Kneeling

Abstract: The purpose of this review of the literature was to investigate the functional range of motion requirements of non-Western populations in respect to artificial hip and knee joint implants. It was discovered that in Asia and the Middle East many activities are performed while squatting, kneeling, or

Abstract: Background:Stress radiography provides an objective tool to measure posterior knee instability. Intraobserver and interobserver reliability has been reported for the Telos device, but it has not been studied using the kneeling technique.Purpose:This study was conducted to evaluate the intraobserver and interobserver reliability of measurements made using kneeling stress radiography to quantify posterior knee instability.Study Design:Case series (diagnosis); Level of evidence, 4.Methods:One hundred thirty-two stress radiographs in 44 patients with suspected posterior knee instability were prospectively taken using the kneeling technique. The amount of posterior displacement on the radiographs was then measured independently by 3 blinded testers (an orthopaedic sports medicine faculty member, an orthopaedic chief resident, and a medical student) on 2 separate occasions. Changes in mean and intraclass correlation coefficients (ICCs) were examined to assess the intraobserver and interobserver reliability of t...

Abstract: Stress radiography presents the golden standard to quantify posterior laxity in posterior cruciate ligament (PCL) insufficiency. Several different techniques are currently available, but comparative data are insufficient. Different stress radiographic techniques result in different values for posterior laxity. Comparative controlled clinical study was designed. Prior to PCL reconstruction 30 patients underwent a series of stress radiographs: Telos device, hamstring contraction, kneeling view, gravity view, and an axial view. Posterior displacement, side-to-side difference (SSD), condyle rotation, required time, and pain were measured. Posterior displacement was: Telos 12.7 ± 3 mm (SSD 10.6 ± 3.1 mm), hamstring contraction 11.2 ± 3.2 mm (SSD 8.5 ± 3.4 mm), kneeling 14.4 ± 3.8 mm (SSD 10.2 ± 3.5 mm), gravity view 10.5 ± 2.8 mm (SSD 9.1 ± 2.4 mm), and axial view 19.4 ± 6.9 mm (SSD 8.5 ± 4.1 mm). In comparison to Telos the hamstring contraction, gravity, and the axial view underestimated the SSD by approximately 2 mm. Telos and kneeling caused significantly more pain than all other techniques (P < 0.001). The axial view was fastest (115 s, P < 0.001) and Telos longest (305 s, P < 0.001), respectively. Telos indicated the lowest rotational error with a significant difference between kneeling and gravity (P < 0.003). In contrast to Telos as the golden standard, hamstring contraction, gravity, and axial view underestimated the SSD. Kneeling and Telos are comparable with respect to SSD and pain. Although kneeling indicates a greater rotational error than Telos, it seems to be a reliable alternative for quantifying posterior tibial displacement in a more simple and fast way.

Abstract: Achieving deep knee flexion >145° is a goal of many patients receiving knee arthroplasty in Asia and the Middle East, yet it is unknown whether knees with implants move similar to the natural knee in these postures. We studied 18 of 36 consecutively operated knees that were able to flex >145° using fluoroscopic analysis during kneeling to maximum flexion. An average of 9° tibial internal rotation was observed in deep flexion. Posterior condylar translations were observed from 80° to 120° flexion, and the condyles translated forward in flexion beyond 120°. Separation of the condyles from the tibial surface was observed in 9 knees at flexion >130°. Very deep flexion can be achieved and is well accommodated using contemporary posterior-stabilized knee arthroplasty, but the kinematics differ from the intact natural knee.