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To determine the optimal stimulation and recording site for infrapatellar branch of saphenous nerve (IPBSN) conduction studies by a cadaveric study, and to confirm that obtained location is practically applicable to healthy adults.
Twelve lower limbs from six cadavers were studied. We defined the optimal stimulation site as the point IPBSN exits the sartorius muscle and the distance or ratio were measured on the X- and Y-axis based on the line connecting the medial and lateral poles of the patella. We defined the optimal recording site as the point where the terminal branch met the line connecting inferior pole of patella and tibial tuberosity, and measured the distance from the inferior pole. Also, nerve conduction studies were performed with obtained location in healthy adults.
In optimal stimulation site, the mean value of X-coordinate was 55.50±6.10 mm, and the ratio of the Y-coordinate to the thigh length was 25.53%±5.40%. The optimal recording site was located 15.92±1.83 mm below the inferior pole of patella. In our sensory nerve conduction studies through this location, mean peak latency was 4.11±0.30 ms and mean amplitude was 4.16±1.49 µV.
The optimal stimulation site was located 5.0–6.0 cm medial to medial pole of the patella and 25% of thigh length proximal to the X-axis. The optimal recording site was located 1.5–2.0 cm below inferior pole of patella. We have also confirmed that this location is clinically applicable.
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To evaluate and compare the effects and outcomes of extracorporeal shock wave therapy (ESWT) and intra-articular injections of hyaluronic acid (HA) in patients with knee osteoarthritis (OA).
Of the 78 patients recruited for the study, 61 patients met the inclusion criteria. The enrolled patients were randomly divided into two groups: the ESWT group and the HA group. The ESWT group underwent 3 sessions of 1,000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.05 mJ/mm2 energy. The HA group was administered intra-articular HA once a week for 3 weeks with a 1-week interval between each treatment. The results were measured with the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test (SCT). A baseline for each test was measured before treatment and then the effects of the treatments were measured by each test at 1 and 3 months after treatment.
In both groups, the scores of the VAS, WOMAC, Lequesne index, 40-m fast-paced walk test, and SCT were significantly improved in a time-dependent manner (p<0.01). There were no statistically significant differences measured at 1 and 3 months after treatment between the two groups (p>0.05).
The ESWT can be an alternative treatment to reduce pain and improve physical functions in patients with knee OA.
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To investigate the effects of early combined eccentric-concentric (ECC-CON) or concentric (CON) resistance training following total knee arthroplasty (TKA).
Patients who underwent a primary TKA were randomly assigned to an ECC-CON group (n=16) or a CON group (n=18). All patients received early, progressive resistance training with five sessions per week for 2 weeks starting 2 weeks after TKA. Isometric knee flexor and extensor strength of the surgical and non-surgical knees, instrumental gait analysis for spatiotemporal parameters, 6-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Timed Stair Climbing Test (SCT) were used to evaluate performance-based physical function. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQOL five dimensions (EQ-5D) questionnaire were used to evaluate self-reported physical function and self-reported quality of life. All patients underwent these evaluations before and 1 month after TKA.
The ECC-CON group showed clinically meaningful improvements in extensor peak torque (PT) of the non-surgical knee, gait speed, and 6MWT from preoperative values. The CON group had an increase in H/Q ratio of the surgical knee and improvement in SCT-ascent postoperatively. Both groups showed significant improvements in WOMAC-Pain, function, and EQ-5D scores. Although extensor PT of the surgical knee did not reach the preoperative level in either group, the postoperative change was significantly less in the ECC-CON group than the CON group.
Early combined ECC-CON resistance training minimizes the loss in quadriceps strength of the surgical knee and improves endurance and gait speed after TKA.
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To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).
A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).
The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.
It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.
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To investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) for knee osteoarthritis.
Seventy-five subjects were recruited, 60 of which met the inclusion criteria. The patients were randomly classified into two groups: group L, which was a low-energy group (n=30; 1,000 shocks/session; energy flux density [EFD], 0.040 mJ/mm2) and group M, which was a medium-energy group (n=30; 1,000 shocks/session; EFD, 0.093 mJ/mm2). For each group, 1,000 shock waves were delivered to the medial tibial plateau area, once a week, for 3 weeks. The main outcome measures were the visual analogue scale (VAS), the Roles and Maudsley (RM) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Lequesne index. Each assessment was performed at the baseline and at 1, 4, and 12 weeks after ESWT.
