Background: Although stress radiography is frequently used to assess abnormal knee instability, the reliability and reproducibility for an evaluation of anterior-posterior instability of the knee may be affected by a variety of factors.

Background Goniometers can be used to assess shoulder ROM with reasonable accuracy, but not internal rotation. Vertebral level, as determined by the hand-behind-the-back method, is used frequently but its reproducibility is questionable. We therefore devised a new measuring tape-based method for determining vertebral level. Questions/purposes We (1) compared the accuracy of a measuring tape-based and conventional vertebral-level method; (2) determined whether BMI affects their accuracy; and (3) devised a formula for converting distances measured using a measuring tape to vertebral levels. Patients and MethodsWe assessed internal rotation in 61 patients with shoulder pain. An electrode was taped to the skin where the thumb reached maximally behind the back. The vertebral-level method involved determining the vertebral level of the electrode by palpating bony landmarks whereas the measuring tape method involved measuring the distance between the C7 spinous process and the electrode. True vertebral levels of the electrode were confirmed by radiography. Results In nonobese patients, the accuracies of the upper thoracic and lumbar-level measurements were better for the measuring tape method than the vertebral-level method (r = 0.861 and 0.700, respectively in upper thoracic; 0.913 and 0.710, respectively in lumbar). Patient BMI affected the accuracy of the vertebral-level method but not that of the measuring tape method. The distances obtained using the measuring tape method could be converted into vertebral-level units using the formula: estimated vertebral level = 0.031 9 [distance between C7 spinous process and thumb behind back] À 0.044 9 [patient height] + 7.277. Conclusions The measuring tape-based method reflected shoulder internal rotation with higher accuracy than the vertebral-level method, and unlike the vertebral-level method, the measuring tape method was not affected by obesity. Level of Evidence Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

We evaluated 158 legs from 79 consecutive patients who had undergone both ankle-brachial index (ABI) measurements and angiography for claudication symptoms between January 2007 and December 2008. The diagnosis of peripheral arterial disease (PAD) in the individual legs was established by angiography. Ankle-brachial index was considered abnormal if it was <0.9. The sensitivity and specificity of ABI was 61% and 87%, respectively. To assess the factors affecting the validity of ABI in the diagnosis of PAD, multivariate logistic regression analysis was conducted. The odds ratios (ORs) for the false negative result of ABI were 4.36 (95% confidence interval [CI] 1.36-13.92) in patients with diabetes mellitus (DM), 3.41 (95% CI 1.10-10.48) in patients with distal lesions, 3.02 (95% CI 1.07-8.49) in elderly patients, and 1.13 (95% CI 0.34-3.42) in patients with mild stenosis. Although ABI is the method of choice for the primary diagnosis of PAD, other supplementary investigations should be considered when there is clinical suspicion of PAD but an ABI <0.9.

Background: The utility of inferior extensor retinacular (IER) reinforcement for arthroscopic repair of a lateral ankle injury is debatable. We hypothesized that the outcomes would not differ significantly between arthroscopic all-inside anterior talofibular ligament (ATFL) repair with and without IER reinforcement. Methods: We prospectively randomized 73 patients who had arthroscopic all-inside ATFL repair into 2 groups: those who had IER reinforcement (37 patients) and those who had no IER reinforcement (36 patients). The primary outcome was the Karlsson Ankle Functional Score (KAFS). The secondary outcomes included the Foot and Ankle Outcome Score (FAOS), Tegner activity score (TAS), ankle range of motion, and radiographic parameters. The functional outcomes were evaluated preoperatively and at 6 and 12 months postoperatively. Stress radiographs were obtained preoperatively and at 12 months postoperatively. Results: The KAFS, all FAOS subscale scores, and TAS improved significantly at 1 year postoperatively in both groups, with no significant differences between the groups with respect to the preoperative and postoperative values. Significant differences were not observed between the ankle range of motion values recorded preoperatively and at 1 year postoperatively in both groups; the preoperative and postoperative range of motion values did not differ significantly between the groups. The mean talar tilt and talar anterior translation decreased significantly at 1 year postoperatively in both groups, with no significant differences between the groups preoperatively and postoperatively. One patient in each group had neuralgia of the superficial peroneal nerve; 2 patients in the IER reinforcement group had knot irritation causing mild discomfort. Conclusions: Arthroscopic all-inside ATFL repair with and without IER reinforcement showed comparable functional and stress radiographic outcomes at 1 year. Performing IER reinforcement in addition to all-inside arthroscopic direct ATFL remnant repair is not necessary. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.