STUDY DESIGN: Clinical measurement. OBJECTIVE: To determine the interrater reliability of a knee joint effusion grading scale in an outpatient orthopaedic physical therapy clinic. BACKGROUND: Knee joint effusion may indicate joint inflammation or irritation. Therefore, objective monitoring of effusion is important to decision making regarding patient prognosis and program progression. The clinicians in the authors' clinic use a modified stroke test to assess for knee joint effusion, which is operationally based on a 5-point grading scale. METHODS: Seventy-five patients (44 male, 31 female) receiving outpatient physical therapy for a unilateral knee problem, for whom effusion assessment was indicated, were tested. The subjects ranged from 16 to 65 years of age. Pairs of therapists graded the knee joint effusion using the clinical grading scale. A contingency table was constructed and analyzed using Cohen kappa values to establish interrater reliability. Percent agreement was also calculated. RESULTS: The kappa value was 0.75, observed as a proportion of the maximum possible kappa, and the percent agreement was 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only 5 had disagreement of 2 grades, and there were no disagreements of greater than 2 grades. CONCLUSION: These findings provide evidence to support the proposed clinical effusion grading scale as a reliable method to assess knee joint effusion between therapists in an outpatient orthopaedic physical therapy clinic in patients with unilateral knee dysfunction. Only 5 of 75 ratings resulted in disagreement that could result in different clinical decisions being made by the therapists.

J Orthop Sports Phys Ther 2009;39(12):845-849, Epub 15 October 2009. doi:10.2519/jospt.2009.3143

KEY WORDS: hydroarthrosis, measurement, swelling, tibiofemoral

Study Design: Descriptive study of phenomenon. Objectives: To determine the extent of failure of voluntary activation of the quadriceps femoris muscle in patients early after patellar contusion. Background: Pain and effusion are related to the presence of quadriceps inhibition. We hypothesized that patients with patellar contusions would be unable to fully recruit their quadriceps muscles and that the activation deficit would be associated with self-report measures of function. Methods and Measures: Sixteen patients who had sustained a unilateral patellar contusion fewer than 4 months prior to testing participated in the study (7 men, 9 women; mean age = 30.0 ± 11.6). Subjects completed a self-report questionnaire to assess knee function and performed an isometric burst superimposition test on the involved and uninvolved quadriceps at 60° of knee flexion. The subjects were assigned to 2 groups according to the presence (n = 5) or absence (n = 11) of quadriceps inhibition. Results: Sixty-nine percent of the subjects tested were able to fully activate their quadriceps. Both groups had a decreased knee extensor force on the involved side compared to the uninvolved, but the group with inhibition had a lower side-to-side percentage of knee extensor force (mean = 65.5% ± 18.9) than those without inhibition (mean = 85.5% ± 16.4). Conclusion: Early after patellar contusion, approximately one-third of the patients demonstrated quadriceps inhibition. According to our working hypothesis, the majority of the patients tested should have demonstrated inhibition. Quadriceps inhibition was not associated with the activities of daily living, sports activity, or global rating scales in this study. Decreased volitional quadriceps force production (the hallmark of inhibition) was the only variable that discriminated patients with patellar contusion who had inhibition from those who did not.

J Orthop Sports Phys Ther. 2000;30(11):654-663.

Key Words:knee function, patellar contusion, patellofemoral joint injury, quadriceps strength, reflex quadriceps inhibition