Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait

Background: The use of ultrasound to perform quantitative musculoskeletal (MSK) measurements requires reliability among different providers with varied levels of experience and training. Recent studies have shown that physical therapists (PT) can reliably measure the glenohumeral joint space using ultrasound imaging (USI) and operator experience or well defined training protocols influences the reliability. Few studies have reported the reliability of medial knee gap measurements with USI. Objective: Evaluate inter- and intra-rater reliability of a novel approach to measuring knee gapping using experienced and trained novice clinicians. Design: Inter-rater and intra-rater reliability study Setting: Physical therapy program Participants: Novice researchers were three upper-year Doctor of Physical Therapy students. Experienced researchers were two PT certified in MSK USI with eight years of experience. Methods: A total of 166 images of two subject’s medial knee joint gaps were captured in resting by a single experience researcher. Three novice researchers, who underwent a three-hour training protocol and two experienced researchers measured the images individually. Measurements were taken using standardized bony landmarks and internal calipers. All researchers were blinded to the subjects and results. Main outcome measures: Data was analyzed using two-way ICC mixed-model single measurement, SEM run for all researchers compared with experienced researcher one. Results: An excellent degree of reliability was found for both intra-rater and inter-rater measurements for Novice One and a good degree of reliability was found between Experienced One and Novice Two and Three. Conclusion: Both experienced and novice researchers attained a clinically significant ICC when compared to Experienced One. An accurate and reliable measurement of the medial knee joint gap maybe useful for further studies and help with diagnosis of joint pathologies. Level of study: IIB

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Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06293-x ◽

2020 ◽

Author(s):

Patricia M. Lutz ◽

Matthias J. Feucht ◽

Judith Wechselberger ◽

Michael Rasper ◽

Wolf Petersen ◽

...

Keyword(s):

Knee Joint ◽

Knee Flexion ◽

Joint Space ◽

Medial Knee ◽

Mean Values ◽

Age Related ◽

Gender And Age ◽

Joint Width ◽

The Mean ◽

The Impact

Abstract Purpose Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions. Methods A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed. Results Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p < 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found. Conclusion Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee. Level of evidence III.

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