Knee osteoarthritis, degenerative meniscal lesion and osteonecrosis of the knee: Can a simple gait test direct us to a better clinical diagnosis

INTRODUCTION

The purpose of the current study was to compare the gait patterns in patients with three differing knee pathologies - knee osteoarthritis (OA), degenerative meniscal lesion (DML) and spontaneous osteonecrosis of the knee (SONK) and a group of healthy controls.

HYPOTHESIS

A simple gait test will detect differences between different knee pathologies.

MATERIAL AND METHODS

Forty-seven patients with bilateral knee OA, 47 patients with DML, 28 patients with SONK and 27 healthy controls were included in this analysis. Patients underwent a spatiotemporal gait assessment and were asked to complete the Western Ontario and McMaster University (WOMAC) Index and the Short-Form (SF)-36 Health Survey. ANOVA tests, followed by Bonferroni multiple comparison tests and the Chi² tests were performed for continuous and categorical variables, respectively.

RESULTS

Significant differences were found for all gait measures and clinical questionnaires between healthy controls and all knee conditions. Patients with SONK differed from patients with bilateral knee OA and DML in all gait measures and clinical questionnaires, except for WOMAC subscales. There were no significant differences between patients with bilateral knee OA and patients with DML. Symmetry was also examined and revealed asymmetry in some gait parameters in patients with SONK and DML.

DISCUSSION

Based on the differences in gait parameters that were found in the current study, adding an objective functional spatiotemporal gait test may assist in the diagnostic process of knee pathologies.

TYPE OF STUDY

Case Control study Level III.

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Low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a Boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.

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Centaur: the system

This paper describes the organization of the CENTAUR system and its main components. The system is a generic interactive environment. When given the formal specification of a particular programming language-including syntax and semantics — it produces a language specific environment. This resulting environment includes a structure editor, an interpreter/debugger and other tools, all of which have graphic interfaces. CENTAUR is made of three parts: a database component, that provides standardized representation and access to formal objects and their persistent storage; a logical engine that is used to execute formal specifications; an object-oriented man-machine interface that gives easy access to the system's functions. CENTAUR is essentially written in Lisp (Le_Lisp). The logical engine is Prolog (Mu-Prolog). The man-machine interface is built on top of the virtual graphics facility of Le_Lisp, itself primarily implemented on top of X-Windows.

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Kerion treatment

We would like to mention an alternative method for the prevention of colonization of the umbilicus by staphylococcal organisms to the one proposed by Johnson et al. (Pediatrics 58:354, September 1976).

Several years ago, as a response to recommendations by the U.S. Food and Drug Administration to discontinue routine total bathing of newborns with hexachlorophene, we studied alternative methods for the care of newborn infants. Despite the use of plain or green soap for infant bathing and scrupulous attention to hand washing with hexachlorophene by nursery personnel, an increased incidence of staphylococcal colonization and infection was seen in our nursery.

UV protective effects of 5-fluorouracil and thymidine

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