In both groups, the VAS, the RM and WOMAC scores, and the Lequesne index were significantly improved over time (p<0.001), and group M showed greater improvement over group L at the 1, 4 and 12 weeks assessments.
In this study, medium-energy group (group M) showed greater improvement in regard to relieving pain and restoring functional outcome than the low-energy group (group L). Therefore, EFD can be considered to have significant influence when treating with ESWT for knee osteoarthritis.
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To correctly measure the knee joint angle, this study utilized a Qualisys motion capture system and also used it as the reference to assess the validity of the study's Inertial Measurement Unit (IMU) system that consisted of four IMU sensors and the Knee Angle Recorder software. The validity was evaluated by the root mean square (RMS) of different angles and the intraclass correlation coefficient (ICC) values between the Qualisys system and the IMU system.
Four functional knee movement tests for ten healthy participants were investigated, which were the knee flexion test, the hip and knee flexion test, the forward step test and the leg abduction test, and the walking test.
The outcomes of the knee flexion test, the hip and knee flexion test, the forward step test, and the walking test showed that the RMS of different angles were less than 6°. The ICC values were in the range of 0.84 to 0.99. However, the leg abduction test showed a poor correlation in the measurement of the knee abduction-adduction movement.
The IMU system used in this study is a new good method to measure the knee flexion-extension movement.
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To determine the reliability and validity of hand-held dynamometer (HHD) depending on its fixation in measuring isometric knee extensor strength by comparing the results with an isokinetic dynamometer.
Twenty-seven healthy female volunteers participated in this study. The subjects were tested in seated and supine position using three measurement methods: isometric knee extension by isokinetic dynamometer, non-fixed HHD, and fixed HHD. During the measurement, the knee joints of subjects were fixed at a 35° angle from the extended position. The fixed HHD measurement was conducted with the HHD fixed to distal tibia with a Velcro strap; non-fixed HHD was performed with a hand-held method without Velcro fixation. All the measurements were repeated three times and among them, the maximum values of peak torque were used for the analysis.
The data from the fixed HHD method showed higher validity than the non-fixed method compared with the results of the isokinetic dynamometer. Pearson correlation coefficients (r) between fixed HHD and isokinetic dynamometer method were statistically significant (supine-right: r=0.806, p<0.05; seating-right: r=0.473, p<0.05; supine-left: r=0.524, p<0.05), whereas Pearson correlation coefficients between non-fixed dynamometer and isokinetic dynamometer methods were not statistically significant, except for the result of the supine position of the left leg (r=0.384, p<0.05). Both fixed and non-fixed HHD methods showed excellent inter-rater reliability. However, the fixed HHD method showed a higher reliability than the non-fixed HHD method by considering the intraclass correlation coefficient (fixed HHD, 0.952-0.984; non-fixed HHD, 0.940-0.963).
Fixation of HHD during measurement in the supine position increases the reliability and validity in measuring the quadriceps strength.
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To investigate the effect on pain reduction and strengthening of the whole body vibration (WBV) in chronic knee osteoarthritis (OA).
Patients were randomly divided into two groups: the study group (WBV with home based exercise) and control group (home based exercise only). They performed exercise and training for 8 weeks. Eleven patients in each group completed the study. Pain intensity was measured with the Numeric Rating Scale (NRS), functional scales were measured with Korean Western Ontario McMaster score (KWOMAC) and Lysholm Scoring Scale (LSS), quadriceps strength was measured with isokinetic torque and isometric torque and dynamic balance was measured with the Biodex Stability System. These measurements were performed before training, at 1 month after training and at 2 months after training.
NRS was significantly decreased in each group, and change of pain intensity was significantly larger in the study group than in the control group after treatment. Functional improvements in KWOMAC and LSS were found in both groups, but no significant differences between the groups after treatment. Dynamic balance, isokinetic strength of right quadriceps and isometric strengths of both quadriceps muscles improved in both groups, but no significant differences between the groups after treatment. Isokinetic strength of left quadriceps did not improve in both groups after treatment.
In chronic knee OA patients, WBV reduced pain intensity and increased strength of the right quadriceps and dynamic balance performance. In comparison with the home based exercise program, WBV was superior only in pain reduction and similarly effective in strengthening of the quadriceps muscle and balance improvement.
