OBJECTIVE: To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables. METHODS: The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis. RESULTS: Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p < 0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data. CONCLUSION: The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.
Classification ; Gait* ; Hip ; Humans ; Knee ; Locomotion ; Logistic Models ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Strength ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensation ; Spinal Cord Injuries* ; Spinal Cord* ; Walking

BACKGROUND: The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. METHODS: From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. RESULTS: Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. CONCLUSIONS: Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/surgery ; Arthroscopy/*methods ; Female ; Humans ; Knee Injuries/classification/*pathology/surgery ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/surgery ; Middle Aged ; Reproducibility of Results ; Retrospective Studies

OBJECTIVE: The purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery. MATERIALS AND METHODS: We retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups. RESULTS: The weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone. CONCLUSION: The additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/*pathology/surgery ; Arthroscopy ; Female ; Humans ; Injury Severity Score ; Knee Injuries/*classification ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Retrospective Studies

PURPOSE: To compare information about fracture type in MRI with simple radiograph in tibial plateau fractures and evaluate tibial plateau fractures type and accompanying soft tissue injury, and evaluate usefulness of MRI in tibial plateau fractures. MATERIALS AND METHODS: Compared MRI with simple radiograph about Schatzker classification, depression of articular surface and displacement of bone fragment from the 68 examples who checked MRI and we evaluated soft tissue injury around knee joint. RESULTS: There were 7 examples of Schatzker type change after MRI check. Average depression of articular surface in simple radiograph was 2.93 mm and 4.28 mm in MRI. It increased by 1.35 mm and it was meaningful statistically (p<0.05). There was no significant difference between MRI and simple radiograph of displaced bone fragment (p=0.168). There were 58 (85.3%) cases of soft tissue injury in MRI. CONCLUSION: MRI can find additional fracture line or articular depression that can't be found in simple radiograph and gives more information about articular depression and soft tissue that is useful in surgical plans. I think preoperative MRI is necessary to better treatment of fracture & treatment of periarticular soft tissue injury in tibial plateau fracture.
Classification ; Depression ; Knee Joint ; Magnetic Resonance Imaging* ; Soft Tissue Injuries*

The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8% and the curative rate 71.4% respectively. So for children whose age is older than 5 years, it's a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.
Femoral Fractures/complications ; Femoral Fractures/*surgery ; Fracture Fixation ; Knee Injuries/classification ; Knee Injuries/etiology ; Knee Injuries/*surgery ; Tibial Fractures/complications ; Tibial Fractures/*surgery ; Treatment Outcome

PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Classification ; Depression ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Soft Tissue Injuries

BACKGROUND: The purpose of this study was to evaluate the relationship between variable factors and clinical results following the operative treatment of the tibial plateau fractures. MATERIALS AND METHODS: The clinical and radiological analysis was performed on 29 cases of the tibial plateau fractures who had been treated with operative treatment and followed up for more than 1 year from January 1991 to December 1997. The analysis of clinical results was performed dividing into age, cause of injury, fracture type of Schatzker classification, associated soft tissue injury and method of operative treatment. RESULTS: According to Schatzker classification, 2 cases(6.9%) were type I, 11 cases(37.9%) were type II, 1 case(3.5%) was type III, 5 cases(17.2%) were type IV, 4 cases(13.8%) were type V, and 6 cases(20.7%) were type VI. In all cases, bony unions were obtained. According to Blokker evaluation, 23 cases(79.3%) of 29 cases were acceptable. CONCLUSION: We could expect good clinical results if early knee joint mobilization following minimal invasive open reduction and internal fixation could be obtained. Bad clinical results were related with young age group under 30, more than Schatzker classification type IV of high energy trauma and associated injury of anterior cruciated ligment or meniscus.
Classification ; Humans ; Knee Joint ; Soft Tissue Injuries ; Tibia

