Patellofemoral crepitus and clunk syndrome are infrequent, yet troublesome complications of total knee arthroplasty with a reported incidence of 0%-18%. They are primarily associated with implantation of posterior cruciate substituting designs. These entities are the result of peripatellar fibrosynovial hyperplasia at the junction of the superior pole of the patella and the distal quadriceps tendon which becomes entrapped within the superior aspect of the intercondylar box of the femoral component during knee flexion. When the knee extends, a crepitant sensation occurs as the fibrosynovial tissue exits the intercondylar box. Numerous etiologies have been proposed such as femoral component designs with a high intercondylar box ratio, previous knee surgery, reduced patellar tendon length, thinner patellar components, reduced patella-patellar component composite thickness, and smaller femoral components. Preventative measures include choice of femoral components with a reduced intercondylar box ratio, use of thicker patellar components, avoidance of over-resection of the patella, and debridement of the fibrosynovial tissue at the time of knee arthroplasty. Most patients with crepitus are unaware of the problem or have minimal symptoms so that no treatment is required. If significant disability is incurred, symptoms can be eliminated in a high percentage of patients with arthroscopic debridement of the fibrosynovial hyperplasia.
Arthralgia/etiology ; Arthroplasty, Replacement, Knee/*adverse effects ; Humans ; Knee Joint/*physiopathology ; Patellofemoral Joint/*physiopathology ; Postoperative Complications/etiology/physiopathology/prevention & control

BACKGROUND: The aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy. METHODS: This prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation. RESULTS: Seventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) < or = 3, 9 patients showed 3 < VAS < or = 7, and one patient showed a VAS > 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98). CONCLUSIONS: Approximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting.
Adolescent ; Age Factors ; Arthralgia/*etiology/physiopathology ; Cerebral Palsy/*complications/physiopathology ; Child ; Female ; Humans ; *Knee Joint/physiopathology ; Male ; Prospective Studies ; Range of Motion, Articular ; Risk Factors ; Walking ; Young Adult

The electrical stimulation of acupoint (ESA) releases several endogenous neuropeptides, which play important roles in management of pain and inflammation. ESA with low and high frequencies has been shown to release different neuropepides, suggesting its various therapeutic effects. Pain and edema are major problems for ankle sprain. However, there have been few reports on the effects of ESA for ankle sprain. We aimed to investigate that ESA can reduce pain and edema resulting from ankle sprain, and whether there is a difference in therapeutic effects between low and high frequency ESA. To induce ankle sprain in Sprague-Dawley rats, the ankle of right hindpaw was overextended in direction of simultaneous inversion and plantar flexion. Stepping force and edema in the paw of the sprained ankle were measured by electronic balance and plethysmometer, respectively. In both 2 and 100 Hz ESA groups, stepping force was increased significantly in similar degrees (p<0.05). Only 2 Hz ESA produced the significant rapid decrease in ankle edema. This study demonstrates that ESA of 2 Hz and 100 Hz shows comparable analgesic effects, but only 2 Hz ESA can facilitate the reduction of edema caused by ankle sprain.
Treatment Outcome ; Sprains and Strains/diagnosis/etiology/*physiopathology/*prevention & control ; Rats, Sprague-Dawley ; Rats ; Male ; Electroacupuncture/*methods ; Edema/diagnosis/etiology/physiopathology/prevention & control ; Arthralgia/diagnosis/etiology/physiopathology/*prevention & control ; Ankle Injuries/complications/diagnosis/*physiopathology/*therapy ; Animals

PURPOSE: The purpose of this research was to test the effects of ST35 & Sulan moxibustion on knee joint pain, range of motion, and discomfort during Activies of Daily Living (ADL) in elderly with knee joint pain. METHOD: A nonequivalent control group pre-post test research design was used. Thirty four elderly who had knee joint pain were studied. Of them, sixteen were in the experimental group and eighteen the control group. The instruments used for this study were NRS, goniometer, and a modified ADL questionnaire developed by Lee. RESULT: The pain scores of right & left knee joint after moxibustion were significantly different between the experimental group and the control group (Right: F=26.27, p=0.000, Left: F=20.77, p=0.000). Right and left knee ROM scores were significantly different between the experimental group and the control group after moxibustion (Right: F=10.74, p=0.003, Left: F=9.239, p=0.005). Discomfort during ADL scores were significantly different between the experimental group and the control group after moxibustion (F= 32.31, p=0.000). CONCLUSION: It is necessary that nurses provide the elderly with knee joint pain with moxibustion to reduce joint pain and to increase knee ROM as an alternative therapy.
*Range of Motion, Articular ; Osteoarthritis, Knee/*nursing ; *Moxibustion ; Middle Aged ; Male ; *Knee Joint/physiopathology ; Humans ; Female ; Arthralgia/etiology/*nursing ; Aged, 80 and over ; Aged ; *Activities of Daily Living