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To assess factors related to standing balance in patients with knee osteoarthritis (OA).
In total, 37 female patients with painful knee OA were included. Pain, knee alignment, and Kellgren and Lawrence grade were evaluated accordingly. Static standing balance was measured with a force-platform system under two different conditions: static standing with eyes open (EO) and eyes closed (EC) for 30 seconds. The mean speed (mm/s) of movement of the center of pressure in the anteroposterior (AP) and mediolateral directions and the mean velocity moment (mm2/s) were analyzed for assessment of static balance.
In the univariate regression analysis, age and knee alignment showed statistically significant relationships with the mean speed in the AP directions with EO. In the multiple linear regression model, age and knee alignment were positively associated and disease severity was negatively associated with mean speed in the AP directions with EO. However, the variables for EC static measurements were not significantly correlated with age, pain, knee alignment, or radiographic severity (p>0.05).
These findings show that the worse balance was associated with advanced age, less varus knee malalignment, and mild radiographic changes. Pain was not associated with standing balance.
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To identify the subtle change of postural control in elderly patients with unilateral knee osteoarthritis (OA) with computerized dynamic posturography.
Twenty-two healthy women and twenty-six women with unilateral knee OA, aged 60 and over, were enrolled. The computerized posturographic measures included a weight bearing pattern during squatting and sit-to-stand, sway velocity of center of gravity (COG) during one leg standing, on-axis velocity and directional control of COG during rhythmic weight shift, rising index during sit-to-stand, end sway during tandem walk, and movement time during step up/over.
It was shown that patients bore significantly less weight on the affected side during the 30° and 60° squat and sit-to-stand. Sway velocity of COG during one leg standing was greater whereas the on-axis velocity and directional control during the front/back rhythmic weight shift were significantly lower in the patient group. The rising index during sit-to-stand was significantly lower and movement time during step up/over with the affected side was significantly longer in patients.
This study demonstrated in detail a decline of postural balance by utilizing computerized posturography in elderly women with unilateral knee OA. They had less weight-bearing, more sway, and less ability of intentional postural control on the affected side.
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To investigate whether the cartilage regenerative effects of intra-aricular platelet-rich plasma (PRP) are different, according to the severity of osteoarthritis (OA), in a collagenase-induced knee OA rabbit model.
New Zealand white rabbits (N=21) were randomly divided into three groups. Three different doses (0.25 mg, group 1; 0.5 mg, group 2; and 1.0 mg, group 3) of collagenase were injected twice into both knees of each group under an ultrasound guidance. The mean platelet concentration of the PRP fraction was 2,664±970×103/µl and was enriched 8.2-times, compared with the whole blood. PRP (0.3 ml) was injected into the left knee and saline (0.3 ml) into the right knee at 4 weeks, and macroscopic and histological scores of both injected knees were evaluated at 9 weeks after the first collagenase injection.
Macroscopic and histological scores of group 3 were significantly higher than those of group 1 and 2 (p<0.05). Macroscopic and histological scores of the PRP-injected knees were significantly lower than those of the saline-injected knees, in all groups (p<0.05). Differences of gross morphologic and histologic scores between saline- and PRP-injected knees in group 3 were significantly higher than those in group 1 and 2 (p<0.05).
Intra-articular PRP injection influences cartilage regeneration in all severities of rabbit knee OA, and the cartilage regenerative power of PRP injection in moderate knee OA was greater than that in mild or very mild OA. A large preclinical trial is needed to establish the validity of our study.
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To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax®).
A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax®, which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax®.
Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups.
These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.
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Method One hundred and twenty six knees of 63 patients were studied. The degree of protrusion for each knee of patients was measured during standing by US. Radiographs were examined in order to determine whether the participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence (K-L) grade. Clinical assessment was performed by recording a visual analogue scale (VAS). Correlation was obtained between the difference of VAS and MMP in the same patient. Assessment of pain, stiffness, and disability were performed by comparison of K-WOMAC index and MMP in a patient.
Results Mean protrusion (mean±S.D.) for knees with each K-L I, II, III, and IV grade were 0.27±0.52 cm, 0.38±0.60 cm, 0.55±0.76 cm, and 0.75±0.08 cm, respectively. The difference was significant (p＜0.05). Significant correlation was observed between MMP and VAS in K-L grades II (p=0.002, r=0.500) and III (p=0.002, r=0.684), also between ԤMMP and ԤVAS (p=0.000, r=0.558). With the K-WOMAC index, MMP were correlated with pain and stiffness (p＜0.01), but not with disability score.
