Background: Kneeling is an important function for many activities of daily life including employment, social and religious practices. Different activities require different patterns of kneeling (upright and high flex kneeling patterns). This study investigates patients' perception of kneeling ability. Methods:Three hundred consecutive patients undergoing Total Knee Arthroplasty (TKA) in Royal Infirmary of Edinburgh received patient specific kneeling ability questionnaires along with the Oxford Knee Score (OKS) preoperatively and one year after surgery. The 'kneeling ability questionnaire was constructed to determine: (1) The ability to adopt one or more of 4 kneeling positions demonstrated in 4 simple illustrations rated on a 4-point Likert scale (0= Impossible, 1=with extreme difficulty, 2=with moderate difficulty, 3=with little difficulty, 4=Easily) pre-operatively and one-year postoperative. The kneeling positions represent different degrees of knee flexion and knee contact with the ground. (2) If unable to kneel, the reason for the inability to kneel. (3) Specific instructions about kneeling given by health care professionals before and after surgery.Results: 251 patients (147 women and 104 men) responded and completed the questionnaires (response rate 84%). The main reasons for kneeling difficulties were pain (111/251), medical problems (77/251), and numbness around the knee (41/251). Most of the patients (147/251 i.e., 63.6%), received advice regarding kneeling before or after TKA; 132 patients (59%) were advised not to kneel after TKAs from the arthroplasty nurse practitioner, 45 patients (20%) received the advice not to kneel after TKAs from their consultants, 29 patients (13%) received the advice not to kneel from their GPs and 9 patients (4%) received the advice not to kneel from their physiotherapists. One hundred and eighty three patients responded to both OKS kneeling question and the kneeling questionnaire preoperatively, and one year after surgery, 15 patients could kneel easily before TKA, this number decreased to 5 patients after TKA; on the other hand 51 patients answered impossible to kneel before TKA and this number increased to 72 patients after TKA. The positive correlation noticed between the OKS kneeling question and the kneeling questionnaire responses showed the strong correlation with the upright kneeling patterns. The data suggest that a high percentage of TKA patients experience postoperative kneeling difficulties. 96% of patients responded that were advised by a health care professionals not to kneel. Conclusion:1. Kneeling is a problem to many patients after TKA. This may have important consequences for work/religious and social life after TKA. 2. Patients are frequently advised not to kneel after TKA. The higher percentage could be because of miss-understanding of the advice. 3. Kneeling questionnaire correlates well with OKS kneeling question. 4. Kneeling is not a single position of the knee and can be interpreted in different ways by different patients.
Objectives: To investigate the retro-patellar cartilage (RPC) morphology and the patterns of retropatellar cartilage wear as well as the patients' kneeling ability to determine whether the kneeling ability is related to the area and pattern of wear in the cartilage.Methods: 30 patients undergoing primary TKAs participated in this study. The patients were seen in the preoperative assessment clinics and consented to allow intraoperative photographing of their retro patellar cartilage. These photographs were used to determine the area and pattern of wear by using Image J software. The total area of the retropatellar cartilage and the area of wear was measured and used to calculate the percentage of RPC wear. The percentages of retro patellar cartilage wear for all the patients were linked with their kneeling ability before the surgery.Results: 15 patients (cases numbered 1-15, termed group A) were able to kneel, and 15 patients (cases numbered 16-30, termed group B) were unable to kneel. The % of wears for all RPC images measured 3 times with a week interval and the average of the records in the 1st, 2nd, and 3rd week recorded for statistical analysis. Mean % of RPC wears in-group A was (15%), and in-group B was (36%). Intra-Rater and Inter-Rater Reliability statistically assessed by using Intraclass Correlation Coefficient. Patients who able to kneel (Group A) had normal RPC superior surfaces with no damages in comparison with patients who unable to kneel (Group B) who had damaged superior surfaces medially and laterally. All the RPC surfaces (Superior, Middle and Inferior) were damaged in Group B patients (Unable to kneel). Conclusion:No direct association was found between the retropatellar cartilage damage and the kneeling ability. The most damaged areas were found in the middle and lower thirds of retropatellar cartilage.
Results: This study comprised of 25 patients and followed for minimum of 6 months. Success rate is 100 %, with 92% graded as excellent to good and rest 8 % with fair functional results. Conclusion: We conclude that Anterior Cruciate Ligament reconstruction with quadrupled semitendinosus graft has good functional results and high success rate.
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