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At least 19 recordsLinked to original sources

Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?

OBJECTIVE: Neuromuscular joint protection requires proprioceptive input and motor output. Impairment of proprioception in knee osteoarthritis (OA) may contribute to, and/or result from, the disease. If this impairment was exclusively a local result of OA, a between-knee difference would be expected in patients with unilateral OA (UOA). To explore causal directions, 2 hypotheses were tested: 1) proprioception is worse in UOA patients versus elderly controls; 2) proprioception is worse in the arthritic knee versus the unaffected knee in UOA patients. METHODS: Twenty-eight UOA patients (Kellgren-Lawrence grade > or =2 in 1 knee and <2 in the other knee) and 29 elderly controls were enrolled. The unaffected knee of each UOA patient and both knees of the elderly controls were required to meet symptom, examination, and radiographic criteria. Proprioception (detection threshold of joint displacement after slow, passive, automated knee motion), body mass index, pain, functional status, range of motion, and laxity were measured. RESULTS: UOA patients had worse proprioception than did elderly controls, in either knee. A between-knee difference was not found in UOA patients. CONCLUSION: Impaired proprioception is not exclusively a local result of disease in knee OA. The relative importance of impaired proprioception in the development and progression of knee OA will require longitudinal study.

Aged↗

Knee height, knee pain, and knee osteoarthritis: the Beijing Osteoarthritis Study.

OBJECTIVE: Few risk factors for knee osteoarthritis (OA) are appreciated, and the discordance between symptoms and the severity of structural disease has not been explained. Knee height contributes to moments around the knee. The longer the leg, the more torque is present. Although this would suggest that having long legs would be related to the occurrence of knee OA and pain, this issue has not been studied. Our aim was to explore the association between knee height, knee pain, and knee OA. METHODS: We recruited a random sample of Beijing residents ages 60 years and older. Subjects answered questions about joint symptoms, and radiographs of their knees were obtained. A knee joint with a Kellgren/Lawrence grade of >/=2 was defined as having radiographic OA. Patellofemoral OA was defined as being present when grade >/=1 osteophytes or grade >/=1 joint space narrowing was observed on skyline views of the patella or anterior femur. Subjects were considered to have symptomatic OA when both radiographic OA and self-reported pain were present in the same joint. Knee height was measured on the right leg using a sliding broad-blade caliper; the subject was seated, and the subject's feet were bare. We used logistic regression analyses to assess whether knee height was associated with prevalent radiographic and symptomatic OA. We then assessed whether knee height was associated with knee symptoms independently of structural change. RESULTS: A total of 1,006 men (mean +/- SD age 68.4 +/- 6.4 years) and 1,500 women (mean +/- SD age 67.5 +/- 6.1 years) participated in this study. Higher knee height was associated with an increasing prevalence of both radiographic and symptomatic OA, especially among women. For radiographic OA, the magnitude of association was similar for the patellofemoral and tibiofemoral compartments. Among women with knee pain, higher knee height was associated with more severe knee pain (P = 0.0004 for the highest quartile versus the lowest quartile of knee height) independently of the severity of radiographic OA. CONCLUSION: Knee height is associated with prevalent radiographic and symptomatic knee OA. It may also play an important role in knee symptoms. This study highlights the importance of mechanical forces in the determination of OA and knee symptoms.

Anthropometry↗

Knee-straining work activities, self-reported knee disorders and radiographically determined knee osteoarthritis.

OBJECTIVES: Earlier studies indicate an increased risk of knee disorders in trades with knee-straining work positions, but no dose-response correlation has yet been documented. This study examined whether self-reported knee complaints and radiologically diagnosed knee osteoarthritis are dose-related to kneeling and squatting work positions. METHODS: Worktasks for floor layers and carpenters were video-recorded, and the time spent in knee-straining work positions was quantified. A questionnaire study included 133 floor layers, 506 carpenters, and 327 compositors, all without earlier acute knee trauma. Radiological examinations were carried out on a stratified sample (N = 150) from the questionnaire study. The individual exposure was calculated from the amount of knee strain quantified in the video-recorded worktasks, the self-reported time spent in the worktask, and the number of years in the trade. Statistical analyses were carried out with a binary logistic regression model, adjusting for age, body mass index, smoking, and knee-straining sports activities. RESULTS: The odds ratios for self-reported knee complaints and radiographically determined knee osteoarthritis were increased in relation to the degree of knee-straining work demands for workers with low-to-moderate, high, and very high exposure to knee-straining work demands in a comparison with the reference group, without knee-stressing work activities. CONCLUSIONS: The results indicate that there is a dose-response correlation between knee-straining work activities and the development of self-reported knee complaints and radiologically diagnosed knee osteoarthritis.

