Relationship between the goniometric alignment and articular cartilage damage in knee osteoarthritis

Introduction: Osteoarthritis of the knee is common among the elderly. The alignment of the knee plays an important part in disease progression. Objectives: The aim was to determine the relationship between goniometric measurement of malalignment and gross and histological damage to articular cartilages of osteoarthritic knees. Methods: Anterior plane knee alignment was measured using a handheld metal goniometer in 84 patients awaiting knee replacement. Articular cartilages removed at surgery were stained and examined for macroscopic and microscopic damage which were quantified with macroscopic visual assessment score and Mankins histochemical score, respectively. The relationship between the type of knee angulation and macroscopic and microscopic damage to medial and lateral compartments was analyzed using analysis of variance (ANOVA), and the relationship between the degree of angulation and the degree of damage was determined using multiple linear regression models. Results: Varus knees had markedly higher macroscopic damage scores in the medial than the lateralcompartment (p<0.0001), while valgus knees showed the opposite (p<0.0001). The knee angulation, together with age and BMI, predicted 54% of the macroscopic (p<0.0001) and 60% of the microscopic damage (p<0.0001) in varus knees. Conclusions: Anterior plane goniometric knee alignment is a significant predictor of the articular cartilage damage present in an osteoarthritic knee. Goniometric measurement is a valuable tool in assessing the disease severity as it is a simple, safe and cost-effective method.

Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains.

UNLABELLED: Objective This study was conducted to determine the most effective thermal modality; heat or contrast therapy-in reducing pain, reducing swelling, and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Design Randomized control trail. Methods One hundred and fifteen participants of both genders who were diagnosed as having grade I or II lateral ankle sprain were randomly assigned to the study on the fifth day of injury. Pain, volume, and ROM were recorded before and after treatment continuously for 3 days. Results Effects were evaluated as "Immediately after application" and "3 days after continuous application." Immediately after application, there was no difference between the 2 modalities on ankle ROM; heat reduced pain over contrast therapy, and both modalities increased swelling. When considering the effects after continuous application for 3 days, no difference was found between the 2 modalities on ROM and the reduction of pain. Contrast therapy reduced swelling while heat caused increased swelling even after 3 days. Conclusion The use of different thermal modalities during the transition from the acute to chronic phase of injury can be suggested as effective treatment options according to the objectives of injury management: pain reduction, improve ROM, and swelling management. LEVELS OF EVIDENCE: Therapeutic, Level II: Randomized clinical trial.

Goniometric alignment of the normal knee joint and the factors which affect it.

OBJECTIVES: Establishing a normative database for anterior plane knee joint alignment in a population is helpful in assessing patients with disorders of the knee joint specially osteoarthritis. Therefore we aimed at establishing the normal alignment in the Sri Lankan adult population using the goniometer which is an inexpensive and simple method of measurement. METHODS: A total of 420 healthy adult volunteers (210 men and 210 women) above 25 years of age were recruited and the anterior plane knee alignment was measured using a hand held metal goniometer. RESULTS: The mean knee joint alignment was 180.56° (SD 2.39) and 183.04° (SD 2.34) in males. The knee joints of the females were varus-oriented by, 2.48° than those of males (p< 0.0001). In the females the knee joint alignment showed a gradually varus inclination with increasing age (p< 0.05). Lifting heavy weights in males caused a significant varus inclination of the knee joint while BMI and squatting for long periods did not have an effect on the normal alignment. CONCLUSIONS: Female knees are more varus inclined than that of males in the Sri Lankan participants and this inclination increases with age. Reasons for this could be genetic and lifestyle differences and may partly explain the reason for the predominance of varus osteoarthritis in Sri Lankan females.

Post-operative critical care and outcomes of limb replantation: experience in a developing country.

Replantation is the treatment of choice for traumatic amputation. Its success rates vary, reaching 80% in world's best centres. This study analyses management practices of replantation in a regional centre in a developing country. Out of six replantations, four were successful. The median warm ischaemia time of the severed limb was 4.5h (range 1-13.5) and the median duration of general anaesthesia required for initial surgery was 6.25h (range 4.7-8.0). All patients needed intensive care following replantation for a median of 7 days (range 5-15). Pulse oximetry values were observed to be the same in the graft and the patient in successful cases. Two grafts failed. The median haemoglobin values on the 1st, 3rd and 5th post-operative day were 9.8, 7.0 and 8.4g/dl, respectively. The median platelet counts in the same time periods were 118x10(9), 68x10(9) and 205x10(9)L(-1). The median total fluid intake was 2.2, 3.1 and 3.4ml/kg/h on the 1st, 3rd and 5th post-operative day and the median urine output was 2.4, 2.6 and 2.7ml/kg/h, respectively. The observed post-surgical reduction in platelet count normalised by the 5th post-operative day. Higher fluid intake and lower haemoglobin levels appear to minimise the systemic effects of reperfusion injury, preventing the onset of renal failure and promoting graft perfusion. Pulse oximetry was a useful tool to assess graft perfusion and appear to offer a prognostic value. Three of the above 4 patients were traced for review 5 years later and had functioning grafts.