Background & Aims: KNEE INSTABILITY has become a debilitating problem among patients with KNEE osteoarthritis which may have many causes and complications. In this study, researchers evaluated the KNEE Flexion Contracture (KFC), function, quality of life, and balance and its relationship with KNEE INSTABILITY (KI). In this study, the researchers investigated the function, quality of life, KNEE Flexion Contracture (KFC), and balance of the patients with KNEE osteoarthritis and its relationship with KNEE joint INSTABILITY. Materials & Methods: In this double-blinded case-control study, 60 females with KNEE osteoarthritis participated and divided into two groups (30 in each) of osteoarthritis (mean age: 52. 80) and without KNEE INSTABILITY (mean age: 54. 43) based on the KNEE INSTABILITY index scores. Pain was evaluated with a visual analog scale(VAS), KFC with a universal goniometer, performance with WOMAC, and physical performance of the patients with the time up and go (TUG) and and time of up and down stairs tests, quality of life with the SF36 questionnaire, and balance with the Single Leg Lift test. Data were analyzed by SPSS version 22 software and independent sample t-test at a significance level of 0. 05. Results: The mean scores of KFC showed significantly difference between the two groups with and without KI (right foot: P=0. 0001, left foot: P=0. 001). Also, the mean scores of pain, fall times, WOMAC, physical function, quality of life, and One-legged balance were significantly different between groups (P=0. 0001 in all variables). Regarding the time of up and down stairs, there was no significant difference between the two groups (P=0. 057), although the difference between them was significant in the descent time (P=0. 0001). Conclusion: According to the findings of this study, it was found that there was a significant difference between the two groups of osteoarthritis with and without KI in pain, function, KFC, quality of life, and One-legged balance, which paying attention to the causes and side effects of this problem makes it more clear.

Background and Aim: COMBINED anterolateral and posterolateral rotary INSTABILITY are treated by correcting KNEE alignment, Anterior Cruciate Ligament (ACL) reconstruction and repair or reconstruction of the Posterolateral Complex (PLC). Because of technical difficulties encountered in these operations and the need for more than tow stages, and considering the controversy among the importance of Posterolateral Complex (PLC) in valgue KNEE, this study was performed to treat this INSTABILITY by ACL reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex and further extra-articular manipulation. Methods: This clinical trial was performed on 29 patients (29 KNEEs) with COMBINED anterolateral and posterolateral rotary INSTABILITY. Subjective and objective INSTABILITY signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, 2 and Wilcoxon tests were used to analyze data. Results: Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special INSTABILITY tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports. Conclusion: Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and posterolateral complex, is sufficient to cure this INSTABILITY, avoiding unneeded complications and longer rehabilitation.

BACKGROUND: The treatment of COMBINED anterolateral posterolateral rotary INSTABILITY has been done by correcting KNEE alignment, anterior cruciate ligament (ACL) reconstruction plus repair or reconstruction of the posterolateral complex. Because of the technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the role of posterolateral complex (PLC) in valgus KNEEs, this study was designed to observe the results of treating this INSTABILITY by ACL-reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex or further extra-articular manipulation.METHODS: This was a clinical trial performed on 29 patients (29 KNEEs) with COMBINED anterolateral posterolateral rotary INSTABILITY. Subjective and objective INSTABILITY signs were recorded. Arthroscopy was then performed and a valgus osteotomy was done to correct alignment. Then in a second stage, an ACL-reconstruction was carried out. Results, after a mean of 23 months follow-up, were compared to the conditions before surgery. Fisher exact test, X2 and Wilcoxon tests were used to analyze the data. P<0.05 was considered to be meaningful.RESULTS: Pain was relieved in more than half and locking was improved in all of the patients. Giving way of the KNEE was diminished from 79.3% to 6.9%. Special INSTABILITY tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports.CONCLUSIONS: Based on the results of this study, ACL-reconstruction alone, after correction of varus, can be sufficient to address this COMBINED KNEE INSTABILITY without farther procedures on extra-articular structures and posterolateral complex, thus avoiding unnecessary complications and longer rehabilitation.

Background: Persistent INSTABILITY following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48%. Surgery is indicated when conservative management fails to produce a satisfactory functional outcome. Associated intraarticular lesions of talus or extraarticualr lesions like peroneus Brevis tendon injuries can impact the functional outcome of lateral ankle reconstruction. The aim of this study was to report our short-term experience and treatment of concomitant lesions in chronic lateral ankle INSTABILITY.Methods: 18 patients, aged 21 to 45 years with recurrent ankle sprain and lateral ankle INSTABILITY who had not responded to at least 3 months conservative treatment and had underwent direct lateral ligament repair were studied. All the patients received ankle arthroscopy and exploration of peroneus Brevis tendon before repair of anterior talofibular and calcaneofibular ligaments with 14 months (6-22 months) follow-ups. The cases were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score.Results: The mean duration of injury was 19 months. In the diagnostic ankle arthroscopy, 6 patients had some degree of talar chondral lesions, two requiring shaving and drilling. Preoperatively, all patients had poor scores (<50).Postoperatively, 14 (79%) ankles obtained excellent and 4 (21%) good scores.Conclusion: Chronic lateral ankle INSTABILITY is often associated with concomitant injuries to peroneus Brevis and talar cartilage. Direct repair of anterior talofibular and calcanofibular ligaments is an effective procedure.

