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Fulltext Single-Bundle Versus Double-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction: Comparison of Long-Term Functional Outcomes

Anandan V, Goh TC, Zamri KS

Cureus, 2020 Dec 23;12(12):e12243.
PMID: 33500862 DOI: 10.7759/cureus.12243

Objective To compare long-term functional results of ACL reconstruction with a single bundle (SB) and double bundle (DB). Methods Sixty patients who underwent ACL reconstructions from January 2007 to December 2008 were retrospectively evaluated (30 SB and 30 DB ACL reconstructions). Clinical and functional outcomes were measured pre- and postoperatively in terms of anterior drawer test, Lachman's test, pivot shift test, KT1000 side-to-side difference, range of motion, International Knee Documentation Committee Scoring, Lysholm knee scoring scale (LKS), and Tegner activity level scale. The period of follow-up was 10 years. Results Clinical outcome measured showed that anterior drawer test result were equally normal for both groups (93.3%; p > 0.995); however, the Lachman test was 76.7% in the DB group and 56.7% in the SB group (p > 0.100), the pivot shift was 83% in the DB group and 50% in the SB group (p < 0.001), and KT1000 was 76.7% in the DB group and 56.7% in the SB group (p > 0.100). Regarding the functional outcome, it favored the DB group of patients, with the LKS being statistically significant (p < 0.007) and the Tegner activity level scale p-value being <0.001 Conclusions DB ACL reconstruction produces better rotational stability and gives superior functional outcome in terms of return to pre-injury activity level in comparison to SB reconstruction. DB ACL reconstruction using hamstring tendon autograft produces better functional results at 10 years follow-up.

Matched MeSH terms: Knee Joint
Fulltext Finite element modelling and simulation for lower limb of human bone: a review

Muhammad Hanif Ramlee

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):262-271.
MyJurnal

Most orthopaedic cases that involved with bone fracture are normally treated with medical implants. To be noticed that some precautions in terms of biomechanical and biomaterial properties are necessary for a successful post-sur- gery process. The biomechanical evaluation of implants could be carried out using computing and engineering technologies. However, in the computer simulation, some assumptions are needed as the limitations on computer resources and data input. This review focuses on the current method of developing the finite element model for patients with specific values of material properties for lower limb part such as hip, knee and ankle joint. Previous literature was reviewed from which keywords and search engines were identified. In this review, inclusion and exclusion criteria were used to limit the literature search. We reviewed the state-of-the-art in this area and provide recommendations for future research. In conclusion, the previous published reports illustrated different methods to develop numerical models.

Matched MeSH terms: Knee Joint
Fulltext Fixation of Comminuted Patellar Fracture with Combined Cerclage and Tension Band Wiring Technique

Ong, T.K., Chee, E.K., Wong, C.L., Thevarajan, K.

Malays Orthop J, 2008;2(2):40-42.
MyJurnal

In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %). Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.

Matched MeSH terms: Knee Joint
Fulltext Treament of tibial plateau Schatzker type VI fractures with the Ilizarov technique using ring external fixators across the knee: a retrospective review

Ranatunga, I.R., Thirumal, M.

Malays Orthop J, 2010;4(2):34-39.
MyJurnal

This is a retrospective review of 18 patients with tibial plateau fractures Schatzker type VI. These cases were performed in our medical centre from January 2003 to December 2004. The Ilizarov technique (Russian technique) using the ring external fixator was the technique performed. Articular reconstruction and joint alignment were achieved with traction and olive wires with washers. One case required percutaneous elevation of the articular surface and bone grafting through a cortical window. Average clinical union was achieved within 4 months of trauma. Mean final knee flexion was 85Â°, which is compatible with walking. All patients successfully returned to their previous occupations. In conclusion, the Ilizarov technique has been shown to be a good option and a viable tool in the management of these complex and unstable injuries.

Matched MeSH terms: Knee Joint
"Doc' do I need an anterior cruciate ligament reconstruction? What happens if I do not reconstruct the cruciate ligament?"

