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Thus, we observed a wide variety of possible methods of evaluation of surgical procedures at the level of the knee in the literature investigated. Among which we proposed an evaluation of the modified Lysholm score 2 Attachment 1.
The choice of this scoring system was based on the modified Lysholm protocol as it is one of the protocols used most often in literature, and, until the start of the survey, the only one validated in Brazil 3. The authors' goal was to evaluate the modified Lysholm scoring system in patients with knees considered normal, i. To apply the modified Lysholm scoring system, we prospectively evaluated patients who appeared at the emergency department of our hospital with orthopedic complaints in other body regions.
Of these, were men and women with a mean age of The age criterion was imposed as we know that patients over 40 years of age present a greater risk of knee osteoarthritis, which could mask our functional evaluation. The criterion of inclusion of the patients was absence of complaints or previous surgery on the knee considered dominant. The group was evaluated by a single physician, member of the Brazilian Society of Knee Surgery and with a postgraduate degree master's , performing bilateral radiographic exam and exhaustive clinical examination, searching for meniscal, ligament and patellofemoral pathologies.
In the modified Lysholm system the maximum score is points, in which: 91 to points is considered excellent; 84 to 90, good; 65 to 83, fair; and 64 or less, unsatisfactory. Lysholm's system is an evaluation system that includes three functional criteria and five subjective criteria. The homogeneity of variance was verified by Levene's test.
The survey verified that The analysis suggests that, although the individuals do not have a diagnosed prior or current pathology, they already present some symptomatology, not obtaining the maximum concept of the score Figure 2.
There is a vast amount of scientific production relating to surgical procedures on the knee; nevertheless, it is difficult to compare results between different students. When we specifically compare the knee evaluation systems, we observe various studies with results of non-concordance between systems However, we can still find some authors today who do not use knee scoring systems to evaluate the clinical follow-up of their patients 7.
We believe that such a difficulty is due to the fact that the available evaluation systems are not completely satisfactory. The IKDC presents very interesting characteristics, as it aims to perform a subjective, objective and functional assessment 8.
Although it initially appears to be a perfect system, we observed some deficiencies in its use. Its final result is represented by the worst result of all the sub-items investigated. Thus the patient's overall evaluation is very radically penalized, often not reflecting their functional level. They compared two groups: one group six months after ACL reconstruction surgery and the other composed of volunteers without previous knee injuries. In the evaluation of the Lysholm and Cincinnati questionnaires, they observed similar results between both groups.
The evaluation of the IKDC protocol presented inferior rating results in comparison to the other two questionnaires. Moreover, it rated Our survey is consistent with this affirmation and observes that so-called normal patients do not reach the maximum rating in the Lysholm score.
However, when we observed the outcome of the survey, just In the middle of the preparation of our study, the IKDC was validated in Brazil; however, due to its stringent final evaluation system, we decided not to use it There was no statistically significant difference, except for the IKDC. Our opinion is based on the fact that patients with ACL injury present repeated buckling, generating a lower functional assessment score. Consequently, we decided to evaluate only patients with normal knees.
Lysholm and Gillquist 14 , when comparing their evaluation system with that of Larson, emphasized its specificity in measuring the functional level more adequately, as it expresses the patient's opinion about their own knee. In the use of this system, they concluded that, besides adequately assessing functional level, it was easy for patients to understand and apply, confirming what we observed in our study on Lysholm's modified protocol.
Tegner and Lysholm 2 assessed 76 patients with ACL injury and compared the modified Lysholm protocol with the Hospital for Special Surgery's first form. Binary questions, requiring answers such as "yes" or "no", provided less detail than the modified Lysholm scale. They concluded that the stability test, performance test, functional score and activity level should not be included in the same scoring scale. They believe that each assessment was important at different times during the treatment of the ligament injury, and that they should therefore be analyzed separately.
When we compared this with our study, we observed that the modified Lysholm system appropriately classifies patients without previous knee injury as "excellent", yet we did not verify the maximum score obtained. Sgaglione et al 15 compared four knee rating systems: score of the Hospital for Special Surgery, Lysholm, Tegner and Cincinnati. They concluded, in comparing the Lysholm test with other methods, that it is of a subjective nature as regards functional assessment of the knee, and that when in use it should be associated with another method.
They support the use of a protocol with subjective, objective and functional assessment, with individualized rather than general results. We agree with this conclusion, as we believe that a subjective, objective and functional assessment creates a more complete scoring system and a more precise evaluation. We used the modified Lysholm system as it is one of the knee evaluation systems used most often in literature and the only one validated in Brazil when we started our survey.
They confirm our opinion that the knee assessment protocol should be composed of a subjective, objective and functional component to reduce examiner interference. We believe that the examiner should be the one to conduct the survey, as a layman would not know how to distinguish between buckling or locking investigated in the modified Lysholm protocol.
There are scoring systems in which the method of assessment is visual analogue. This method of evaluating subjective findings has proven efficacy 17 ; however, we observed some difficulties in its application. As it is a scale, the patient's understanding of the test requires notions of mathematics and proportion, skills usually acquired at school. In our group we found a large number of patients with a low level of education, to whom the understanding of the test would require several explanations by the examiner. In these eventualities it was clear how the final score can be influenced by external interferences 16,18 , which, in our opinion, is the main disadvantage of this kind of system.
Labs and Paul 5 , in a prospective study of 56 patients with ACL reconstruction, compared eight knee rating systems. In analyzing the results of the knee rating systems, they concluded that they are incomparable, since there are individual variations of the subjective, objective and functional parameters. They observed that there is frequently disagreement between subjective satisfaction and objective results.
As regards sex, we perceived that the functional assessment score of the women was lower than that of the men, probably due to the greater patellofemoral complaint and more accentuated genus valgum. Aiming to decrease the bias 19 , our survey was conducted by only one examiner experienced in the use of this scoring system. On the other hand, Demirdjian et al 20 carried out a semiological evaluation using some colleague or another with a different degree of experience.
Raymond G. Besides, he has given many invited talks at various institutions in India and abroad. Erhan, Fixed points of generalized alpha-admissible contractions on b-metric spaces with an application to boundary value problems,Journal of Nonlinear and Convex Analysis, Within the last 15 years substantial research has been performed in humans indicating that training, and chronic loading reduces injury 7 , 8. No prior Animal Institutional Care Committee approval was obtained because no animals were used in this research. Share Give access Share full text access. We value your input.
We believe that this study loses its credibility and that the likelihood of errors increases. The inclusion criteria used in our survey were: absence of complaints or previous surgery on the knee considered dominant. As regards possible knee symptoms, anything that could limit the functional assessment was considered relevant. We emphasize that crepitation in the patellofemoral joint, or pain at the femorotibial interline, were not exclusion criteria, as in our understanding, they are hardly trustworthy findings for defining a knee as abnormal.
In our study, no patient was excluded due to symptoms in the knee. Moreover, we executed a bilateral radiographic evaluation in which we compared the knees for better functional analysis. Complaints of pain, locking and climbing stairs were mentioned the most often, respectively. Previous pain in the knee was the main cause of these findings, since it is the main complaint of the population in general E-mail address: sandberg ece.
Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. We also give a necessary and sufficient condition under which the limit can be written as a convolution with an integrable impulse—response function. A key role is played by a certain family of weighting operators. It is observed that for the large family of inputs and maps addressed, the Dirac impulse—response concept is in fact not the key concept concerning the representation of H , and that instead the input—output properties of H are determined, in general, by a certain type of family of responses.
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The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Irwin W. Sandberg Corresponding Author E-mail address: sandberg ece.
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