جستجوی مقالات مرتبط با کلیدواژه "knee injuries" در نشریات گروه "پزشکی"

Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity reported in a few studies so far with controversial mechanism. They are reported to accompany anterior cruciate ligament or meniscal injuries with their main fracture planes usually oriented coronally.

The patients was a 52-year-old male with a hyperextension-valgus tibial plateau fracture. There was a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected in our patient. The avulsed fragment was oriented axially and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in a meniscal ramp lesion, but actually without any soft-tissue injuries. The fragment was fixated using tension band wiring technique with two Kirschner wires and one cancellous screw to approximate it to the tibia. Radiological and functional outcomes were excellent at 12-month follow-up

This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to get separated from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of posterior horn of medial meniscus and its underlying bony fragment; without soft-tissue injuries of a real medial meniscal ramp lesion.

In order to improve the efficacy of requesting knee radiography and reduce unnecessary radiation expo-sure, some clinical decision rules have been proposed for the assessment of knee injuries. Among them, the Ottawa KneeRule (OKR) was considered as one of the best guidelines with several validation studies. Therefore, in this meta-analysis,we aimed to investigate the accuracy of OKR for diagnosis of fracture in patients presenting with knee trauma.

A systematic search was conducted in PubMed, Web of Science, Scopus, Google Scholar, and EBSCO from inception toSeptember 2022. Quality assessment of the included studies was performed using QUADAS-2 tool. Diagnostic accuracyparameters were analyzed using random-effects model. Statistical analysis was performed using Meta-Disc and Statasoftwares.

The meta-analysis of the 18 included studies (6702 patients) showed that the pooled sensitivity andspecificity of OKR for diagnosis of fractures were 0.98 (95% CI: 0.96-0.99) and 0.43 (95% CI: 0.42-0.45), respectively. Thepooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 1.56 (95% CI: 1.39-1.75) and 0.12 (95%CI: 0.05-0.26), respectively. The area under curve (AUC) of the hierarchical summary receiver operating characteristic(HSROC) curve was 0.54.

This meta-analysis indicates that OKR has a high diagnostic performance fordiagnosis of fracture, with a pooled sensitivity of 98% and a pooled specificity of 43%. These results propose potentialeffects of OKR on reduction of unnecessary radiography, time spent in emergency departments, and direct and indirectcosts, which should be confirmed using high-quality studies in the future.

Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children.

In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature.

Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages

Simultaneous ipsilateral floating knee and hip is a very rare injury and so far, no standard guideline has been determined for its treatment.

In the current study, we report a surgical technique for the treatment of a 17-year-old patient with this condition on his left side.

We recommend to start the fixation from proximal and stabilize the pelvic ring at first, then fix the posterior part of the acetabulum and femoral shaft with the same posterior approach.

Impaired lower extremity kinematics has beenconsidered as a contributing factor to patellofemoral pain (PFP). However, current knowledge about the correlation between lower extremity kinematics and muscle strength is very limited. This study investigated the correlation between lower extremity kinematics and muscle strength, pain, physical activity level, as well as functional status in females with PFP.

Seventy-five females with PFP participated in this analytical crosssectional study. Lower extremity kinematics, maximal isometric strength of muscles, pain severity, physical activity level, as well as subjective and objective function were assessed using a motion analysis system, a dynamometer, Visual Analog Scale, the International Physical Activity questionnaire, and the Kujala questionnaire and the step-down test, respectively. The hip and knee kinematics were determined during the initial contact and the initial phase of landing. Pearson’s correlation coefficients were calculated to establish the correlation between the variables.

The knee rotation at the initial contact was significantly correlated with quadriceps strength (r=-0.240, P=0.038) and pain severity (r=0.268, P=0.020). Pain was significantly correlated with hamstring (r= -0.310, P=0.007) and quadriceps strength (r=-0.253, P=0.029) and the Kujala score (r=-0.346, P=0.002).

Our findings do not indicate a strong correlation between muscle strength and joint kinematics in females with PFP. An explanation is the presence of various subgroups of people with PFP. Future studies should focus on evaluating the correlation between the risk factors of PFP in subgroups, classified based on biomechanical, psychosocial, and anatomical characteristics.

Lower extremity injuries are frequently observed in car-to-pedestrian accidents and due to the bumper height of most cars, knee joint is one of the most damaged body parts in car-to-pedestrian collisions.

The aim of this paper is first to provide an accurate Finite Element model of the knee joint and second to investigate lower limb impact biomechanics in car-to-pedestrian accidents and to predict the effect of parameters such as collision speed and height due to the car speed and bumper height on knee joint injuries, especially in soft tissues such as ligaments, cartilages and menisci.