Dhillon KS

Malays Orthop J, 2015 Mar;9(1):47-52.
PMID: 28435599 DOI: 10.5704/MOJ.1503.008

We are all aware that there has been a dramatic increase in the number of anterior cruciate ligament (ACL) reconstructions that are carried out here in Malaysia as well as around the world. The numbers of ACL injuries have undoubtedly increased over the years with greater participation of young adults in sporting activities. However it is not certain whether the increase in the numbers of reconstructions can be accounted for by the increasing numbers of ACL injuries. Without doubt commercial interests as well the influence of the biomedical companies have a role to play. In the past the rational for surgical treatment of an ACL tear was that the ACL is vital for knee function and that in the long term ACL deficiency will lead to more injuries of the meniscus and more degeneration of the joint. This belief was prevalent because the natural history of an ACL deficient knee was not known although the ultimate outcome of reconstruction of the ACL was not known either. However in past few years a substantial amount research has been published, which has elucidated the natural history of ACL deficient knees as well as the long term outcome of reconstruction of the ACL.

Matched MeSH terms: Knee Joint
Fulltext Measuring peak angular velocity of Knee Extension during unloaded kicking: a pilot study

Vanrenterghem, Jos, Zulezwan A. Malik, G. Burniston, Jatin

Jurnal Sains Sukan & Pendidikan Jasmani, 2016;5(2):9-14.
MyJurnal

Journal of Sports Science and Physical Education 5(2): 9-14, 2016 - Jump squat tests can be
used to investigate the differences in the force - velocity (f-v) profile in movement that is
more a sport-specific than isolated exercises such as open chain leg extension. However,
squat jumps involve multi-joint movement, making it questionable which muscle is the main
contributor for the movement. The main aim of this study is to develop a test of isolated knee
extension that encompasses the entire range of human f-v relationship and to investigate the
correlation between linear encoder and kinematic measurement of angular velocity using a
camera system during unloaded kicking. One healthy male subject volunteered to participate
in the study and performed 10 unloaded kicks (knee extension). A cuff was strapped around
the lower leg, approximately 2 cm above the medial malleoli and connected to a linear
velocity encoder (MuscleLab Ergotest version 4010, Norway). During the test sessions, threedimensional
motion analysis was performed with an Oqus Motion Capture System (Qualisys,
Sweden). Data were transferred to Windows-based data acquisition software (Qualisys Track
Manager). There was a positive linear relationship (r = 0.94). The unloaded kicking test to
determine maximum angular velocity at knee extension measured using the QTM showed
that the mean angular velocity was 362˚.s-1, with the highest value being 528˚.s-1. This
preliminary study suggests isokinetic dynamometry (IKD) can be used to investigate the
entire range of velocities (i.e isometric – velocity maximum) of knee extension in normal
human subjects. Further studies can examine the use of IKD in measuring higher velocities.

Matched MeSH terms: Knee Joint
Fulltext The Use of PROSTALAC in Two-stage Reimplantation of Septic Total Knee and Hip Arthroplasty

Wam, B.L., Chee, E.K., Ewe, T.W.

Malays Orthop J, 2010;4(3):11-15.
MyJurnal

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

Matched MeSH terms: Knee Joint
Fulltext Early Functional Outcome of Total Knee Arthroplasty

Suhail, A., Idham, H., Norhamdan, M.Y., Shahril, Y., Masbah, O.

Malays Orthop J, 2009;3(2):33-35.
MyJurnal

Objective: To evaluate the early results of patients in a single institution who underwent total knee arthroplasty using an implant system. Methods: We retrospectively reviewed 76 total knee replacements using the Genesis II prosthesis (Smith and Nephew, Memphis) in 60 patients (16 were bilateral cases) performed between February 2005 andFebruary 2008. Patient related outcomes and clinical evaluations were done by an independent observer. Knee function and patient satisfaction were evaluated using the American Knee Society (ASK) score and the Western Ontario and Mac Master University Osteoarthritis Index (WOMAC). Results: The mean age of the patients at the time of operation was 63.5years. The mean follow up period was 1 year 5 months. At the final follow up, the mean Knee Society Knee Score was 87.9 with 77.3% (58 knees) rated excellent, 21.3% (16 knees) rated good and1.3% (1 knee) rated fair; none were rated poor. The mean Function Score was 87.1 with 64% (48 knees) rated excellent, 29.3% (22 knees) rated good, 6.7% (5 knees) rated fair, no knee was rated poor. The mean WOMAC Score was 94.4 (standard deviation 6.59). Conclusion: Most patients treated for knee osteoarthritis with total knee replacement showed high rates of excellence and good early functional outcomes.

Matched MeSH terms: Knee Joint
Fulltext Intra-articular sodium hyaluronate for the treatment of osteoarthritis of the knee. A retrospective review of 45 patients.