OBJECTIVES: To assess the prevalence of knee osteoarthritis through proper diagnosis in a rural community and to elucidate the relevant factors of this health problem in order to develop educational methods for the prevention of female knee osteoarthritis as well to provide basic data for prospective research. METHODS: Over a period of three months starting from August, 2000, 432 women over the age of 40 and living in a rural area were selected by a multistage cluster sampling method in order to investigate the prevalence of knee osteoarthritis and the related factors. The study utilized interviews and radiological examination. The criteria of knee osteoarthritis used was the American College of Rheumatology classification criteria for osteoarthritis of the knee(1995). RESULTS: The adjusted prevalence of knee osteoarthritis among the subjects was 55.0%, and multiple logistic regression analysis showed that the odds ratio(OR) of knee osteoarthritis among subjects 50-59 years of age and subjects older than 60 years of age as compared to subjects 40-49 years of age were 2.43(95% CI: 1.30-4.70) and 4.40(95% CI: 2.47-7.83), respectively. The OR of knee osteoarthritis among factory workers or farmers as compared to others was 1.79(95% CI: 1.03-3.12). The OR of knee osteoarthritis among subjects who had a family history and subjects who had knee injury or surgical history against those subjects had neither were 2.56(95% CI: 1.42-4.63) and 4.70(95% CI:1.45-15.19), respectively. The OR of knee osteoarthritis among smokers against non smokers was 0.47(95% CI: 0.22-0.97). CONCLUSIONS: Related factors of knee osteoarthritis included age, occupation, family history, smoking, knee injury and history of surgery. In order to prevent knee osteoarthritis in high risked rural woman, education concerning self-care methods and safety guideline must be provided at the work place by the public and private health sectors. Additionally, these women should be continually encouraged to exercise, including jogging and swimming regularly.
Classification ; Diagnosis ; Education ; Female ; Humans ; Jogging ; Knee Injuries ; Knee* ; Logistic Models ; Occupations ; Osteoarthritis ; Osteoarthritis, Knee* ; Prevalence* ; Rheumatology ; Rural Population ; Self Care ; Smoke ; Smoking ; Swimming ; Workplace

PURPOSE: To demonstrate the frequency of soft tissue injuries associated with tibial plateau fracture and analyze the pattern of fracture more accurately by magnetic resonance imaging (MRI). MATERIALS AND METHODS: The plain films and MRI of 27 patients with acute tibial plateau fracture were analyzed. Every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and in measuring the displacement and depression of fragments. Fracture types of 2 cases classified by the findings of plain film were changed to different types by MRI findings. Evidence of internal derangement of the knee was found in 26(96.3%) patients. Anterior cruciate ligament injuries were seen in 12(44.4%) patients and posterior cruciate ligament injuries in 10(37.0%) patients. Medial collateral ligament injuries were seen in 11(40.7%) patients and lateral collateral ligament injuries in 8(29.6%) patients. Medial and lateral meniscus tears were seen in 8(29.6%) patients respectively. CONCLUSIONS: Most of the patients with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Anterior Cruciate Ligament ; Classification ; Collateral Ligaments ; Depression ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Soft Tissue Injuries

PURPOSE: Retrospective study was performed about the incidence, type and pattern of tears, and clini-cal results after arthroscopic management for the symptomatic discoid lateral meniscus. MATERIALS AND METHODS: 54 cases in 49 patients who were managed arthroscopically and followed up for minimum one year for the symptomatic discoid lateral meniscus from Sept. 1993 to Aug. 1998 were included. Mean age at the time of surgery was 30.9 years(ranged, 12-63), most commonly in the second decade(42.5%) and mean duration of symptoms was 22.2 months. Females were more commonly affected than males(25 males and 29 females), and right knees were involved in 25 cases, left knees in 19 cases and bilateral in 5 cases. Most common symptoms was pain in 83.3% and snapping sound in 43.3%. The cause of symptoms was mostly related to previous trauma or sports injury in 66.7%, but none in 18 cases(33.3%). Discoid meniscus was classified according to the Watanabe's classification system and tears were classified as a transverse, longitudinal, horizontal with cystic degeneration, peripheral, wear in the inferior surface and complex. All the partial meniscectomies were done by a piecemeal fashion and the menisci were sutured in a vertical and horizontal way by inside-out or outside-in technique on the basis of day surgery. Postoperative regimens of the immediate passive and active ROM and quadriceps setting exercises were prescribed, and mean follow-up was 31.7 months(ranged, 12-62). RESULTS: According to the Ikeuchi's scale(1969), overall 83.4% of good or excellent clinical results were obtained and poor in 2 cases. Among 5 cases of retear, 3 cases showed excellent clinical results after the second arthroscopic treatment, and 1 case was fair, but 1 case progressed to arthrofibrosis which was rated poor result, and in another one case of poor result without retear, persistent pain was complained due to preexisting osteoarthrosis. CONCLUSIONS: Arthroscopic partial meniscectomy or reshaping is recommmended for the symptomatic discoid lateral meniscus tears in children and adults, but more long-term follow-up and its clinical results about the treatment method in children and adults will be needed.
Adult ; Ambulatory Surgical Procedures ; Arthroscopy ; Athletic Injuries ; Child ; Classification ; Exercise ; Female ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Male ; Menisci, Tibial* ; Osteoarthritis ; Retrospective Studies