Conclusion The degree of MMP measured by US is associated with K-L grade in knee OA patients. The degree of MMP can be a reliable indicator, like K-L grade, for radiological severity of knee OA. MMP has been correlated with VAS and with subscore of pain and stiffness, but not disability in the K-WOMAC index.
Method: Three dimensional gait analysis was performed in 19 unilateral below-knee amputees and 20 controls. Measured gait parameters were temporal parameters and kinematic and kinetic parameters at hip, knee and ankle joints. Gait parameters obtained from amputated limbs were compared with those of sound limbs and control group.
Results: There were no significant differences in temporal parameters among 3 limbs. In amputated limbs, degree of knee flexion and knee extension moment in stance phase were less than sound limbs and control group. In addition, timing of peak knee extension moment occurred later. Also, timing of ankle plantar flexion in loading response and preswing phase occured later, and degree of ankle plantar flexion in preswing phase were less in amputated limbs compared to other limbs. Peak plantar flexion moment in amputated limbs were less than sound limbs, but not than control group.
Conclusion: This study suggested that most significant gait abnormalities in unilateral below-knee amputees were observed at the knee and ankle joint in amputated limbs. (J Korean Acad Rehab Med 2003; 27: 958-963)
Method: Each of the two methods of cryotherapy, cold-jet stream (CS) and cold-jet stream combined with infrared therapy (CSCI), was applied to the medial aspect of 32 volunteers' knees. The first phase was the required time that skin was dropped to 10oC with CS/CSCI. The second phase was the time for rewarming to 20oC without CS/CSCI. The third phase was the required time that skin dropped to 10oC again with CS/CSCI. The fourth phase was the time for re-warming to 20oC again without CS/CSCI.
Results: The required time which cold pain appeared after CS/CSCI were 51.3 sec and 62.3 sec, respectively, with significance (p＜0.01). In CS and CSCI, first phase was 71.6 sec and 90.7 sec, respectively, and third phase was 33.2 sec and 39.9 sec, respectively (p＜0.01). At second and fourth phases, it took 46.9 sec and 56.6 sec in CS (p＜0.01), and took 46.9 sec and 54.6 sec in CSCI (p＜0.01).
Conclusion: As compared with CS, CSCI delayed sensation time of cold pain and prolonged application time of CS at the knee. (J Korean Acad Rehab Med 2003; 27: 106-109)
Objectives: To evaluate changes of the gait pattern and the clinical improvement in patients with degenerative arthritis of the knee after total knee arthroplasty (TKA).
Method: Gait analysis was performed in 64 patients with degenerative arthritis of the knee at pre- and post-surgery 1 year, also Hospital for Special Surgery (HSS) knee score and Visual analogue scale (VAS) for clinical assessment were investigated.
Results: 1) In the HSS knee score and VAS, there were statistically significant improvement after surgery (p＜0.05). 2) In the postoperative gait analysis, all the linear parameters except single limb support period were significantly improved (p＜0.05). Single limb support period was improved, but statistically insignificant. All the kinematic and kinetic parameters also were significantly improved (p＜0.05).
Conclusion: This study suggests that gait analysis can be used for quantitative evaluation of the effects of total knee arthroplasty in patients with degenerative arthritis of the knee. (J Korean Acad Rehab Med 2002; 26: 581-586)
Objective: To evaluate the effects of dextrose prolotherapy on knee osteoarthritis.
Method: The patient population consisted of 20 individuals with knee osteoarthritis. Patients have suffered from knee pain for six months or more along with Kellgren's grade 2 or more radiographical change in knee compartment. They were injected monthly with 15% and 25% dextrose on knee joints for 4 months. The outcome was measured by visual analogue scale (VAS) for pain, pain rating score, and WOMAC osteoarthritis index at a month after 4th injection.
Results: Seventeen of the 20 patients achieved significant diminution of pain or disability scores after dextrose prolotherapy compared with pre-treatment status. There were significant reductions in VAS score, pain rating score, and WOMAC osteoarthritis index after dextrose injection (p＜0.05). Three patients dropped out over follow up period due to lack of efficacy.
