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Background&Objective: To assess the effect of a lateral – wedge insole with subtalar supporting on the femorotibial angle in patients with varus defomrity of the knee. Materials&Methods: The efficacy of a wedged insole with subtalar supporting and that of traditional wedge insole shoe insert were compared. 20 outpatient with knee osteoarthritist were randomized to be treated with either the supported or traditional inserted insole. In both group , the baseline and 2 month koos scores for subjective knee pain and ADL and quality of live and symptoms were compared. Results: At the baseline , there were no significant difference in the femorotibial angle and pain and ADL, quality of life and symptoms, the 10 subjects wearing the subtalar supporting demonstrated a significatly increase femoretibial angle and koos scores without pain compared with insole group, there were no significant difference between twe group in pain after treatment. Conclusion: These results suggest that an insole with a subtalar supporting maintained the valgus correction of the, femoretibial angle in patgle in patients with varus knee OA for 2 months.

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Background and Objective: Weight bearing position is considered as a functional condition. However, available data about it and also knee position sense is little. This study aimed to compare knee joint position sense in weight bearing and non weight bearing positions in men and women, and to determine the effect of target angle on knee joint position sense. Materials and Methods: This interventional study was performed in Zahedan University of medical sciences, Zahedan, Iran in 2006. Forty-four healthy subjects (22 women, 22 men) participated in this study through simple non-probability sampling. Subjects were asked to flex their knees in prone or in standing position, while their eyes closed. Three target angles (45, 60, 90 degrees of knee flexion) were reproduced by each subject. Angle matching errors were measured using an electrogoniometer. Outcomes were collected in form of relative, absolute and variable errors. Data were analyzed using MANOVA test. Results: There was significant difference between weight bearing and non weight bearing positions in terms of angle matching error (P<0.05), while no significant difference was seen between women and men, and also in three target positions. Conclusion: This study showed that subjects are more capable of recognition and identification of the angles during weight bearing position. A larger amount of proprioceptive afferent data may result from sources other than examined knee and lower extremity.

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Background and Objective: Anterior cruciate ligament (ACL) tear is one of the most common knee injuries among young adults and sportman. They need reconstruction when they are accompanying with other knee internal derangements to prevent knee osteoarthritis. This study was designed to explore early complication of anterior cruciat ligament reconstruction with bone-patellar tendon- bone graft. Materials and Methods: This prospective and cross-sectional study was done on 13 patients which refered to Qaem hospital in Mashhad-Iran during 2008. The first 3 months complications and problems of anterior cruciate ligament reconstructions, with bone-patellar tendon, bone graft technique, was recorded on regular basis, symptoms and signs were documented. Results: Anterior knee pain and knee stiffness were common as 70% and 38% respectively. We did not observe any infection but in 15% of patients a minor instability (ADT+) was detected. Patients cooperation was low and even 54% of them did not implement, post-operative advices. Conclusion: This study showed that minor instability and subsequent pain are the early problems during the first three month after anterior cruciate ligament constraction.

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Background and Objective: Osteoarthritis is the most common joint disease and associated with degeneration of the joint cartilage. Its high prevalence, particulary in the elderly, and the high rate of disability related to disease make it a leading cause of disability. The symptoms of osteoarthritis are pain, morning stiffness and joint limited motion. This study was carired out to compare the effects of physical modalities and home based exercise training on symptoms and function of knee osteoarthritis. Materials and Methods: In this randomized clinical trial study, fourty patients with knee osteoarthritis according to the American college of rheumatology (ACR) criteria randomly divided into two treatment groups. The physical modality group (A) received TENS, US and Hot pack at pain areas. The exercise group (B) received isometric exercise of the knee. Each group received 3 treatment sessions per week for 4 weeks. Evaluating measuring tools were pain intensity (based on Visual Analogue Scale: VAS) and function was measured with koos questionnare. Results: Improvement in pain, quality of life, symptoms, sports and reduction, in pain intensity on VAS in the physical modality group after treatment were seen (P<0.05). Also significant improvement in symptoms and quality of life observed in the exercise group. Improvement in activity of daily life found in the physical modality group in comparison with exercise group (P<0.05). Conclusion: This study showed that physical modality and exercise training reduce pain and improve quality of life, activity of daily life and sport in patients with the same rate. While activity of daily life improve more in physical modality method.

