Correlation between gait analysis and clinical questionnaires in patients with spontaneous osteonecrosis of the knee.

BACKGROUND: Spontaneous osteonecrosis of the knee is usually verified by magnetic resonance imaging accompanied by clinical questionnaires to assess the level of pain and functional limitation. There is a lack however, in an objective functional test that will reflect the functional severity of spontaneous osteonecrosis of the knee. The purpose of the current study was to examine the correlation between spatiotemporal gait parameters and clinical questionnaires in patients with spontaneous osteonecrosis of the knee. METHODS: 28 patients (16 females and 12 males) were included in the analysis. Patients had unilateral spontaneous osteonecrosis of the knee of the medial femoral condyle confirmed by magnetic resonance imaging. All patients performed a computerized spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis Index and the Short-Form 36. Relationships between selected spatiotemporal gait measures and self-assessment questionnaires were assessed by Spearman non-parametric correlations. FINDINGS: Significant correlations were found between selected spatiotemporal gait parameters and clinical questionnaires (r ranged between 0.28 and 0.79). Single limb support was the gait measure with the strongest correlation to pain (r=0.58), function (r=0.56) and quality of life. INTERPRETATION: Spatiotemporal gait assessment for patients with spontaneous osteonecrosis of the knee correlates with the patient's level of pain and functional limitation there by adding objective information regarding the functional condition of these patients.

Anterior cruciate ligament reconstruction by using bioabsorbable femoral cross pins: MR imaging findings at follow-up and comparison with clinical findings.

PURPOSE: To determine the frequency of imaging findings and complications related to bioabsorbable femoral cross pins at follow-up magnetic resonance (MR) imaging studies after anterior cruciate ligament (ACL) reconstruction and compare these MR imaging findings with clinical evaluation findings. MATERIALS AND METHODS: The institutional review board approved this retrospective study, and informed consent was waived. Follow-up MR imaging studies (average, 26 months after surgery) in 218 patients with prior ACL reconstruction were retrospectively reviewed. Cross-pin fracture, posterior transcortical breach, migration, resorption, and lateral prominence of cross pins, as well as the cross-pin angle relative to the transepicondylar line, were investigated on MR images. The clinical evaluation included Lachman, anterior drawer, and pivot shift tests, as well as assessment for joint tenderness. RESULTS: Fracture, posterior transcortical breach, migration, and lateral prominence of cross pins were excluded from analysis when at least one cross pin was completely resorbed (n = 16 patients). Forty-five fractured cross pins were seen in 35 (17%) of 202 patients. The posterior femoral cortex was breached in 57 (28%) of 202 patients. Migration of fractured pin fragments occurred in 12 (6%) of 202 patients. There was a significant relationship between fractures and posterior breach of cross pins (P = .001), as well as between cross-pin angles and fractures (P = .002). Both cross pins were completely resorbed in 12 (6%) of 218 patients (average time since surgery, 53 months; range, 8-92 months). No significant association was found between any MR imaging finding related to cross pins and clinical test findings. CONCLUSION: Fracture and posterior transcortical breach of bioabsorbable femoral cross pins, commonly seen at follow-up MR imaging studies, do not correlate with clinical findings of joint instability or pain. Posteriorly angulated cross pins and posterior transcortical breach are significantly associated with cross-pin fractures.

The medial longitudinal arch as a possible risk factor for ankle sprains: a prospective study in 83 female infantry recruits.

BACKGROUND: Ankle sprains are frequent, especially in athletes, soldiers, or others who perform high levels of physical activity. Although prevention is a primary goal, little is known about the risk factors. We evaluated the association of the structure of the medial arch of the foot to the occurrence of acute and recurrent ankle sprains in 83 female infantry recruits. We found no previous studies on ankle sprains in women in the English literature. METHODS: Arch height was quantified using the Chippaux-Smirak index, and each arch was classified as high, normal, or low. Retrospective data were obtained from questionnaires in which the soldiers noted whether or not they had had ankle sprains in the past, the grade of the sprain, and recurrence. Prospective data were accumulated in the 4 months of basic training, during which time every ankle sprain was documented and classified according to its grade and cause. RESULTS: The retrospective data showed more frequent ankle sprains in the low arch group than in the normal arch group, mainly in the right foot (RR of 2.9, p <0.05). Recurrent sprains studied retrospectively also showed that more sprains occurred in the low arch group than in the normal arch and high arch groups (RR of 10.3, p <0.05). The prospective data suggested a pattern toward the same outcome (50% in the low arch as opposed to 36% in the normal arch group, RR, 1.3), but with no statistical significance. CONCLUSIONS: We concluded that a low arch of the foot might be a risk factor for ankle sprains. However, our study consisted of a relatively small population, and further studies are needed.