Adolescent↗

Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis.

OBJECTIVES: To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA). DESIGN: Baseline analyses of an observational prospective study. SETTING AND PARTICIPANTS: Participants were 429 men and women aged 65 years and older experiencing knee pain or knee pain with radiographic evidence of OA enrolled in the Observational Arthritis Study in Seniors (OASIS). MEASUREMENTS: Demographic variables (age, gender, ethnicity, education), health (X-rays of knee rated for OA severity, medical conditions, medication use, smoking status, body mass index, self-rated health), physical functioning (self-rated physical functioning, physical performance), knee pain, and psychosocial functioning (social support, depression) were measured. RESULTS: Problems with sleep onset, sleep maintenance, and early morning awakenings occurred at least weekly among 31%, 81%, and 51% of participants, respectively. Bivariate correlates of greater sleep disturbance in those with OA were less education, cardiovascular disease, more arthritic joints, poorer self-rated health, poorer physical functioning, poorer physical performance, knee pain, depression, and less social support. In regression analyses, each set of variables representing the domains of health, physical functioning, pain, and psychosocial functioning contributed to the prediction of sleep disturbance beyond the demographic set. Finally, in a simultaneous model, white race (trend, P = .06), poorer self-rated health, poorer physical functioning, and depressive symptoms were predictive of sleep disturbance. CONCLUSIONS: Sleep disturbance is common in older adults experiencing knee pain or knee pain with radiographic evidence of OA and is best understood through the consideration of demographic, physical health, physical functioning, pain, and psychosocial variables. Interventions that take into account the multidetermined nature of sleep disturbance in knee pain or knee OA are most likely to be successful.

Activities of Daily Living↗

Above-knee versus below-knee stockings in total knee arthroplasty.

INTRODUCTION: Graduated compression stockings are frequently used following arthroplasty surgery for deep vein thrombosis (DVT) prophylaxis. There are often strongly held beliefs regarding whether below-knee or above-knee stockings should be used in total knee joint replacement. Many surgeons argue that below-knee stockings are more likely to induce wound complications because of increased swelling above the stocking and the elastic causing localised pressure on the wound. PATIENTS AND METHODS: This study is a prospective comparison of above and below-knee stockings in patients undergoing total knee joint replacement. A total of 50 patients were recruited and studied - 23 patients in the above-knee stocking group and 24 in the below-knee group. Swelling around the knee was measured over the course of an in-patient stay, together with wound complication rates and patients' preference. RESULTS: No statistical difference was found between the groups and no difference in wound complication rates was determined. CONCLUSIONS: Below-knee stockings are safe following total knee replacement and are preferred by patients.

Aged↗

Knee motion in total knee arthroplasty. A roentgen stereophotogrammetric analysis of the kinematics of the Tricon-M knee prosthesis.

The three-dimensional kinematics of the Tricon-M knee prosthesis during active knee flexion and extension were recorded in 11 patients with arthrosis or rheumatoid arthritis using roentgen stereophotogrammetric analysis. Twenty-three normal knees constituted the control group. The prosthetic knees displayed the same degrees of freedom regarding rotational and translational movements as the normal knees, although the kinematics were different. A combination of internal rotation, abduction, and lateral translation of the tibia was recorded during flexion, and the reversed movements were recorded during extension. During the first 25 degrees of flexion, these movements were small, reflecting the high congruency between the articular surfaces, while beyond 25 degrees they increased. The normal knees displayed a combination of internal rotation, adduction, and medial translation of the tibia during flexion and the reversed movements during extension. The prosthetic knees also exhibited an increased posterior displacement during increasing flexion when compared with the normal knees. There was a correlation between the positioning of the femoral component in the sagittal plane and the recorded anterior/posterior translations. In conclusion, the kinematics of the Tricon-M knee prosthesis significantly differ from the normal knee, probably because of the design of the prosthesis and the absence of the cruciate ligaments.