Background: Posterolateral rotatory INSTABILITY is one of the most complex problems in ligamentous injuries of the KNEE. It represents a challenging diagnostic and therapeutic problem for the orthopaedic surgeon. We present the results of biceps tenodesis in chronic posterolateral rotatory instabilily of the KNEE.Methods: In this case series we included all of the patients with positive reverse pivot shift test and prone external rotation test at least 3 weeks after their trauma. We excluded the patients with varus malalignment of the KNEE and concomitant anterior cruciate ligament (ACL) rupture. Biceps tenodesis (Clancy method) was performed. We did not reconstruct posterior cruciate ligament (PCL) if its insufficiency was diagnosed in addition to posterolateral rotatory INSTABILITY. KNEE scoring scale of Lysholm was used during and after follow ups. The results were statistically compared using Wilcoxon signed rank test (WSRT), paired samples t-test and friedman test. Data analysis was done using SPSS (version 11.5) and Stata (version 8) computer software’s.Results: Our series consists of 13 patients (12 male and one female). 31% of the patients had isolated posterolateral injury and 69% of the patients had COMBINED posterolateral and PCL injuries. The patients were between 17 to 45 years old (mean 30.25 years). Follow up was between 4 to 44 months (mean: 31 months). At the end of follow up 85% of patients had negative reverse pivot shift test. Prone external rotation test at 30o of KNEE flexion was negative in 92% of patients. In 92% of patients giving way was negative and in 77% of patients pain was decreased. Before operation the average KNEE scoring scale of Lysholm was 73 and at the end of the follow up it increased to 85 (p value<0.001).Conclusions: Biceps tenodesis using Clancy method is a safe, effective and reliable method in management of chronic posterolateral rotatory INSTABILITY of the KNEE. During surgery careful exploration of the common peroneal nerve is recommended. Although we found this method effective in COMBINED posterolateral and PCL injuries the results are much better in the cases with isolated posterolateral injuries.

Background and Aim One of the common problems among patients suffering from Osteoarthritis, is KNEE INSTABILITY, which can effect on patients physical functional. The purpose of this study was to investigate of self-report INSTABILITY on gait parameters, dynamic gait, balance and quality of life in patients suffering from Osteoarthritis. Materials and methods In this cross-sectional study, 68 patients with Osteoarthritis after confirmed by specialized and having inclusion criteria, were participated in the study. 31 patients with self-report INSTABILITY put on INSTABILITY group and 37 patients without put on without INSTABILITY group. Berg test for balance, foot trace for gait pattern, WOMAC for function, SF36 for quality of life, Up and Go test(UGT)-going up and down stairs-40 meter walking for physical function, were used. to compare means, Independent sample t-test with α =0. 05 and confidence interval %95 was used. Results the results showed that a significant difference in Berg scores between groups (p=0. 016). As well it was significant between groups in 3 parameter related to daily physical activities UGT (p=0. 016), going up and down stairs (p=0. 027 and p=0. 05). About WOMAC, Groups had significant difference only in the joint stiffness (p=0. 04). But, two groups hadn’ t difference in dynamic gait indicator parameters, gait pattern and quality of life (p>0. 05). Conclusion based on the effect of INSTABILITY on some key factors of daily physical activities and prevention of falling in Osteoarthritis patients, it is recommended that specialists and physiotherapists identifying patients with osteoarthritis with INSTABILITY before any rehabilitation program and intervention to design right solutions of improvement.

Introduction: Previous studies suggest that hip muscle weakness may contribute to patellofemoral pain (PFP). Accordingly, addition of hip strengthening exercises to conventional KNEE exercises was recommended for treatment of PFP. However, evidence to support superior efficacy of additional hip exercises in treatment of PFP is limited. This study compared the clinical efficacy of KNEE exercises versus COMBINED KNEE and hip exercises in females with PFP.Materials and Methods: In this randomized clinical trial 60 females with PFP were randomly assigned into two groups: “the KNEE exercises” and “the KNEE and hip exercises”. Participants performed progressive therapeutic exercises 3 times a week for 4 weeks. Pain, muscle strength (the KNEE extensors, the hip abductors and the hip external rotators) and physical function were evaluated before and after treatment interventions using Visual Analogue Scale (VAS), a dynamometer, and step-down test, respectively.Results: Both groups showed significant improvements in pain, function, and the KNEE extensor, hip abductor and hip external rotator muscles strength after the interventions (P<0.001). There were no significant differences in muscle strength, pain and function between the groups (P>0.05).Conclusion: Four weeks of either KNEE exercises or COMBINED KNEE and hip exercises significantly improve function and reduce pain in women with PFP. Addition of hip strengthening exercises to conventional KNEE exercises was not associated with superior treatment outcomes.

Background: Fractures of the KNEE account for about 6% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome.Objectives: This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of KNEE INSTABILITY and health-related quality of life.Patients and Methods: This retrospective, cross-sectional, cohort study was carried out on 80 patients with either isolated proximal tibial (n=42) or distal femoral (n=38) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic KNEE surgeon for clinical assessment of KNEE INSTABILITY. In their last follow-up visit, these patients completed a Lysholm KNEE score and the short-form (SF) 36 health survey.Results: Among the 42 tibial plateau fractures, 25% were classified as Schatzker type 2. Of the 38 distal femoral fractures, we did not find any type B1 or B3 fractures. The overall prevalence of anterior and posterior INSTABILITY was 42% and 20%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in 50% and 28%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) 26%, Posterior Collateral Ligament (PCL) 7%, MCL 24%, and LCL 14%. Medial collateral ligament injury was the most common in the Schatzker type 2 (50% of the injuries). Distal femoral fractures were associated with ACL injury in 16%, PCL in 13%, MCL in 26% and LCL in 14%. However, final KNEE range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at 30°KNEE flexion, which was more positive in tibial fractures. All eight domains of SF-36 score in the distal femoral and proximal tibial fractures were significantly different from the normal values, however, there were no statistically significant differences between femoral and tibial fracture scores.Conclusions: Although ROM is acceptable in KNEE joint fractures, INSTABILITY is common. However, it seems that KNEE function and quality of life are not associated with the location of the fracture.