Arthur L. Boland

Development and Validation of the International Knee Documentation Committee Subjective Knee Form

A committee of international knee experts created the International Knee Documentation Committee Subjective Knee Form, which is a knee-specific, rather than a disease-specific, measure of symptoms, function, and sports activity. The purpose of this study was to evaluate the reliability and validity of the new International Knee Documentation Committee Subjective Knee Form. To provide evidence for reliability and validity, we administered the final version of the form, along with the Short Form-36, to 533 patients with a variety of knee problems. Analyses were performed to determine reliability, validity, and differential item function related to age, sex, and diagnosis. Factor analysis revealed a single dominant component, making it reasonable to combine all questions into a single score. Internal consistency and test-retest reliability were 0.92 and 0.95, respectively. Based on test-retest reliability, the value for a true change in the score was 9.0 points. The International Knee Documentation Committee Subjective Knee Form score was related to concurrent measures of physical function (r = 0.47 to 0.66) but not to emotional function (r = 0.16 to 0.26). Analysis of differential item function indicated that the questions functioned similarly for men versus women, young versus old, and for those with different diagnoses. In conclusion, the International Knee Documentation Committee Subjective Knee Form is a reliable and valid knee-specific measure of symptoms, function, and sports activity that is appropriate for patients with a wide variety of knee problems. Use of this instrument will permit comparisons of outcome across groups with different knee problems.

Responsiveness of the International Knee Documentation Committee Subjective Knee Form

Background and Purpose The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form. Study Design Cohort study (diagnosis); Level of evidence, 1. Methods Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patients perception of change on the global rating of change scale. In addition, a receiver operating characteristic curve was plotted to determine the change in score that best distinguished patients who improved from those who did not. Results The overall standardized response mean was 0.94, which is considered large. With the exception of those who were slightly worse or unchanged, the mean change in the International Knee Documentation Committee Subjective Knee Form score compared to the patients’ perceived global ratings of change was as expected (greatly worse,–15.1; somewhat worse,–8.4; slightly worse, 20.6; no change, 10.7; slightly better, 5.9; somewhat better, 18.1; greatly better, 38.7). The receiver operating characteristic curve analysis revealed that a change score of 11.5 points had the highest sensitivity, and a change score of 20.5 points had the highest specificity to distinguish between those who were or were not improved. Conclusion The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.

Current concepts. Concussion in sports.

This is a special report of the findings of the Concussion Workshop, sponsored by the AOSSM in Chicago in December 1997. Here follows a listing of the members of the workshop: Julian Bailes, MD, American Association of Neurological Surgeons; Arthur Boland, MD, AOSSM; Charles Burke III, MD, National Hockey League; Robert Cantu, MD, American College of Sports Medicine; Letha “Etty” Griffin, MD, National Collegiate Athletic Association; David Hovda, PhD, Neuroscientist, UCLA School of Medicine; Mary Lloyd Ireland, MD, American Academy of Orthopaedic Surgeons; James Kelly, MD, American Academy of Neurology; Greg Landry, MD, American Academy of Pediatrics; Mark Lovell, PhD, Neuropsychology Specialist, Henry Ford Health Systems; James Mathews, MD, American College of Emergency Physicians; Michael McCrea, PhD, Neuropsychology Specialist, Waukesha Memorial Hospital; Douglas McKeag, MD, American Medical Society for Sports Medicine; Dennis Miller, ATC, National Athletic Trainers Association; Jeffrey Minkoff, MD, AOSSM; Stephen Papadopoulus, MD, Congress of Neurological Surgeons; Elliott Pellman, MD, National Football League; Richard Quincy, MS, PT, ATC, Sports Physical Therapy, El Pomar Sports Center; Herbert Ross, DO, American Osteopathic Academy of Sports Medicine; Bryan Smith, MD, National Collegiate Athletic Association; and Edward Wojtys, MD, Workshop Chairman, AOSSM. The views in this report do not necessarily represent the views of the entire group comprising the Concussion Workshop Group.

The Effects of Donor Age and Strain Rate on the Biomechanical Properties of Bone-Patellar Tendon-Bone Allografts

Over 50% of all knee injuries involve partial or com plete tear of the anterior cruciate ligament. Surgical reconstruction of this ligament using an isometrically placed bone-patellar tendon-bone autograft is the cur rent technique of choice; however, harvest of patellar tendon as a free graft can lead to increased morbidity. To address this issue, allogenic patellar tendon grafts have been introduced as alternatives to autogenic graft material. The purpose of this study was to exam ine effects of age and strain rate on tensile strength, modulus, and failure mode of bone-patellar tendon- bone allografts from a typical population of tissue do nors. Eighty-two, fresh-frozen, bone-patellar tendon- bone allografts were harvested from 25 different donors, aged 17 to 54. Paired grafts from individual patellar tendons were assigned randomly to tensile testing at either 10% or 100% elongation per second. Tensile strength, modulus, and failure mode were not significantly different for tests conducted at these 2 strain rates. Correlations between tensile strength and age were not significant for tests conducted at either strain rate. Specimens tested at a strain rate of 100% per second exhibited weak but significant negative correlation between modulus and age, with modulus decreasing 25% over the age range examined.

Three-dimensional dynamic motion analysis of the anterior cruciate ligament deficient knee joint

Dynamic three-dimensional motion analyses of 15 fresh human knee joints subjected to combinations of flexion velocity and moment, internal and external femoral torque, and horizontal shear before and after sectioning the ACL were performed. ACL deficient specimens demonstrated marked anterior instability without rota tional instability. The pivot shift phenomenon occurred with an isolated ACL deficiency and was the result of anterior instability. The pivot shift was accentuated by external femoral torque, decreased by internal femoral torque, and was present in the absence of any applied torque. The pivot shift produced a sudden directional change in the motion of both femoral condyles and may be responsible for the meniscal degeneration that ac companies chronic ACL deficiency.

Team Physicians in College Athletics

Background There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. Hypothesis A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Study Design Descriptive epidemiology study. Methods For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the universitys health service were also recorded. Results More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P<. 05). Four percent of musculoskeletal injuries required surgery. Most general medical evaluations were single visits for upper respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P<. 05). Per capita, men and women sought care at an equal rate. In contrast, 10% of physician encounters with the general pool of undergraduates were for musculoskeletal diagnoses. Student athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Conclusion Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

Herodicus, the father of sports medicine

Herodicus (fifth century bc) is the first person in the history of medicine who actually combined sports with medicine. He used to be a sports teacher, who later studied medicine and managed to succeed Euryphon in the medical school of Cnidos, one of the most prominent in ancient Greece together with its neighbor medical school of Cos (Hippocrates’ home). In Cnidos Herodicus formed his own theoretical perspective of medicine. He considered, namely, bad health to be the result of imbalance between diet and physical activity and for this reason he recommended strict diet, constant physical activity and regular training. He believed that this combination was the ideal way to maintain good standards of health and he applied this type of treatment method to his patients. Unfortunately, Herodicus’ works are lost today. However, excerpts of his medical system, which can be traced in ancient texts, support the fact that Herodicus can be considered as the father of sports medicine.