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Background and Objective: Anterior Cruciate Ligament (ACL) tear is One of the most common injuries at knee joint. Threshold of motion sense included inputs that are received by mechanical receptors at dynamic position. The objection of present study was to find the effect of functional brace on the Kinesthesia motion sense in patients with ACL rupture.

Materials and Methods: In this Quasi- experimental study, 20 patients with ACL tear, with aging range between 18 to 44 years old were recruited. Patients were selected in a simple non probability sampling manner. Using Continuous passive motion for testing the Kinesthesia motion sense, as a dependent variable. Data was analyzed with Paired t-test and Colmogrof-Smirnof tests.

Results: Threshold of motion sense at affected knee before and after bracing was 3.93±1.67, 4.45±1.86 in open eyes and 3.82±1.61, 4.13±1.96 in closed eyes (P<0.05).

Conclusion: This study showed that the functional brace did not play in important role in the improvement of threshold of motion sense in patients with ACL tear.

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Background and Objective: Internal derangement of knee (IDK) is a common problem following knee trauma. Magnetic resonance imaging (MRI) extensively is used to diagnose the ligamentous and meniscal injuries, but the use of ultrasonography remains controversial. Previous studies showed different results about the usefulness of sonography (IDK). This study was done to determine diagnostic accuracy of ultrasonography in comparison with magnetic resonance imaging in patients with knee trauma. Materials and Methods: This descriptive study was done on internal knee disorders of 73 patients with knee trauma who referred to MRI center of Imam Khomeini hospital in Sari, Iran during 2009-10. Three radiologists independently reported the ultrasonography and MRI of the patients. Results: The study population comprised of 61 (83.6%) men and 12 (16.4%) women, 91.9% of patients were less than 40 years old. The joint pain was the most common complaint (89%). The sensitivity, specificity, positive and negative predictive value of ultrasonography for the lateral meniscus was 100%, 97.14%, 60%, 100%, for the medial meniscus were 61.90%, 94.23% ,81.25%, 85.96%, for the anterior cruciate ligament (ACL) was 65%, 100%, 100%, 70.21% and for the medial collateral ligament (MCL) was 100%, 94.28, %42.86 and 100%. Conclusion: This study showed that the high specificity of ultrasonography as a noninvasive and inexpensive method to exclude the ACL and meniscal lesion. Ultrasonography can reasonably be applied for screening of internal derangement of knee in the absence of MRI, especially in urgent conditions. In clinical setting of highly suspicious of ACL and meniscal tear, MRI is preferred due to low sensitivity of sonography.

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Background and Objective: Improving the ability to walk is often a key target for the treatment of abnormal gait in children with spastic diplegic cerebral palsy (CP). One of the goals of orthotic rehabilitation is to improve walking in this field. The aims of this study was to design and manufacture the dynamic neoprene orthoses and evaluate its impact on the gait parameters in children with cerebral palsy. Materials and Methods: This quasi-experimental study was done on 12 children with spastic CP at University of Social Welfare and Rehabilitation, in Tehran, Iran during 2010-11. Initially neoprene dynamic orthosis is designed specifithy for each subject, this neoprene dynamic orthosis was used for six weeks and 6-8 hrs daily. For evaluating the walking speed and the gait variation, 10 meter walking test and visual analogue scale have been used. Modified Ashworth’s Scale and electro-goniometre were used to assess muscle spasticity and the flexion degrees of knee joint. Data were analyzed using SPSS-16, Kolmogorov-Smirnov and Paired t-tests. Results: The alteration of knee flexion angle, walking speed and walking distance following dynamic orthosis were -18.31±4.61 (degree), -0.50±1.82 (meter) and 4.18±1.51, respectively. The improvement in knee joint angle and walking following dynamic orthosis was significant (P<0.05), but the walking speed was not significant. Conclusion: This study showed that neoprene dynamic orthosis can improve knee flexion angle and walking distance among children with spastic diplegic cerebral palsy.

