Cutoff Value for the Patient Acceptable Symptom State of the Thai IKDC Subjective Knee Form in Patients After Primary ACL Reconstruction.

Background: The Patient Acceptable Symptom State (PASS) cutoff is the value on a patient-reported outcome measure beyond which patients consider themselves to be "feeling well." There are limited data regarding the PASS threshold for non-English versions of the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF). Purpose: To establish the PASS cutoff for the Thai version of the IKDC-SKF for patients undergoing primary anterior cruciate ligament reconstruction (ACLR) and to identify factors to achieve PASS after surgery. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included in this study were patients aged 18 to 50 years who had undergone primary unilateral ACLR between January 2016 and February 2020. After enrollment, patients completed the Thai IKDC-SKF and answered the anchor question for determining the PASS. Results: Questionnaires were sent to 321 patients, of whom 173 (53.9%) responded. The vast majority (156 patients; 90.2%) considered themselves to have achieved the PASS. This group of patients had significantly higher IKDC scores than did those who did not have an acceptable symptom state (79.6 ± 14.2 vs 60.7 ± 16.5; P < .001). The receiver operating characteristic curve of the IKDC score for predicting the PASS had an area under the curve of 0.82 (95% CI, 0.72-0.91). The optimum PASS cutoff of the Thai IKDC-SKF was a score of 74.2 (sensitivity, 0.72; specificity, 0.82). Factors that provided favorable odds for achieving the PASS were the use of a hamstring tendon autograft (odds ratio, 4.1; 95% CI, 1.5-20.6) and the absence of a patellofemoral chondral lesion (odds ratio, 3.8; 95% CI, 1.03-14.1). Conclusion: For patients undergoing ACLR, the cutoff for the PASS of the Thai version of the IKDC-SKF was a score of 74.2. Two surgery-related factors provided favorable odds for achieving the PASS: the use of a hamstring tendon autograft and the absence of a patellofemoral chondral lesion.

Efficacy of a Single Intra-Articular Injection of 2% Sodium Hyaluronate Plus 0.5% Mannitol in Patients with Symptomatic Osteoarthritis of the Knee: A Preliminary Report.

Background: Intra-articular injection of hyaluronic acid is widely used as a treatment for osteoarthritis of the knee. The recommended dosing regimens have generally ranged from 3 to 5 injections. Objective: To assess efficacy and safety of a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol in patients with symptomatic osteoarthritis of the knee. Material and Method: Twenty patients between 40-70 years of age with osteoarthritis of the knee (Kellgren-Lawrence grade II or III) were included in the study. After a 2-week NSAIDs washout period, ten patients in the intervention group received a single intra-articular 2 ml dose of the combination of 2% sodium hyaluronate and 0.5% mannitol and ten patients in the control group received no injection. No other pain-killer medication was allowed during the study except diclofenac as rescue pain medication in both groups. The efficacy parameters were the WOMAC Index and diclofenac consumption. All adverse events were recorded. Results: Patients who received a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol had a significant improvement from baseline in all WOMAC subscales over 24 weeks (p<0.001). Pain, stiffness, and physical function subscales were significantly lower in the intervention group than in the control group until Week 20, 12, and 16, respectively (p<0.05). Patients who received sodium hyaluronate also required significantly lower amounts of diclofenac (p<0.05). No serious adverse event related to the intervention was reported. Conclusion: Symptomatic OA knee patients who received a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol had better outcomes over the 24-week follow-up period than control group patients who received no injection intervention.

Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis.

OBJECTIVE: This meta-analysis study compares the treatment outcomes between single bundle (SB) and double bundle (DB) anterior cruciate ligament reconstructions (ACLR) including manual laxity tests, KT-1000 measurements and functional knee scores including International Knee Documentation Committee (IKDC) and Lysholm scores. DATA SOURCES: Medline, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (January 1985 to March 2008). MATERIAL AND METHOD: All randomized controlled trials reporting one or more outcomes related to single bundle versus double bundle ACLR were recruited in the present study. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomization status and type of ACLR. RESULTS: There were 2,119 studies initially identified, 7 studies met our inclusion criteria. Four hundred and eighty two patients (238 in SB group and 244 in DB group) were included in the present study. The results of KT 1,000 arthrometry in 7 studies favor DB-ACLR with statistical significance (p < 0.05). Pivot shift test were available for 374 patients from 6 studies, 183 and 191 patients in SB group and DB group respectively. The results favor DB-ACLR with statistical significance (p < 0.001). IKDC scores were available for 257 patients from 4 studies. The results trend to favor DB-ACLR but not statistically significant (p = 0.17). Lysholm scores were available for 174 patients from 3 studies. The results trend to favor DB-ACLR without statistical significance (p = 0.10). CONCLUSION: The present study shows that DB-ACLR provides better AP and rotational stability than SB-ACLR. There is no difference in the results of functional scores. DB-ACLR should be considered in patients who particularly require rotational stability of the knee. In the future, the interesting issue is to develop the functional knee score that is more specific to rotational stability evaluation.

Validity and reliability of Thai version of the International Knee Documentation Committee Subjective Knee Form.

BACKGROUND: Self-administered questionnaires have become an important aspect for clinical outcome assessment of knee-related surgery. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a knee-specific questionnaire that is widely used and translated to many languages. The purposes of the present study were: (1) to translate the questionnaire into Thai; and (2) to assess the validity and reliability of the Thai version of the International Knee Documentation Committee (IKDC) Subjective Knee Form. MATERIAL AND METHOD: The IKDC Subjective Knee Form was translated into Thai using forward-backward translation protocol. Afterward, reliability and validity were tested The responses of 55 consecutive patients on two questionnaires, the Thai IKDC Subjective Knee Form and the Short Form-36, were used. The validity was tested by correlating the scores from both questionnaires. The reliability was adopted by measuring the test-retest reliability and internal consistency. RESULTS: The Thai IKDC Subjective Knee Form showed good correlations with the physical functioning and bodily pain domains of the SF-36 (Pearson's correlation coefficient = 0.75 and 0.76 respectively). The reliability proved excellent with an intra-class correlation coefficient of 0.92 for test-retest. The internal consistency was strong (Cronbach alpha = 0.92). CONCLUSION: The Thai version of IKDC Subjective Knee Form showed good value to retain the characteristic of the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.

Difference in isokinetic strength of the muscles around dominant and nondominant shoulders.

BACKGROUND: Muscle training usually plays an important role in the treatment of shoulder disorders. Clinicians traditionally predict the pre-injury strength of an injured shoulder by using the contralateral uninjured side as the baseline data. OBJECTIVE: The primary purpose of the present study was to determine the difference in isokinetic peak torque of dominant and nondominant shoulders. MATERIAL AND METHOD: Both shoulders of 39 healthy subjects (24 men, 15 women) were tested isokinetically by using the CON-TREX MJ dynamometer at two angular velocities (60 and 180 degrees/sec) during abduction, adduction, flexion, extension, internal rotation and external rotation. RESULT: There were statistical differences of contralateral peak torque in almost all directions of shoulder muscle contractions except in shoulder flexion at both speeds. Peak torque of shoulder adduction, extension, and internal rotation were greater in the dominant side. Shoulder abduction and external rotation peak torque were greater in the nondominant side. CONCLUSION: Therefore, clinicians should not directly use the isokinetic strength of the contralateral shoulder as normal baseline data for an injured side without consideration.