Aged↗

In healthy subjects without knee osteoarthritis, the peak knee adduction moment influences the acute effect of shoe interventions designed to reduce medial compartment knee load.

The purpose of this study was to evaluate shoe sole material stiffness changes and angle changes that are intended to reduce the peak knee adduction moment during walking. Fourteen physically active adults were tested wearing their personal shoes (control) and five intervention pairs, two with stiffness variations, two with angle variations, and a placebo shoe. The intervention shoes were evaluated based on how much they reduced the peak knee adduction moment compared to the control shoe. An ANOVA test was used to detect differences between interventions. Linear regression analysis was used to determine a relationship between the magnitude of the knee adduction moment prior to intervention and the effectiveness of the intervention in reducing the peak knee adduction moment. Peak knee adduction moments were reduced for the altered stiffness and altered angle shoes (p < 0.010), but not for the placebo shoe (p = 0.363). Additionally, linear regression analysis showed that subjects with higher knee adduction moments prior to intervention had larger reductions in the peak knee adduction moment (p < 0.010). These results demonstrate that shoe sole stiffness and angle interventions can be used to reduce the peak knee adduction moment and that subjects with initially higher peak knee adduction moments have higher reductions in their peak knee adduction moments.

Adult↗

Immediate effects of a knee brace with a constraint to knee extension on knee kinematics and ground reaction forces in a stop-jump task.

BACKGROUND: A small knee flexion angle in landing tasks was identified as a possible risk factor for noncontact anterior cruciate ligament injuries that are common in sports. HYPOTHESIS: A specially designed knee brace with a constraint to knee extension would significantly increase the knee flexion angle at the landing of athletic tasks preceded with horizontal movement components, such as stop-jump tasks. STUDY DESIGN: Repeated measure design for brace effects. METHODS: Three-dimensional videographic and force plate data were collected for 10 male and 10 female recreational athletes performing a stop-jump task with and without the specially designed brace. Knee flexion angle at landing, maximum knee flexion angle, and peak ground reaction forces during the stance phase of the stop-jump task were determined for each subject with and without the knee brace. RESULTS: The knee brace decreased the knee flexion angle at the landing by 5 degrees for both genders but did not significantly affect the peak ground reaction forces during the landing. CONCLUSIONS: The specially designed knee brace may be a useful device in the prevention and rehabilitation of noncontact anterior cruciate ligament injuries in sports.

Adolescent↗

Pre-surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty.

This study tested if abnormal sagittal knee joint loading patterns after total knee arthroplasty (TKA) were present pre-surgery, and if patterns with higher external knee flexion moments were related to the presence and severity of post-surgery anterior knee pain. Gait analysis and clinical evaluation were performed on 34 patients (41 arthroplasties) both before and 12-18 months after TKA, and on 20 healthy age-matched controls at matched velocities. The majority of knees with abnormal flexor or extensor sagittal knee joint loading patterns post-surgery (18 of 26, 69%) also displayed these patterns pre-surgery. Knee joint loading in the early mid-stance phase of walking prior to surgery was identified by stepwise regression as a significant predictor of the presence (exp(beta)=2.9, CI: 1.2-6.8, p=0.017) and severity of post-surgery anterior knee pain (R2=0.314, p=0.019). Therefore, the frequency and severity of anterior knee pain after TKA can be partially explained by retained pre-surgery gait patterns that had higher external flexion moments in the early mid-stance phase, which place higher forces on the patellofemoral joint.

Arthroplasty, Replacement, Knee↗

Muscle balance at the knee--moment arms for the normal knee and the ACL-minus knee.

