The mystery of a 134-year-old anatomical "enigma" has finally been solved with the announcement of a new knee ligament. Described in 1879 only as a "pearly resistant fibrous band," the newly named anterolateral ligament (ALL) could affect tibial rotation and the pivot shift phenomenon, according to researchers.
The presence of the ligament was verified through examination of 41 cadaveric knees, which, with 1 exception, included the ALL. A recounting of the research (abstract only) that led to the discovery was published in the October 2013 issue of the Journal of Anatomy, and word quickly spread to major news organizations such as the Huffington Post and Time.
Researchers describe the ALL as a "well defined structure" that is situated "at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament." It follows an oblique course to the anterolateral aspect of the proximal tibia, with its insertion on the tibia "grossly located between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB)."
While the authors cite the need for more research on the ALL, they hypothesize that the ligament plays the role of a stabilizer for internal rotation, and speculate that the ALL could play a part in "rotary knee instability patterns witnessed in many [anterior cruciate ligament] deficient knees."
Advising exercise to patients with osteoarthritis or sciatica may be a highly recommended approach to treatment, but it's an approach that may not be widely used by physicians, according to a recent factorial experiment (abstract). Researchers found that out of 192 primary care physicians studied, fewer than a third said that they would advise physical activity as part of a course of treatment for patients presenting symptoms of either condition. The results of the study were published online in early October in Arthritis Care & Research.
In the experiment, the physicians watched 2 videos of (actor) patients who presented with pain from undiagnosed sciatica or knee osteoarthritis that had been diagnosed. Afterwards, the physicians were interviewed to find out what recommendations they would make.
Results showed that 30.2% of physicians would give exercise advice to the osteoarthritis patient, and 32.8% would provide this advice to the patient presenting with sciatica. The study pointed to a general tendency for physicians with fewer years in practice to advise lifestyle changes more frequently than their more veteran peers. These newer physicians were also found to be more likely to prescribe nonsteroidal anti-inflammatory drugs, but less likely to order tests.
The low rate of exercise advice runs counter to widely accepted recommendations from the American College of Rheumatology and the American Pain Society. APTA's Physical Therapist's Guide to Osteoarthritis of the Knee webpage provides information on why exercise plays an important role in treatment, and the association's PTNow research portal provides members with access to evidence-based research on physical therapy and sciatica.
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking a cadre of members with diverse clinical expertise to serve on the Credentialing Services Committee. The committee comprises trained reviewers identified by the Credentialing Services Council as having experience and/or expertise relevant to program credentialing. Committee members review applications and visit program sites undergoing credentialing.
Members interested in being considered for service on the committee must complete the application on the ABPTRFE website by December 31, 2013. The Credentialing Services Council will make appointments on February 3, 2014. Notification regarding appointments will be sent by February 28, 2014.
Selected members must be available for training at APTA headquarters in Alexandria, Virginia, in October 2014. Exact dates will be set after the appointments are made. APTA will reimburse all travel expenses for this meeting.
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