Yoga R, Mukaram M, Ramachandran

Malays Orthop J, 2009;3(2):4-7.
MyJurnal

Intrarticular Hyaluronic Acid was administered to 45 patients with various grades of osteoarthritis in the knee. Following 3 fortnightly injections, these patients were reviewed at 6 weeks and 3 months with regard to their knee pain. We found the most patients (84.4%) has decreased knee pain following these injections. Patients who had severe grade osteoarthritis based on knee radiographs before the injections were less likely to have pain reduction compared to those with milder grade osteoarthritis. Only 4 (8.9%) patients showed no improvement and were subsequently considered for surgery. Many patients did not require any further treatment (24.4%) and the remaining were given analgesia (64.4%) to aid in their pain. One patient required another course of this injection. there were no complications recorded in this study. We concluded that Intrarticular Hyaluronic acid is an easy and safe method to treat osteoarthritis. The short-term outcome with regard to knee pain is good in patients with milder grades of osteoarthritis.
Study site: Private orthopaedic clinic, Johor, Malaysia

Matched MeSH terms: Knee Joint
Fulltext Efficacy of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis

Narayanan SS, Suhail A, Harjeet S, Shahril Y, Masbah O

Malays Orthop J, 2009;3(1):19-23.
MyJurnal

This study was conducted to evaluate the efficacy of intra-articular injection of hyaluronic acid for the treatment of knee osteoarthritis. Patients with knee osteoarthritis were followed for a period of six months to assess the efficacy of intra-articular injection of hyaluronic acid given three times in three consecutive weeks. Fifty patients were reviewed at two, eight and 24 weeks post-injection. The average age was 60.9 years and female to male ratio was 3:1. Patients were assessed using the Lequesne Algofunctional Index for function, and the visual analogue score for pain and side effects. We found that the knee pain reduced and the function improved in most patients and these beneficial effects maintained for till the last follow up. The only side effect noted was one case of acute non-septic joint effusion after the 3rd injection. We concluded that intra-articular injection of hyaluronic acid can produce pain relief and functional improvement for up to 6 months.

Matched MeSH terms: Knee Joint
Fulltext The study on range of motion of hip and knee in prayer by adult muslim males.a preliminary report

Ariff, M.S., Arshad, A.A.

International Medical Journal Malaysia, 2015;14(1):49-58.
MyJurnal

Introduction: Praying represents a fundamental activity of daily living in Muslim community. Muslims need to adopt several postures that require deep flexion of the knee and hip to perform this daily obligation. This is a preliminary report of the study on hip and knee range of motion conducted to obtain normative passive and functional range of flexion data during Muslim prayers in both weight-bearing joints of normal Muslim adults. Methods: A cohort of Malay men aged between 20 to 30 years was recruited in this cross-sectional study. Passive range of motion and flexion angles of the joints in various postures during prayer were measured using a standard goniometer. The difference against existing normative range of motion database available and the influence of various factors were analysed. Factors analysed include body mass index and other anthropometric measurements. Results: Sixty participants recruited for the preliminary phase of this study. The mean (SD) of passive hip and knee flexions were higher compared to other existing normative range of motion database. A unit increase in body mass index will have 0.782 units lower of knee range of motion. The hip and knee flexion arc were from 74.1° to 119.0° and from 3.3° to 119.7° respectively. Conclusion: The range of motion involved for prayers was more for the knee but less for the hip as compared to the measured passive range of motion. Body mass index has a significant linear negative relationship with the passive range of motion of the knee, but not the hip.

Matched MeSH terms: Knee Joint
Fulltext Normal anterior cruciate ligament laxity in the Malaysian population

Kamarul T, Razif A, Elina R, Azura M, Chan KY

Malays Orthop J, 2007;1(2):11-16.
MyJurnal

A study to determine average knee laxity in the Malaysian population and how it affects daily living was conducted at the University Malaya Medical Centre between January and April 2004. Fifty two male and 76 female subjects were recruited for this study, all of whom were healthy volunteers with no ambulatory problems. Side to side knee laxity testing was performed using a KT-1000 arthrometer. Significant differences in knee laxity were noted among different races and between sexes. For instance, overall, Chinese and female study participants had higher knee laxity: (left knee, 2.17 mm (SD=1.30) and right knee was 2.88 mm (SD= 1.51)). On average, the difference between knees was 0.70 ± 1.26 mm (less than 1 mm) which is a smaller variation than reported in previous studies which suggested 3 mm. Despite finding knee laxity ranging from 0 to 8mm, no correlations were found between Lysholm, IKDC and Tegner knee outcome scores and the degree of knee laxity. No other predictors such as height, weight and age correlated with levels of knee laxity. We therefore conclude that knee laxity is a common occurrence in the normal population and is therefore not suitable as a sole predictor of knee function and should not be used as the only criteria for surgical intervention.
Study site: Orthopedic clinic, Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Knee Joint
Fulltext Functional Results after Anterior Cruciate LigamentReconstruction using the bone-patella Tendon-bone Method