Conclusion: Prolotherapy injection with dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. (J Korean Acad Rehab Med 2002; 26: 445-448)
Objective: To evaluate the effects of a new periarticular injection in the patients with knee osteoarthritis.
Method: Twenty seven patients, who had knee pain, were met criteria of knee osteoarthritis of American Rheumatology Association. Two injection sites were used: one to infrapatellar fat pad and the other to near the insertion area of popliteus. At first, 1 cc of 0.5% lidocaine was injected to both sites. If pain was not releaved above 50%, a mixture of 1 cc of 0.5% lidocaine and 10 mg of triamcinolone acetonide was injected to twenty seven patients, 46 knees. All patients were evaluated visual analogue scale (VAS), time for 10 meter walking, time for stair up and down, isometric knee strength before and after
treatment. Paired student t test was done to investigate statistical significance of change of pain and function.
Results: Before treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 6.1⁑2.1, 10.4⁑3.6, 10.8⁑7.1 and 34.0⁑11.4 respectively. After last treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 3.5⁑2.5, 8.3⁑1.7, 8.2⁑3.6 and 38.8⁑12.9 respectively. The difference was stastistically significant between before and after treatment (p＜0.05).
Conclusion: The new periarticular injection is useful in treatment of patients with knee osteoarthritis. (J Korean Acad Rehab Med 2002; 26: 198-202)
Objective: The purpose of this study is to identify how the isotonic and isometric mixed excercise training for 12 weeks take influence on the muscular strength, muscle size and foot pressure (by EMEDⰒ) in patients with degenerative knee joint disease.
Method: Seven patients with degenerative knee joint disease were chosen for the experimental objects and were trained isotonic exercise program for twelve weeks. Before and after exercise, CybexⰒ, Computed Tomography and EMEDⰒ were examined.
Results: After exercise program, peak torque, peak torque %Bwt and average power were significantly increased at 60o/sec and 180o/sec in both knee flexors and extensors. But peak torque ratio flexor/extensor were not significantly increased. Cross-sectional area of quadriceps and hamstrings were significantly increased. But there were no significant difference in the peak pressure at the heel and time (from initiation of initial contact to peak pressure at the heel).
Conclusion: We knew that isotonic and isometric mixed exercise training to the patients with degenerative knee joint disease for 12 weeks improved the muscular strength and muscle size, but this is not influenced on heel pressure. So, there may be needed to study with kinetic and kinematic analysis to more experimental patients.
Objective: To analyze the patterns of isokinetic knee torque curves in normal population and determine the characteristics of those curves.
Method: Two hundred and eightly-six normal subjects were included. The isokinetic knee torque curves were divided into three parts; to the angle of peak torque generation, to the point 10∼20 degrees prior to end of joint motion, and to the end of joint motion. Each part was classified as convex(1), flat(2) and concave(3) type according to the shape. The curves were named such as 1-2-2 in order. Types of the curves, peak torque, angle of knee at peak torque, total acceleration energy, age, and sex of the subjects were compared.
Results: For knee extensors, frequencies of the curve types were 1-2-2(A), 1-2-1(B), 1-3-1(C), and 1-3-2(D). Mean ages of type A and B curves were slightly higher than types of C and D. Mean peak torque was greatest in type D. For knee flexors, the frequencies were 1-2-2(A), 1-2-1(B), and 1-1-2(C). Female predominance were found in type B while type C was found mostly in male. Mean peak torque was greatest in type C.
Conclusion: The most common torque curve type was 1-2-2 for knee extensors and flexors. Torque curve types of knee extensors showed differences in age and torque curve types of knee flexors showed differences in sexual distribution.
Objective: To investigate the cross-sectional association of the obesity with the knee osteoarthritis (OA) in a rural population.
Method: We studied the cross-sectional asssociation between the obesity and the knee OA by analysis of data (Juam-Study based data) from an epidemiologic survey of a population of 1,100 adults who resided around the Juam lake in Chonnam. The recruited sampling were 475 adults above 40 years old. We diagnosed knee OA by typical clinical features such as bony swelling, crepitus and pain on movement and divided the subjects into non-OA group (143 males：148 females) and OA group (60 males：124 females). There is no difference in the mean ages of two groups. The body mass index (BMI) was calculated from a weight and height (kg/m2) and body fat percent (BFP) was measured by bioelectric impedance fatness analyzer (BIA). We defined obesity as a BMI over 30 kg/m2 in both sex or a BFP over 25% in male and over 30% in female. The BMI and BFP were 23.2⁑3.2 kg/m2, 24.0⁑7.5% in non-OA group and 23.5⁑3.4 kg/m2, 26.0⁑7.0% in OA group and were compared in two groups.
