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Bringing Knee Examination to Easy-Ville

Does your knee pain dictate your heart and soul at times?

Does your knee look and feel terrifying just like this? If so, then your knee urgently needs to be examined by a professional.

Essentially, a perfect knee examination doesn’t exist, or does it? Come on, let’s be realistic, no, it doesn’t. But what we can do, is bring it pretty damn close. What does a knee examination require? For starters, it requires a keen sense of observation and sensitive palpation skills to identify the problem, or specifically, what is causing the patient discomfort.

In cases such as post-operative knee stiffness, or muscular imbalances in the knee, one such aspect of knee examination is considerably important, and that is Movement Testing and Gait Analysis. Here’s an unbelievable statistic for you, approximately 2,50,000 people undergo total knee replacements every year in India! And guess what, about 14% of them experience post-operative knee stiffness! If that isn’t baffling enough, India is set to become the TKR hotspot with the most knee replacement surgeries in the span of 2020 to 2026.

The USA reports around 8,00,000 TKR surgeries annually! A survey by Kurtz et al reported approximately 70,00,000 knee replacement surgeries in the entire world annually. And if you thought that knee stiffness occurs only after replacement surgeries, you are wrong. Post-operative knee stiffness occurs with several surgeries such as ACL, PCL, LCL, MCL, and meniscal reconstruction too. Imagine the number of people undergoing knee surgery every day!

With thousands of people suffering from knee stiffness, muscular imbalances, and arthritis, it is high time we start assessing every individual’s knee with accuracy, objectivity, and credibility.

Movement testing includes a wide variety of tests but mainly focuses on –
Passive range of motion testing
Active range of motion testing
Muscle strength and length testing

These tests provide a clinician with important information regarding the mobility of the knee. The problem though is how to accurately quantify the range of motion and muscle strength. Muscle strength, as discussed in previous articles, can be accurately measured by using a hand-held dynamometer. It not only provides objectivity to muscle strength but also makes documentation and prognostic assessment easier.

Now, how do we quantify the range of motion of the knee? Traditionally, therapists have been using goniometry as the prime measurement method. For years goniometry has been a standard tool for ROM evaluation, but is it truly accurate?

Major drawbacks of goniometry are that the starting position, the center of rotation, the long axis of the limb, and the true vertical and horizontal positions can only be visually estimated; moreover, conventional goniometers must be held with two hands, leaving neither hand free for stabilization of the body. A study conducted by GE Hancock et al reported that there exists an average of 14 degrees of variation between 2 testers using goniometry. The reliability of goniometry is often questioned because accurate palpation and identification of the joint’s axis are difficult.
So now what? Well, therapists can overcome all these drawbacks through the use of fitknees. With the help of this device, the active, and passive ranges of motion can be accurately quantified. With the help of AI and modern technology, the device leaves no margin of error when it comes to angular measurement. Not only is it easy to use, but it also eliminates the concept of intra and inter-rater reliability.

Along with movement testing, there is another essential aspect of knee examination, which is, Gait Analysis. Gait analysis is an assessment of the way the body moves, usually by walking or running, from one place to another. The purpose of gait analysis is to detect any abnormalities in locomotion. For a person to move/walk normally, all the joints of the body need to work harmoniously with each other. To assess gait, therapists usually use active markers and computer software such as Kinova. But through the use of traditional methods, there comes a requirement for a large amount of space and a gait lab, which may not be accessible at all times.

Fitknees provides a therapist with access to measure spatial and temporal variables of the gait cycle with accuracy. And that’s not even the best part, clinicians can assess an entire gait cycle in under a minute. The use of fitknees surpasses observational and visual methods of gait analysis as it adds objectivity to the assessment. Fitknees allows for easy and fast documentation as it stores patient records in an organized fashion. The software allows for several user interfaces which allows several therapists to use the device and store patient records separately under each user id. Not only does this provide credibility and organization to the documentation system, but it also improves the patient-therapist bond.
The quantification and prognostic reports provide a patient with satisfaction and relief as he can understand his prognosis and current physical state.
With the number of knee surgeries growing ever so fast, the need for accurate gait analysis and movement testing also grows just as much. Without advancement in assessment methods, treatment becomes stagnant and bland without the power of quantification. With the help of fitknees, physiotherapy comes one step closer to becoming data-driven and makes it a better place for patients and clinicians alike.


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