteers (10 female, 10 male; mean age 37.2 years). Knee motion was observed as subjects squatted from standing with knee fully extended to maximum flexion. The following parameters were determined: (1) Anteroposterior translations of the medial and lateral ends of the TEA; and (2) changes in the angle of the TEA on the tibial axial plane (rotation angle).

Results

The medial end of the TEA demonstrated anterior translation (3.6 ± 3.0 mm) from full extension to 30° flexion and demonstrated posterior translation (18.1 ± 3.7 mm) after 30°, while the lateral end of the TEA demonstrated consistent posterior translation (31.1 ± 7.3 mm) throughout knee flexion. All subjects exhibited femoral external rotation (16.9 ± 6.2°) relative to the tibia throughout knee flexion.

Conclusion

Compared to previously used parameters, the TEA showed bicondylar posterior translation from early flexion phase. These results provide control data for dynamic kinematic analyses of pathologic knees in the future and will be useful in the design of total knee prostheses.

     

Comparisons of cervical and thoracic spine kinematic joint and body segment angles,timing, and velocity between individuals with and without chronic idiopathic neck pain during functional tasks

BackgroundFew studies comprehensively analyse 3D neck kinematics in individuals with chronic idiopathic neck pain during functional tasks considered challenging. This critical knowledge is needed to assist clinicians to recognise and address how altered movement strategies might contribute to pain.Research questionAre there differences in 3D neck kinematics (angles, timing, velocity) during functional tasks in people with chronic neck pain compared to matched asymptomatic control participants?MethodsParticipants with chronic idiopathic neck pain (n = 33) and matched asymptomatic controls (n = 30) performed four functional tasks (overhead reach forward, right and left, and putting on a seatbelt) while evaluated using 3D motion capture. Kinematic variables included joint angles, range of motion (ROM,°), velocity (m s⁻¹) and timing (% of movement phase) for joint angles (head-neck [HN joint], head+neck-upper trunk [HNT], and thoracolumbar) and segments (head, neck, head+neck [HN segment], upper trunk, and trunk. Generalised linear mixed models examined between-group differences.ResultsThere were few between-group differences. The neck pain group had less HN segment extension that controls (mean difference [MD] left −2.06°; 95% CI −3.82, −0.29; p = .023; and right reach −2.52°; −4.67, −0.37; P = .022), and had less total sagittal HNT ROM across all tasks (−1.28; 95% CI −2.25, −0.31; p = .010). Approaching significance was the pain group having less thoracolumbar left rotation than controls (MD −2.14, 95% CI −4.41 to 0.13, p = .064). The pain group had higher neck segment peak flexion velocity than controls across all tasks (MD −3.09; 95% CI −5.21 to −0.10; P = .004). Timing of joint angle peaks did not differ between groups.SignificanceWhen performing an overhead reach task to the left and right and putting on a seatbelt, people with neck pain maintain a more flexed HN segment, use less sagittal ROM and have higher velocity peaks. These findings can assist clinicians in their assessment of patients by identifying possible underlying contributors to neck pain.     

Specificity of limited range of motion variable resistance training

The present study evaluated the effect of limited range of motion (ROM) variable resistance training on full ROM strength development. Twenty-eight men and 31 women were randomly assigned to one of the three training groups (A, B, AB) or a control group (C). A, B, and AB performed variable resistance bilateral knee extension exercise 2 (N = 25) or 3 (N = 19) d.wk-1 for 10 wk with an amount of weight that allowed one set of 7-10 repetitions. Group A trained in a ROM limited to 120 degrees to 60 degrees of knee flexion. Group B trained in a ROM limited to 60 degrees to 0 degrees of knee flexion. Group AB trained full ROM. Prior to and immediately following training, isometric knee extension strength was evaluated at 9 degrees, 20 degrees, 35 degrees, 50 degrees, 65 degrees, 80 degrees, 95 degrees, and 110 degrees of knee flexion with a Nautilus knee extension tensiometer. Reliability coefficients for repeated measurements of isometric strength at multiple joint angles were high (r = 0.86-0.95, P less than 0.01; SEE = 23.1-37.2 N.m). Compared to the control group, all training groups improved in isometric strength (P less than 0.01 at each angle tested except for group A at 9 degrees and 20 degrees of knee flexion and group B at 95 degrees of flexion. Isometric strength gains for group AB were similar throughout the full ROM. Isometric strength gains for the limited ROM trained groups were greater in the trained ROM than in the untrained ROM (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion

Purpose

The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction.

Methods

Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction.

Results

No correlation was found between FTA and flexion angle (r = ?0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03).

Conclusion

For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle.

Level of evidence

Case–control study, Level III.     

Computer analysis of PCL fibres during range of motion

An understanding of the orientation of posterior cruciate ligament (PCL) fibres can contribute to current knowledge of PCL biomechanics and potentially improve the effectiveness of PCL surgical reconstruction. In this paper, the orientation of PCL fibres with respect to the tibia and femur was analysed by means of a new computer method. The antero-lateral (AL) and postero-medial (PM) bundles of the PCL showed an increasing slope with respect to the tibial plateau during flexion and a statistically significant difference between them (AL: 37–65°, PM: 47–60°). PCL bundles showed similar orientation with respect to the femur and varied 14° average during flexion. The study also measured 84° twisting of PCL bundles during passive range of motion.     

Manipulation under anaesthesia versus low stretch device in poor range of motion after TKA

Purpose

The purpose of this study was to evaluate the effectiveness of two frequently used non-operative treatment techniques for a stiff knee after total knee arthroplasty.

Methods

Sixty-four patients with a stiff knee after total knee arthroplasty (TKA) were randomized into a manipulation under anaesthesia group, or a low load stretch (stretch) group. The patients were followed up for 6 weeks and were evaluated for maximum flexion and extension, range of motion (ROM), pain, stiffness and function.

Results

Both groups showed a significant increase in knee flexion in this study. Only the stretch group showed a significant increase in extension ROM. In both groups, a significant increase in Western Ontario and McMaster Universities was observed. No significant difference was observed between both groups for the flexion or extension ROM, or for any of the pain, function or stiffness scores during this study.

Conclusions

The results of this study showed that the stretch technique had equal or superior results concerning ROM and function compared to manipulation under anaesthesia. The stretch technique achieved this without requiring the patient to undergo in-hospital treatment or anaesthesia, limiting the costs and the risks for complications. The results of this study showed that stretching is a valuable tool for treating joint contractures of the knee. Therefore, the use of this stretching technique may be an excellent first choice of treatment modality in patients with slow progress of knee flexion or persistent knee stiffness following TKA, prior to manipulation under anaesthesia or lysis of adhesions.

Level of evidence

I.