Zaidi, M., Azuhairy, Chan, C.K.,

Malays Orthop J, 2008;2(1):8-11.
MyJurnal

This study evaluates the outcome of anterior cruciate ligament (ACL) reconstruction with arthroscopy using the boneâ€“patella tendon-bone method. We performed this procedure in 24 patients with the average age of 33.1 years (range: 17-51 years ) between 2004 and 2006. Sixteen of the 24 patients were available for evaluation using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) system. Based on the Lysholm score, there was a statistically significant improvement in knee function when comparing pre- and post-surgical scores (p

Matched MeSH terms: Knee Joint
Fulltext Muscle bulk, strength and proprioceptive difference between anterior cruciate ligament deficient and normal knee

Mokhtar A.H., Kalimuthu, M.

JUMMEC, 2017;20(1):1-5.
MyJurnal

The anterior cruciate ligament (ACL) deficient knee has been subjected to various research and many conclusions
have been drawn to the loss of function in relation to it. ACL reconstruction is also very commonly done as
this ligament damage is the most common injury in sports. Muscle strength and proprioception have been
postulated to be affected alongside this injury. We conducted a cross sectional study in 19 patients who have
ruptured their ACL. We measured their muscle strength, thigh muscle bulk and proprioception in comparison
to their contralateral normal knee. The Biodex Isokinetic machine was used to measure the muscle strength
and proprioception. The thigh circumference was measured manually using a measuring tape. There was
significant reduction of muscle strength and thigh circumference in the ACL deficient limb as compared to the
normal side, p

Matched MeSH terms: Knee Joint
Fulltext Does Vertical Ground Reaction Force of the Hip, Knee, and Ankle Joints Change in Patients with Adolescent Idiopathic Scoliosis after Spinal Fusion?

Yusof MI, Shaharudin S, Sivalingarajah P

Asian Spine J, 2018 Apr;12(2):349-355.
PMID: 29713418 DOI: 10.4184/asj.2018.12.2.349

Study Design: Comparative cross-sectional study.
Purpose: We measured the vertical ground reaction force (vGRF) of the hip, knee, and ankle joints during normal gait in normal patients, adolescent idiopathic scoliosis (AIS) patients with a Cobb angle <40° and in AIS patients with spinal fusion. We aimed to investigate whether vGRF in the aforementioned joints is altered in these three groups of patients.
Overview of Literature: vGRF of the lower limb joints may be altered in these groups of patients. Although it is known that excessive force in the joints may induce early arthritis, there is limited relevant information in the literatures.
Methods: We measured vGRF of the hip, knee, and ankle joints during heel strike, early stance, mid stance, and toe-off phases in normal subjects (group 1, n=14), AIS patients with Cobb angle <40° (group 2, n=14), and AIS patients with spinal fusion (group 3, n=13) using a gait analysis platform. Fifteen auto-reflective tracking markers were attached to standard anatomical landmarks in both the lower limbs. The captured motion images were used to define the orientations of the body segments and force exerted on the force plate using computer software. Statistical analysis was performed using independent t-test and analysis of variance to examine differences between the right and left sides as well as those among the different subject groups.
Results: The measurements during the four gait phases in all the groups did not show any significant difference (p>0.05). In addition, no significant difference was found in the vGRF measurements of all the joints among the three groups (p>0.05).
Conclusions: A Cobb angle <40° and spinal fusion did not significantly create imbalance or alter vGRF of the lower limb joints in AIS patients.