In this analytical study, a 3D finite element (FE) model of human body knee joint is developed based on human anatomy. The model consists of femur, tibia, menisci, articular cartilages and ligaments. Material properties of bones and soft tissues were assumed to be elastic, homogenous and isotropic.

FE model is used to perform injury reconstructions and predict the damages by using physical parameters such as Von-Mises stress and equivalent elastic strain of tissues.

The results of simulations first show that the most vulnerable part of the knee is MCL ligament and second the effect of speed and height of the impact on knee joint. In the critical member, MCL, the damage increased in higher speeds but as an exception, smaller damages took place in menisci due to the increased distance of two bones in the higher speed.

Alpine skiing has high rates of knee injuries. Prophylactic knee braces (PKBs) and functional knee braces (FKBs) are often prescribed by clinicians to reduce injuries or re-injuries in skiers.
This literature review evaluates current knowledge on the biomechanical and clinical effectiveness of prophylactic and functional knee braces in preventing knee injuries and their impact on the athletic performance of non-injured and injured individuals.
A literature review was performed to analyze the efficiency of knee braces concerning the reduction of mechanical stress, influence on muscle control, performance and injury prevention.
Most of the available literature describes research on the use of knee braces in contact sports, specifically American football. In this context, several studies show braces to be more effective in preventing medial collateral ligament injuries than anterior cruciate ligament injuries in both cadaveric and clinical studies. The use of functional braces after anterior cruciate ligament reconstruction has been supported and refuted in both postoperative and long-term studies. Ski-specific studies show a positive effect of knee braces on proprioception; no influence on performance; and a protective effect on previously injured skiers.
Current literature indicates PKBs may have a protective function in healthy patients, while influence on performance is minimal. Functional braces are recommended in ACL-deficient patients and are biomechanically effective under low-loading conditions. They may not be as effective in high-loading conditions, such as athletic activity. There is a protective effect of FKBs of preventing re-rupture of reconstructed ACLs and preventing further knee injuries on ACL-deficient knees in skiers. More research is needed to determine the effectiveness of PKBs snow sports.

Detailed injury epidemiology is an unmatched tool for reducing injury risks associated with any sport. Very little epidemiologic data exists regarding injuries sustained by kabaddi players..
To study knee injuries in kabaddi players..
Patients and This is a cross-sectional, observational study. Seventy six kabaddi players (both professionals and amateurs) presenting with sports-related knee injuries were identified from previous records; data was analysed for demographic features, injury mechanism, injury scenario, duration of injury before presentation, injury pattern, management, return to sport and time lost in sport due to the knee injury..
The mean duration prior to presentation was 14.4 months. Majority of the injuries (88.16%) occurred during competitive games. The most common injury noted was ACL tear (89.47%), followed by meniscus tears which were noted in 68.42% of the players. Forty four players (57.89%) retired from the sport as a consequence of the knee injury. Time lost in sport in those who returned to kabaddi was an average of 16.6 months; signifying the high morbidity due to knee injuries in kabaddi players. Return to sport was significantly more (P = 0.04) in those treated surgically than in those treated conservatively; but was not affected by mechanism of injury, injury scenario, injury pattern, duration of injury at presentation or level of competition of the athlete..
Epidemiologic studies in kabaddi are the need of the hour to assess the burden of this predominantly rural sport and to implement injury prevention programs. Our study emphasises the morbidity of knee injuries in kabaddi players of India and the exacting toll it takes on their careers..

During the past decade, magnetic resonance imaging (MRI) has been accepted as the ideal approach for primary diagnosis of traumatic knee intra-articular lesion. Despite this, the overall diagnostic accuracy of MRI has been carefully scrutinized in Iran. The purpose of this investigation was to scrutinize the diagnostic accuracy of MRI of the knee in identifying traumatic intra-articular knee lesions. We compared MRI findings with subsequent arthroscopic findings (as the gold standard) in 107 patients (107 knees) with a clinical diagnosis of traumatic intra-articular knee lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of MRI were calculated based on arthroscopic findings for menisci and cruciate ligaments. MRI showed the following results for medial meniscus: sensitivity 83%; specificity 37%; positive predictive value 46%; negative predictive value 77%; and accuracy 55%. For lateral meniscus it showed the following sensitivity 43%; specificity 86%; positive predictive value 40%; negative predictive value 87%; and accuracy 79%. MRI showed the following results for anterior cruciate ligament (ACL): sensitivity 62%; specificity 90%; positive predictive value 71%; negative predictive value 66%; and accuracy 75%. In addition, it showed the following results for posterior cruciate ligament (PCL): sensitivity 60%; specificity 94%; positive predictive value 42%; negative predictive value 98%; and accuracy 94%. The overall accuracy of MRI was 62.5%. We compared MRI accuracy in two time periods to investigate if there was any improvement over time. Our data showed a significant increase in the accuracy of detection of ACL injuries by MRI in more recent patients; however, there was no improvement in the diagnosis of other internal knee derangements. In addition, overall MRI accuracy was the same in patients from different age groups. We concluded that the overall accuracy of MRI in diagnosing intra-articular lesions of the knee in Iran is comparable with other published studies in the literature. However, it could be improved; if radiologists and orthopedists work together to find possible flaws, their cooperation would result in optimal use of this diagnostic modality.

