Clinical assessment of osteoarthritis of the knee.

Cushnaghan, J; Cooper, C; Dieppe, Paul; Kirwan, John R.; McAlindon, Timothy E.; McCrae, F.

doi:10.1136/ard.49.10.768

Cited by 47 publications

(47 citation statements)

References 6 publications

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“…The assessment for bony swelling, which is a key component of the ACR clinical diagnostic criteria for OA (10), was found to be highly reliable (grade A) in contrast to that observed in previous studies (11,12,15). Even with a change from a 3-point to a 4-point scale, reliability further improved after standardization, achieving a reliability coefficient of 0.97 (Table 3 and Figures 1 and 2).…”

Section: Cibere Et Almentioning

confidence: 58%

“…However, the reliability of these and other signs by physical examination has not been evaluated comprehensively. A search of the literature revealed very few studies on the intra-and interrater reliability of the knee examination in OA (11)(12)(13)(14)(15) (Table 1). Although the data in Table 1 suggest apparently large between-study differences in reliability, a comparison of these values is not appropriate because they are not all based on the same measure of reliability and because the kappa statistic is very sensitive to differences in bias and prevalence.…”

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confidence: 99%

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Reliability of the knee examination in osteoarthritis: Effect of standardization

Cibere¹,

Bellamy²,

Thorne³

et al. 2004

Arthritis & Rheumatism

160

144

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Objective. To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization.Methods. Forty-two physical signs and techniques were evaluated using a 6 ؋ 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK ‫؍‬ 0.14), medial instability at 30°flexion (PABAK ‫؍‬ 0.02), and lateral instability at 30°flexion (PABAK ‫؍‬ 0.34) were the only 3 signs that were highly unreliable.Conclusion. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.In clinical practice and in research, the knee examination is a key component in the assessment of patients with osteoarthritis (OA). Recommendations for the physical examination of the OA knee include many different signs and techniques (1-9). In the American College of Rheumatology (ACR) clinical diagnostic

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Section: Cibere Et Almentioning

confidence: 58%

mentioning

confidence: 99%

Reliability of the knee examination in osteoarthritis: Effect of standardization

Cibere¹,

Bellamy²,

Thorne³

et al. 2004

Arthritis & Rheumatism

160

144

View full text Add to dashboard Cite

show abstract

“…The AE5 scale of the vertical axis (except for standing sagittal measurements) was chosen to reflect the typical repeatability of other methods of assessing both sagittal [10] and coronal [24] knee alignment, including human variations in joint angle estimation [11]. However, it should be noted that considerably greater intra-observer estimates of knee flexion and extension angles have been reported, with critical differences between measurements of 7.1 to 21.4 [28]. The use of externally mounted markers and a motion capture system was not an entirely novel approach to measuring lower limb alignment.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive computer-assisted measurement of knee alignment

Clarke

Riches

Picard

et al. 2011

Computer Aided Surgery

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The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1 larger than for the rigid model with statistically similar variance ( p ¼ 0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost AE1, with up to AE0.5 loss of repeatability for coronal alignment measured before and after stress maneuvers, and a AE0.2 loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were AE1.6 and AE2.3 , respectively. Varus and valgus stress measurements agreed to within AE1.3 and AE1.1 , respectively. Agreement limits for standing MFT angles were AE2.9(coronal) and AE5.0 (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs.

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“…The cutoff of 5 degrees was used as an exclusion criterion in our study because the reliability of physical examination of laxity is low, with reported interobserver agreement of 0.55 (25). In our study participants the mean Ϯ SD knee laxity measurement was 2.7 Ϯ 3.0 degrees varus.…”

Section: Muscle Biopsy Samples (1 CMmentioning

confidence: 99%

Morphologic changes in the vastus medialis muscle in patients with osteoarthritis of the knee

Fink¹,

Egl²,

Singer³

et al. 2007

Arthritis & Rheumatism

104

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Objective. To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee.Methods. Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee undergoing total joint arthroplasty were examined histopathologically. Morphologic changes were assessed in relation to clinical features that might have contributed to muscle injury.Results. All muscle specimens exhibited atrophy of type 2 fibers. In 32% of the patients, atrophy of type 1 fibers was also noted. Fiber type grouping of type 1 fiber in 15% of the patients and type 2 fiber in 37%, indicating reinnervation, led to the diagnosis of neurogenic muscular atrophy in 32% of the patients; selective atrophy of type 2 fiber in 68% of the specimens was interpreted as possibly resulting from pain-associated disuse. Signs of muscle degeneration and regeneration were found in 65% and 96% of the samples, respectively. Soft tissue changes indicating long-term disease, such as calcification, fibrosis, and lipomatosis, were frequently observed (in 69%, 71%, and 94% of the patients, respectively). Statistical analysis of clinical and morphologic parameters revealed a significant association between degenerative muscle changes and the presence of a varus deviation of the leg axis.Conclusion. Patients with OA of the knee frequently exhibit muscle changes, with probable multifactorial etiology. Selective atrophy of type 2 fibers might reflect pain-related immobilization of a limb. Changes such as neurogenic muscular atrophy, muscle fiber degeneration, and regeneration might contribute as cofactors in the development or progression of OA.The muscles surrounding the knee play an important role as active stabilizers and are crucial in protection of the joint structures against damaging influences (chondroprotection) (1-13). In a longitudinal study of female subjects (14), Slemenda et al showed that adequate quadriceps strength in healthy knees had a protective effect against the development of osteoarthritis (OA). In addition, there is considerable evidence that an imbalance in the activity of the joint-stabilizing muscles due to age-related reduction in sensory joint innervation (1,2,4,15) or proprioception (9-12,16-20) plays a decisive role in the development of OA of the knee. Slemenda and colleagues (20) and Brandt (21) have suggested that quadriceps weakness and atrophy might not only be the result of OA and resultant pain-related immobilization of the affected limb and muscles, but might also have to be regarded as direct preceding risk factors for the development and progression of OA. It is conceivable that, in addition to imbalance of muscle function, structural muscle changes might interfere with the chondroprotective effect of the musculature and thus contribute to the development of OA.Normal muscle contains 2 major fiber types, which differ with respect to histochemical staining pattern, twitch contraction time, and resistance to fatigue. The speed of contraction is mainly determin...

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Clinical assessment of osteoarthritis of the knee.

Cited by 47 publications

References 6 publications

Reliability of the knee examination in osteoarthritis: Effect of standardization

Reliability of the knee examination in osteoarthritis: Effect of standardization

Non-invasive computer-assisted measurement of knee alignment

Morphologic changes in the vastus medialis muscle in patients with osteoarthritis of the knee

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