Results: 1) Prevalence odds ratio (POR) for risk factors of knee OA was high in seventh decade, female, a high cholesterol group, and a high BFP group, and was not high in BMI group. 2) There was no association between BMI and knee OA. 3) There was no association between BFP and knee OA.
Conclusion: We were not able to prove the cross-sectional association between obesity and knee OA. The results suggested that knee OA was a heterogeneous disorder and more possibly influenced by multiple other factors, such as age, sex, and various metabolic abnormalities than obesity itself.
Objective: The purpose of this study is to evaluate the effects of the cold air application on the subjective pain threshold of knee joint pain.
Method: We recorded the changes of the pain threshold in 60 patients before and after cold air application who complaint of knee joint pain. Patients were divided into 3 groups randomly with each 20 patients and each group received cold air application for 30 seconds, 1 minute, 3 minutes. Cold air of CRAis (Kyung-won Century, Korea) was applied to the anterior portion of the knee with a temperature of 30oC. The changes of the pain threshold was estimated by visual analogue scale.
Results: In 30 seconds treating group, VAS score was lowered 2.25±1.16 and 2.26±1.13 immediately after, and 30 minutes after cold air application, respectively (P＜0.05). In 1 minutes treating group, VAS score was lowered 1.65±2.58 and 2.41±2.59 immediately after and 30 minutes after cold air application, respectively (P＜0.05). In 3 minutes treating group, VAS score was lowered 1.94±1.80 and 2.10±2.3 immediately after and 30 minutes after cold air application, respectively (P＜0.05). The VAS score was lowered significantly after cold air application in all groups, but there's no significant correlation between change of VAS score and cold air application time. In group with initial VAS score greater than 5, the VAS score was more decreased after cold air application.
Conclusion: Cold air application for 30 seconds using CRAis machine is useful treatment method for knee joint pain.
Objective: To assess the jumper's knee for the symptoms and diagnostics by MRI and ultrasonography in basket ball players.
Method: Twenty knees of 10 basketball players with chronic knee pain were assessed by the history taking, physical examination and diagnosis by magnetic resonance imaging and ultrasonography. Their average age was 17.4 years. Stanish classification is used for grading the symptoms of jumper's knee.
Results: Nine proximal patellar tendons were diagnosed as jumper's knees (45%) and 11 distal tendons were diagnosed as jumper's knees (55%). In ultrasonographic findings, average proximal patellar tendon thickness was 4.5 mm⁑1.2 mm, and distal patella tendon thickness was 7.1⁑1.1 mm. Sensitivity was 63% (12/19) and specificity was rated as 100% (21/21). By the MRI findings, sensitivity was rated as 32% (6/19) and specificity was rated as 90% (16/21). Study between the patient's clinical severity level by Stanish classification and thickness of patellar tendon showed no significant correlation (＜0.5).
Conclusion: The ultrasonography to be more convenient and easier as a diagnostic method for the jumper's knee than MRI.
Objective: To develop and evaluate a new orthotic device for the knee to improve the ambulation patterns in paraplegic patients.
Method: The new orthotic device combined a high torque servo motor with a bail-lock knee joint, and a its wireless controller adopting open-loop control system. The device was tried in a paraplegic volunteer for two months, simultaneously with the conventional long leg brace.
Results: The new device could keep the orthotic knee joint exended during the stance phase, and allow the sequential flexion and extension of the joint during the swing phase. The new orthotic device provided both longer step length(p＜0.05) and fewer cadence(p＜0.05) maintaining the same walking speed. Also, a circumduction during the swing phase reduced, and the posture of the trunk became straighter. The stride time and the double support period became longer(p＜0.05), and the magnitude of the shift of pelvic center increased(p＜0.05).
Conclusion: The new orthotic device for the knee was developed and evaluated in a paraplegic volunteers who had failed to use the functional electrical stimulation. The results were satisfactory with a probable lower energy efficiency with the new orthosis. Further study for verification of the results seems to be necessary.
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