The purpose of this study was to investigate the relationship between hip and knee strength with knee valgus angle during drop jump in elite female athletes. Forty female athletes (mean ± SD age, 21.5 ± 1.99 years; height, 169.08 ± 8.25 cm; body mass, 61.05 ± 10.06 kg) participated in this study. Isometric hip and knee muscles strength were evaluated using standard clinical procedures and a handheld dynamometer. Knee valgus angle was assessed using a 6-camera motion analysis system during a drop jump task. Pearson correlation analyses were performed to determine the relationship between hip and knee muscles strength and knee valgus angle at initial contact (P≤0.05). Hip abductor strength and knee flexor-extensor ratio were found to be negatively correlated with knee valgus angle (r = –0.229, P = 0.04 and r = –0.446, P = 0.002, respectively). No relationship between measure of hip external rotation strength and knee valgus angle was observed (P = 0.39). Strength training of the hip and knee musculature may still need to be addressed in prevention programs, but it also should be combined with teaching proper.

In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits.

Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot.

Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05).

Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects.

Magnetic resonance imaging (MRI) of the knee joint has often been regarded as a noninvasive alternative to diagnostic arthroscopy. In day-to-day clinical practice, the MRI scan is routinely used to support the diagnosis for meniscus or ligamentous injuries prior to recommending arthroscopic examination and surgery. On the other hand, rapidly progressing medical technology sometimes obscures the importance of history and physical examination. This study aims to evaluate the accuracy of physical examination and MRI scanning in the diagnosis of knee injury, including meniscus tears and cruciate ligament ruptures. In a cross-sectional, descriptive analytical study, 120 patients with knee injury who were candidates for arthroscopy were referred to Tabriz Shohada Hospital during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. Before ordering an MRI and arthroscopy, a thorough physical examination of the affected knee was performed and a preliminary diagnosis made. The results of arthroscopy were considered as the definitive diagnosis, therefore the results of the physical examination and MRI were judged accordingly. Of the 120 evaluated patients with knee injuries, there were 108 males and 12 females with a mean age of 29.13 ± 7.37 (16–54) years. For medial meniscus injuries, clinical examination had an accuracy of 85%, sensitivity of 94.8%, and specificity of 75.8%. Lateral meniscus injuries had the following accuracy (85%), sensitivity (70.8%) and specificity (88.5%). Clinical examination of anterior cruciate injuries had an accuracy of 95.8%, sensitivity of 98.6% and specificity of 91.7%. According to MRI results, for medial meniscus injuries there was an accuracy of 77.5%, sensitivity of 84.2%, and specificity of 71.4%. In lateral meniscus injuries, MRI had an accuracy of 85.8%, sensitivity of 56.5% and 92.8% specificity. MRI evaluation of anterior cruciate injuries was 92.5% for accuracy, 98.6% for sensitivity, and 83.3% for specificity. Both clinical examination and MRI were 100% for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than with complicated cases. The opposite results were seen for MRI findings in this regard. According to our results, both physical examination and MRI scans are very sensitive and accurate in the diagnosis of knee injuries, with a mild preference for physical examination. MRI should be reserved for doubtful cases or complicated injuries.

Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery.Patients and For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg tramadol intra-articularly. Pain was evaluated by means of the verbal pain rating score (VRS) preoperatively (at rest and on movement of the knee joint) and postoperatively at 0, 1, 2, 3, 4, 6, 12 and 24 hours. Meanwhile, the time of the first analgesic request and need for supplemental analgesic were also recorded. There was no statistically significant difference in VRS scoring between the two groups during the preoperative period either at rest or on knee movement. Meanwhile, VRS scores did not differ significantly between the morphine and tramadol treated groups postoperatively, except for in the one-hour post-operative scores in which the tramadol-treated group experienced less pain (P < 0.007). Post-operative VRS scores at 6, 12, and 24 hours were significantly decreased when compared with previous scores in both morphine and tramadol prescribed subjects (P < 0.001), hence, both local analgesics can significantly reduce pain after minor knee surgery. We have found a postoperative analgesic effect of intra-articularly administered morphine and tramadol following minor arthroscopic knee surgeries with a maximum effect 6 hours post injection.