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Background and Objective: Rheumatoid arthritis is an autoimmune-inflammatory disease with possible joint destruction and disability. Persica plant, seems contain anti-inflammatory capabilities. This study was done to determine the effect of hydroalcoholic extract of Ferula persica resin on induced rheumatoid arthritis by Freund's complete adjuvant in rat.
Methods: In this experimental study, 36 male Wistar rats (200-250 g) and 8 weeks old were randomly allocated in 6 groups including normal group, positive control, negative control, and groups treated with the hydroalcoholic extract of persica resin with 25, 50 and 75 mg/kg/bw doses. The resin of persica was extracted by Maceration method. On the first day, inflammation was induced with injection of 0.2 ml of Freund's complete adjuvant into the right knee joint of rats and from the fifteenth day hydroalcoholic extract was injected intraperitoneally and daily for 15 days. On the 30^th day, blood samples were taken from hearts for rheumatoid factor measurement. Histological slides were prepared from knee joint.
Results: The level of RF in the three treatment groups was significantly reduced compared to the negative control group (p<0.05). Destruction of cartilage were observed in treated group with dose of 25 mg/kg/bw in comparision with positive control group, treated group with 50 and 75 mg/kg/bw doses. Also in the negative control group, synovial hyperplasia, pannus and the destruction of cartilage were observed.
Conclusion: It seems that hydroalcoholic extract of Ferula persica resin can causes dose dependent reduction of inflammation and destruction of cartilage result from induced rheumatoid arthritis in the rats.

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Background and Objective: Sodium levothyroxine is one of the common medicines used for treatment of hypothyroidism and thyroid cancer. The study was done to determine the effect of sodium levothyroxine on knee articular cartilage tidemark integrity, plateau tibia cartilage thickness (calcified and non-calcified) and liver enzymes in induced hypothyroidism rats.
Methods: In this experimental study, 50 adult female BALB/c mice, weighting 25-30 grams were randomly allocated into one control and four experimental groups. Animals in control did not receive any medicine. Animals in the second group were received different increasing doses of sodium levothyroxine daily for 8 weeks. Animals in the third group were received constantly high dose of levothyroxine daily for 8 weeks. In the fourth group, the animals became hypothyroid with propylthiouracil (PTU). In the fifth group, animals with hypothyroidism were received sodium levothyroxine by gavage same as group 2. After 8 weeks serum samples were taken to determine ALT, AST and ALP. The plateau tibia cartilage stained with hematoxylin-eosin. Histologic changes evaluated by light microscopy. Using a light microscope equipped with camera, the samples were photographed and using a computer equipped with axiovision software. Cartilage (calcified and non-calcified) thickness measured in micrometer. The integrity of tidemark line on hematoxylin-eosin staining also evaluated.
Results: The results of the present study showed separation, disruption and destruction in tidemark line in group 3 (the group with high dosage of sodium levothyroxine from the beginning of the treatment). The total cartilage and non-calcified part thickness in groups 3, 4, 5 were reduced and in group 3 showed significant reduction (P<0.05). Calcified cartilage thickness in all groups were reduced and in group 3 showed significant reduction (P<0.05). ALT level decreased in all groups compared to control group but only in the second and third groups, the decrease of ALT was significant (P<0.05). AST serum level in all groups significantly increased in compared to control group (P<0.05). ALP serum level in all groups increased compared to the control group, but this increase was significant only in the groups 4, 5.
Conclusion: Consumption of sodium levothyroxine with constantly high dose can cause severe alteration in knee joint cartilage in hypothyroidism rats.