Matched MeSH terms: Knee Joint
Fulltext Isolated complete popliteus tendon rupture following a trivial occupational injury

Arifaizad Abdullah, Mohd Hezery Harun, Hariati Jamil, Ezamin Abdul Rahim

Malaysian Journal of Medicine and Health Sciences, 2018;14(1):73-75.
MyJurnal

Traumatic rupture of the popliteus tendon is a rare type of knee injury. Most reported cases had occurred in athletes or following high impact trauma. We report a case of a 23-year-old male with an isolated complete popliteus tendon rupture that was diagnosed arthroscopically. The patient worked as a general labourer in a sawmill. He fell at his workplace and presented with acute painful fixed flexion of the right knee. Initially he was suspected to have a meniscus tear. Diagnostic arthroscopy of the knee was carried out; and diagnosis of popliteal tendon rupture was established. The patient was subsequently managed conservatively by arthroscopic debridement. He was allowed to mobilize the knee as tolerated after the surgery. He was well with a full knee range of movement and was able to walk normally at six weeks after surgery. This article highlights the possibility of complete popliteus tendon rupture following a minor occupational injury in a previously normal knee.

Matched MeSH terms: Knee Joint
Fulltext Effects of passive joint mobilization on patients with knee osteoarthritis

Nor Azlin M, Lyn SK

Sains Malaysiana, 2011;40(12):1461-1465.

A controlled, single blinded experimental study was conducted to determine the effects of passive joint mobilization on pain and stairs ascending-descending time in subjects with knee osteoarthritis (OA knee). A total of 22 subjects aged 40 and above with mild and moderate OA knee were assigned to either passive knee mobilization plus conventional physiotherapy (experimental group) or conventional physiotherapy alone (control group). Both groups received 2 therapy sessions per week, for 4 weeks. A blinded assessor measured pain with Visual analogue scale and stairs ascending-descending time with Aggregated Locomotor Function test, at baseline and at week 4. There was a significant reduction in pain among subjects in the experimental group (18.07 mm, t = 3.48, p = 0.01) compared to the control group (6.66 mm, t = 0.44, p = 0.67). Non-significant clinical difference was found in stairs ascending-descending time between the two groups (i.e. 6.25s in the experimental group versus 6.78 s in the control group, F(1,10) = 0.70, p = 0.42). No significant correlation was found between pain score and stairs ascending-descending time, r = 0.34, p = 0.16. The addition of passive joint mobilization to conventional physiotherapy reduced pain but not stairs ascending-descending time among subjects with knee osteoarthritis.

Matched MeSH terms: Knee Joint
Fulltext Pes anserine syndrome in post knee arthroplasty. A rare case report

Kamudin NAF, Rani RA, Yahaya NHM

J Clin Orthop Trauma, 2018 11 20;11(1):171-174.
PMID: 32002008 DOI: 10.1016/j.jcot.2018.11.007

Pes anserine syndrome is a cause of inferomedial knee pain. It occurs in patients with diabetes mellitus, osteoarthritis, rheumatoid arthritis and in overweight patients. It is a challenge to identify the causes of knee pain following knee replacement surgery. We present a case report of pes anserine syndrome in a 79-year-old female who had undergone knee arthroplasty 13 years prior. She was pain free until one year ago when her knee pain resurfaced without any symptoms of infection or history of trauma. She was successfully treated with a combination of stretching exercise and steroid local steroid injection. We want to highlight that such common condition as pes anserine syndrome, could occur in total knee arthroplasty, and should be considered as one of the possible diagnosis.

Matched MeSH terms: Knee Joint
Fulltext Post-operative Hypertension following Correction of Flexion Deformity of the Knees in a Spastic Diplegic Child: A Case Report

Vipin M, Sujendra DM, Imthiaz VK, Hitesh-Shah

Malays Orthop J, 2016 Nov;10(3):46-48.
PMID: 28553449 DOI: 10.5704/MOJ.1611.006

An adolescent boy with spastic diplegic cerebral palsy presented with crouch gait. He had bilateral severe flexion deformities of knees and hips. He was treated with single event multilevel surgery for the correction of deformities. Surgical procedures included bilateral adductor release, iliopsoas lengthening, bilateral femoral shortening and patella plication. Persistent hypertension was noted in the post-operative period. All causes of secondary hypertension were ruled out. Having persistent hypertension following the femoral shortening procedure is unusual. Antihypertensive medication controlled his blood pressure 15 months after surgery. Hypertension following correction of knee flexion deformity and limb lengthening is well known. Hypertension has not been described with the shortening osteotomy of the femur. Hypertension is a rare complication following the corrective surgery for the treatment of crouch gait. Blood pressure should be monitored during the post-operative period to detect such a rare complication.

Matched MeSH terms: Knee Joint
Fulltext Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

Tan T, Ho W

Malays Orthop J, 2015 Nov;9(3):65-67.
PMID: 28611915 DOI: 10.5704/MOJ.1511.010

Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA) bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

Matched MeSH terms: Knee Joint

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