Forces, moments and stresses at the knee are dependent upon external and internal loading factors including muscle forces, segmental position and velocity, load carried, and the moment arms (mechanical advantage) of the muscle-tendon units. Requisite to prediction of forces and moments is a detailed understanding of effective moment arms throughout the knee range-of-motion (ROM). Existing muscle models for the knee are based upon limited static studies of only a few preserved specimens. The objectives of this report are to develop a comprehensive description of muscle-tendon moment arms for the normal knee and the anterior cruciate ligament (ACL)-minus knee during flexion-extension motion. Recent research results describe two nonorthogonal, nonintersecting axes of motion for the knee--one describing flexion-extension (FE) and the other longitudinal rotation (LR, equivalent to internal-external rotation). The effective flexion-extension moment arms of the muscles crossing the knee were developed with respect to the FE axis in 15 fresh, hemi-pelvis cadaver specimens. The normal moment arms for each of 13 muscles plus the patellar tendon exhibited variable, yet repeatable and recognizable patterns throughout the ROM. For most muscles there was no significant difference between the normal and ACL-minus moment arms. The results provide a basis for more accurate predictions of joint reaction forces and moments as well as useful knowledge for practitioners and therapists to assist in the assessment of muscle balance at the knee following injury, repair, and throughout rehabilitation.

Adult↗

Selection of knee radiographs for trials of structure-modifying drugs in patients with knee osteoarthritis: a prospective, longitudinal study of Lyon Schuss knee radiographs with the definition of adequate alignment of the medial tibial plateau.

OBJECTIVE: The quality of medial tibial plateau (MTP) alignment, which is assessed by measuring the distance between the anterior and posterior margins (intermargin distance [IMD]) of the tibial plateau, and the reproducibility of alignment in serial radiographs are suggested to be key elements in determining the accuracy and sensitivity to change in knee radiographs in patients with tibiofemoral osteoarthritis (OA). We evaluated the influence of both MTP alignment and radiograph superimposition on the sensitivity to change in radiographic joint space narrowing (JSN) in knee OA. METHODS: The study group comprised 106 patients with knee pain (73 with OA). Lyon schuss radiographic images of the knee were obtained twice (at baseline [month 0] and 12 months later), using a standardized radiographic procedure. Computerized measurement of the IMD for the assessment of MTP alignment was compared with the grading of MTP alignment by 2 observers using a 5-point scale (excellent, good, fair, poor, bad). To obtain the rate of JSN, computerized measurement of the joint space width was performed at month 0 and month 12. The sensitivity of the joint space width to change over 1 year was evaluated by the standardized response mean (SRM). RESULTS: The mean (+/-SD) IMD was 1.2 +/- 0.9 mm. The correlation between scoring and computer measurement of MTP alignment was highly significant. The cutoff value for satisfactory alignment (excellent or good) was an IMD of </=1.2 mm. In OA knees, the mean (+/-SD) annual rate of JSN and the SRM were statistically higher in knees with an IMD of </=1.2 mm at both month 0 and month 12 (0.34 +/- 0.50 mm and 0.68, respectively) than in knees with an IMD of >1.2 mm at month 0 and/or month 12. CONCLUSION: The quality of MTP alignment at both baseline and the end point highly influences the sensitivity to change in radiographic JSN in knee OA. To obtain relevant data, only radiographs showing an IMD of </=1.2 mm at both baseline and the end point would have to be analyzed in studies of structure-modifying OA drugs.

Clinical Trials as Topic↗

Knee extension torque during repeated knee extension-flexion reversals and separated knee extension-flexion dyads.

I measured the knee extension torque, produced by eight hemiparetic patients during repeated knee extension-flexion reversals and during separated knee extension-flexion dyads, to determine the effect of "reversal of antagonists" on knee extension torque. The hemiparesis in these eight patients was secondary to intracranial lesions. I tested their involved lower extremity on an isokinetic dynamometer at 60 degrees/sec. Using a sequential medical-trials design, I found knee extension torque to be significantly greater during repeated knee extension-flexion reversals than during separated knee extension-flexion dyads (p less than .05). I, therefore, concluded that reversal of antagonists may facilitate knee extension torque production in the type of patients tested, under the specific conditions of their testing.

Adult↗

Internal/external rotation moment arms of muscles at the knee: moment arms for the normal knee and the ACL-deficient knee.

