Karen Hambly

ABSTRACT BACKGROUND: Ultrasound imaging (USI) has been shown to be a valid method to investigate the morphology of the thoracolumbar fascia (TLF) [1]. A USI-based study has demonstrated that the TLF of subjects with chronic lower back pain (LBP) is on average 25% thicker and more disorganised compared to a control group [1]. The aim of this study is to explore inter-observer agreement between a range of clinicians on (dis)organisation of TLF in ultrasound images. There are currently no validated methods for the evaluation of USI of TLF. METHODS: Design: an exploratory analysis using a fully crossed design of inter-observer agreement. This study was approved by the University of Kent's School of Sport and Exercise Sciences Research and Ethics Committee (Prop. 163 – 2013). Participants: Thirty observers consisting of 21 (70%) Medical Doctors, 7 (23%) physiotherapists and 2 (6%) radiologists, with a combined total average of 13 years of clinical experience (± SD 9.4). 57% had no experience in USI, 36% had experience ranging from monthly to daily evaluations of USI, no observers had experience in evaluating USI of TLF. Protocol: A subset of thirty ultrasound scans of TLF were randomly selected from a data set of 308 scans of subjects with and without LBP (from a larger study conducted by the first author). All scans were anonymised and displayed on a desktop computer, or projected on a screen. All observers viewed and rated each of the 30 scans independently on a Likert-type scale from 1(very disorganised) to 10 (very organised). Inter-observer agreement was assessed using a two-way mixed, consistency, average measures intra-class correlation (ICC), the Cronbach's Alpha, to assess consistency among observers. The Krippendorff's Alpha (Kalpha) [2] reliability estimate was used to assess agreement. RESULTS: The resulting ICC was in the excellent range, ICC = 0.98, indicating that observers had a high degree of consistency, suggesting that (dis)organisation was rated similarly across observers. Observers without USI experience scored an ICC = 0.96, observers with USI experience scored an ICC = 0.95, again both in the excellent range. In this small cohort, experience in USI does not appear to impact on consistency. The Krippendorff's ordinal alpha α was .621, indicating a modest degree of agreement.

Autologous chondrocyte implantation (ACI) is a tissue-engineered surgical technique initially developed for articular cartilage repair of isolated chondral lesions of the knee. Third-generation techniques (ACI3) are now available that deliver autologous cultured chondrocytes into the defect using cell scaffolds. The successful outcomes of these techniques have some dependency on presurgical and postsurgical patient rehabilitation. To determine if the standard of reporting for rehabilitation has improved in ACI3 studies; previous reviews in this field recommended describing the detail of this rehabilitation and patient compliance as integral elements. A computerized search was performed in March 2013. Criteria for inclusion were any studies that evaluated or described the process of ACI3 in the knee and subsequent rehabilitation. The modified Coleman Methodology Score (CMS) was used to rate the standard of reporting of rehabilitation and surgical procedures; review articles were also...

Background: The use of the Internet for seekers of health-related information provides convenience and accessibility to diverse sources (of variable quality) for many medical conditions. There is a suggestion that patients may find empowerment by engaging with Internet health care strategies and communities. The profile of consumers of online health information on knee pain has not been explored.
Objective: Our objective was to identify the characteristics and motivations of online health information-seekers accessing the online health community, KNEEguru (KG). The study was designed to obtain the respondents’ sociodemographic profile, together with their main reasons and motivations for joining such a community, their health information-seeking behavior, the extent of their knee problems, and their general Internet usage.
Methods: We undertook an online questionnaire survey, offered to users of the KG website from June to July 2012. A mix of open and closed questions was used to facilitate inductive enquiry. Quantitative responses were analyzed using univariate analysis; qualitative thematic analysis of the open responses was completed and a conceptual model was developed.
Results: One-hundred and fifty-two respondents took part (11.56% response rate, 152/1315), with a mean age of 40.1 years. Of this cohort, 61.2% were female, 68.4% were in domestic partnerships, 57.2% were employed, 75.0% had higher education qualifications, and 80.3% were of white/Caucasian ethnicity. Females were associated with joining KG in order to get emotional support from other users (OR 2.11, 95% CI 1.04 - 4.27, P=.04). Respondents’ self-perception of health was associated with reported quality of life (OR 10.86, 95% CI 3.85 - 30.43, P<.001). Facebook users were associated with joining KG to share experiences (OR 2.34, 95% CI 1.04 - 5.56, P=.03). Post-surgery respondents were associated with joining KG to compare symptoms with other users (OR 7.31, 95% CI 2.06 - 39.82, P<.001). Three key themes were induced: condition, emotion and support. Respondents expressed distress and frustration at uncertainty of prognosis around various knee conditions, with some users preferring to initially observe rather than engage. Conversely, a strong desire to inform and support other community members was stated with reciprocation of ideas and experiences. KG was conceptualized as a filter that takes an individual’s condition and emotional response to that condition as basis for support; this filter facilitated validation as the outcome of engagement.
Conclusions: This study, in line with wider literature, suggests that users of an online knee-specific community are typically female, middle-aged, white/Caucasian, married, employed, and have attained a level of higher education. These users demonstrate a pragmatic approach to health care information with altruistic motivations and a desire to share experiences as a means of validation. This finding emphasizes a means of promoting efficient and appropriate online health care, and demonstrates the benefits of the Internet as a viable complement to clinical engagement.

Background:
Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to non-athletes. The management of chondral defects in the football player is complex and multifactorial.

Objective:
The aim of this paper is to provide an overview of the current strategies for rehabilitation after articular cartilage repair of the knee in the football player. 

Design:
A review of current literature and the scientific evidence for rehabilitation after articular cartilage repair of the knee.

Conclusions:
Articular cartilage repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after articular cartilage repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation especially in the transition from therapy to performance care. It should be recognised that not all players will return to football after articular cartilage repair. The evidence base for rehabilitative practice after articular cartilage repair is increasing but remains sparse in areas.

Key words:
Rehabilitation; articular cartilage repair; knee

Background: Articular cartilage injury in the athlete’s knee presents a difficult clinical challenge. Despite the importance of return- ing injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee.
Hypothesis: Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint sur- face restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee.
Study Design: Systematic review.
Methods: A comprehensive literature review of original studies was performed to provide information about athletic participation after articular cartilage repair. The athlete’s ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time.
Results: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the abil- ity to return to sport: athlete’s age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology.
Conclusion: Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is help- ful for the clinical decision-making process and for the management of the athlete’s postoperative expectations.
Keywords: sport; athletics; cartilage; articular; injury; repair; resurfacing; chondroplasty; knee

Hambly, Karen and Van Assche, Dieter and Wondrasch, Barbara and Bobic, Vladimir and Marlovits, Stefan (2006) Current status and prospects for rehabilitation following cell-based cartilage repair. In: Basic science and clinical repair of articular cartilage defects: Current status ...

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