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Background and Objective: One of the most common malalignments of the knee joint is valgus. This study was done to determine the effect of using graded knee brace at two angles of 60 and 30 degrees on the ground reaction force components in males with genu valgus during landing.
Methods: This clinical trial study was done on twenty males with genu valgus with age range of 21.70±2.12 years. The graded knee brace was used in two flexion angles of 60 and 30 degrees. Landing from a platform with 40 cm height on a force plate was done during three conditions including without brace, with a brace at flexion angles of 30 and 60 degrees.
Results: A significant reduction was observed in the vertical force during contact phase while landing with brace at a 60-degree angle compared with landing without brace by 15.21% (P<0.05). Also, the peak of medio-lateral force during the heel contact phase while landing with knee brace at 30 degree was significantly greater than that landing with knee brace at 60 degree by 27.18 % (P<0.05).
Conclusion: By reducing the knee flexion angle, the forces of the lower extremities increase and this issue could possibly increase the risk of injury in the knee joint. Therefore, the use of this type of brace is recommended for individuals with genu valgum at a 60 degrees limiting angle.

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Background and Objective: Genu recurvatum deformity shifts the mechanical axis of the lower extremity posteriorly, which may disturb balance and stability. The goal of this study was to compare the balance and core stability of female students with and without genu recurvatum.
Methods: This case-control study was conducted on 25 female students with genu recurvatum (mean age: 14.88±0.6 years) and 25 healthy counterparts (mean age: 15±0 years) in city of Salmas (Iran). The criterion for genu recurvatum was a 5-degree knee hyperextension. To measure static and dynamic balance, we used the stork balance stand test and Y test, and to measure core stability, we used the Sorensen, plank, side plank, and 60-degree sitting tests.
Results: The mean values of static balance of dominant (19.86±3.64) and non-dominant (17.16±4.67) leg of healthy students were significantly higher than that of students with genu recurvatum (14.44±2.03 and 10.53±1.66, respectively) (P<0.05). The median values of the dynamic balance of the dominant (32.04) and non-dominant (31.84) leg of healthy students were significantly higher than that of students with genu recurvatum (18.96 and 19.16, respectively) (P<0.05). The median values of central stability for the Sorensen (30.40), plank (30.58), lateral plank (31.04), and sitting (34.12) tests in healthy students were significantly better than the median values of central stability for the Sorensen (42.60), plank (20.20), lateral plank (19.96), and sitting (16.88) tests in students with genorcorvatum (P<0.05).
Conclusion: The balance and core stability of female students with genu recurvatum deformity is poor compared to their healthy counterparts.
 

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Background and Objective: Using lumbar orthoses changes the running mechanics. An essential biomechanical factor in rehabilitation and injury prevention is the co-contraction of the knee and ankle joints. Therefore, this study aimed to investigate the effect of 2 types of thoracolumbosacral braces on ankle and knee joint co-contraction in people with kyphosis during running.
Methods: This quasi-experimental study was conducted on 15 men aged 18-25 years suffering from kyphosis greater than 40 degrees in the Biomechanics Laboratory of the University of Mohaghegh Ardabili Health Center during the summer of 2020. Each participant randomly performed 3 running tests in each condition: without a brace, with a sensor brace, and with a simple brace. The test consisted of electromyographic data of the selected lower limb muscles, which also recorded the contraction of the knee and ankle muscles in the right leg when running at a constant speed.
Results: The results showed a reduction of the general knee co-contraction while using a sensory brace compared to without the brace by 6% during the loading phase (P<0.05). Additionally, using a simple brace compared to the condition without a brace, the ankle-directed contraction during the push-off phase decreased by 38% (P<0.05). Directed vastus medialis and lateralis co-contraction while using a sensory brace increased by about 49% compared to without the brace at the loading phase and increased by about 47% at the mid-stance phase without a brace condition compared to the simple brace condition (P<0.05).
Conclusion: General knee co-contraction after using a sensory brace was lower than when a simple brace was used.