Knowledge of the three-dimensional balance of loads at the knee joint is required to adequately assess the treatment and rehabilitation of the malfunctioning knee. This report focuses upon the moment arms for the knee in internal/external (IE) rotation motion. It augments prior work that defined flexion/extension moment arms. Muscle excursions and angular motion of the lower leg during IE rotation were measured in 17 fresh-frozen hemi-pelvis specimens. Moment arms were calculated as the derivatives of excursion with respect to the angle. Rotational motion was performed for the normal and anterior cruciate ligament (ACL)-deficient knee. Of the 13 muscles measured at the knee, seven were significant contributors to IE rotation: the biceps femoris long and short head externally rotate opposite the gracilis, sartorious, semimembranosis, semitendonosus and popliteus, functioning as internal rotators. Moment arm magnitudes were greatest with the knee in a flexed position (internal [external] rotators peaked at 70 degrees [90 degrees] flexion). At 30 degrees flexion, the IE rotation moment arm minima and maxima were 10.1-11.6, 6.8-9.0, 6.0-15.7, 8.2-14.1 and 0.0-10.4 mm for the semimembranosis, semitendonosus, gracilis, sartorius and popliteus, and 14.7-27.9 and 18.5-31.5 mm for the biceps femoris short and long, respectively. Moment arms for the ACL-deficient condition were significantly changed only at extremes of flexion-extension.

Adult↗

The Knee Clinical Assessment Study--CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population.

BACKGROUND: Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities but the clinical usefulness of these two approaches to classifying knee pain in older adults has not been established. We plan to conduct a prospective, population-based, observational cohort study to investigate the relative merits of disease-based and regional pain syndrome-based approaches to classification and prognosis of knee pain in older adults. METHODS: All patients aged 50 years and over registered with three general practices in North Staffordshire will be invited to take part in a two-stage postal survey. Respondents to this survey phase who indicate that they have experienced knee pain within the previous 12 months will be invited to attend a research clinic for a detailed assessment. This will consist of clinical interview, physical examination, digital photography, plain x-rays, anthropometric measurement and a brief self-complete questionnaire. All consenting clinic attenders will be followed up by (i) general practice medical record review, (ii) repeat postal questionnaire at 18-months.

Aged↗

Improved range of flexion after total knee arthroplasty. The total condylar knee versus the KU knee.

One objective of the modification of the total condylar knee is to increase the range of flexion without compromising the durability of the prosthesis. The KU knee prosthesis was designed to improve postoperative range of motion. This prosthesis has a unique ball-and-socket joint in the center of the posterior portion of the femorotibial articulation. A retrospective comparative study was undertaken to determine whether the KU knee prosthesis had achieved its design objectives. The study was based on the clinical observation of two populations: one (the TC group: 31 joints) with total condylar prostheses and the other (the KU group; 31 joints) with KU knee prostheses. At two years postoperatively, the mean postoperative range of flexion was 94 degrees (range: 60 degrees to 120 degrees) in the TC group and 120 degrees (range: 95 degrees to 150 degrees) in the KU group. The mean postoperative range of flexion was 24 degrees better in the KU group than in the TC group (p < 0.01). The mean functional score was 76 points (range: 61 to 86) in the TC group and 81 points (range: 56 to 92) in the KU group. There were no statistically significant difference in pain, walking ability, deformity, extension lag, and activities of daily living (ADL) score between the two groups. However, a statistically significant difference was detected in the range of motion (ROM) score (p < 0.01). No major complications occurred in either of the two groups. Although the follow-up period was not long enough, the KU knee was thought to be a promising modification of the total condylar knee prosthesis.

Activities of Daily Living↗

The Knee Clinical Assessment Study-CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population: baseline recruitment and retention at 18 months.

BACKGROUND: Selective non-participation at baseline (due to non-response and non-consent) and loss to follow-up are important concerns for longitudinal observational research. We investigated these matters in the context of baseline recruitment and retention at 18 months of participants for a prospective observational cohort study of knee pain and knee osteoarthritis in the general population. METHODS: Participants were recruited to the Knee Clinical Assessment Study-CAS(K)--by a multi-stage process involving response to two postal questionnaires, consent to further contact and medical record review (optional), and attendance at a research clinic. Follow-up at 18-months was by postal questionnaire. The characteristics of responders/consenters were described for each stage in the recruitment process to identify patterns of selective non-participation and loss to follow-up. The external validity of findings from the clinic attenders was tested by comparing the distribution of WOMAC scores and the association between physical function and obesity with the same parameters measured directly in the target population as whole. RESULTS: 3106 adults aged 50 years and over reporting knee pain in the previous 12 months were identified from the first baseline questionnaire. Of these, 819 consented to further contact, responded to the second questionnaire, and attended the research clinics. 776 were successfully followed up at 18 months. There was evidence of selective non-participation during recruitment (aged 80 years and over, lower socioeconomic group, currently in employment, experiencing anxiety or depression, brief episode of knee pain within the previous year). This did not cause significant bias in either the distribution of WOMAC scores or the association between physical function and obesity. CONCLUSION: Despite recruiting a minority of the target population to the research clinics and some evidence of selective non-participation, this appears not to have resulted in significant bias of cross-sectional estimates. The main effect of non-participation in the current cohort is likely to be a loss of precision in stratum-specific estimates e.g. in those aged 80 years and over. The subgroup of individuals who attended the research clinics and who make up the CAS(K) cohort can be used to accurately estimate parameters in the reference population as a whole. The potential for selection bias, however, remains an important consideration in each subsequent analysis.

Aged↗

Knee arthroplasty for spontaneous osteonecrosis of the knee: unicompartimental vs bicompartimental knee arthroplasty.

Spontaneous osteonecrosis of the knee (SON) is an osteonecrosis that mainly affects the medial femoral condyle. In endstage SON, knee arthroplasty is the therapy of choice. Because of the unicompartimental nature of the knee, unicondylar knee arthroplasty is considered an ideal implant for treatment of this condition. The purpose of this study was to prove that the long-term results of unicondylar implants are better than the results of bicondylar implants for the treatment of SON. All patients treated for SON between 1984 and 2000 have been recorded. Two groups were formed according to the implant used. In all patients the preoperative radiograph was analyzed according to stage and size of the osteonecrotic lesion and the osteoarthritic changes. Postoperatively, the Knee Society Score and the radiograph were recorded. Thirty-nine patients were included in this study, of which 23 patients were treated by a unicondylar implant and 16 by a bicondylar implant. On a short-term basis, unicondylar implants had better clinical results; however, on a long-term basis bicondylar implants were better. In comparison, only unicondylar implants had to be revised. Radiolucency lines were mainly observed in patients with unicondylar impants and large areas of osteonecrosis. Our long-term results suggest that patients with SON are better treated by bicondylar implants. The reasons for the higher failure rate for unicondylar implants are poor bone stock and secondary arthritic changes.

Aged↗

The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries.

The purpose of this study was to contrast the magnetic resonance imaging appearance of uninjured components of the posterolateral knee with that of injured structures, and to assess the accuracy of magnetic resonance imaging in identifying posterolateral knee complex injuries. Thin-slice coronal oblique T1-weighted images through the entire fibular head were used to identify the posterolateral structures in seven uninjured knees. The appearance of corresponding grade III injuries to these structures was identified prospectively in 20 patients and verified at the time of surgical reconstruction. The sensitivity, specificity, and accuracy of imaging for the most frequently injured posterolateral knee structures in this series were as follows: iliotibial band-deep layer (91.7%, 100%, and 95%), short head of the biceps femoris-direct arm (81.3%, 100%, and 85%), short head of the biceps femoris-anterior arm (92.9%, 100%, and 95%), midthird lateral capsular ligament-meniscotibial (93.8%, 100%, and 95%), fibular collateral ligament (94.4%, 100%, and 95%), popliteus origin on femur (93.3%, 80%, and 90%), popliteofibular ligament (68.8%, 66.7%, and 68%), and the fabellofibular ligament (85.7%, 85.7%, and 85.7%). Magnetic resonance imaging of the knee was accurate in the identification of these injuries.

Humans↗