Purpose
Choosing the optimal radiographic methods to diagnose the cartilage height and degree of knee osteoarthritis is crucial to determine suitability for unicompartmental knee replacement. This ...study aims to evaluate and compare articular cartilage thickness measured using the Rosenberg view and coronal stress radiography. Intra- and interrater agreement and test–retest reliability of each method were determined. The hypothesis of the study was that the Rosenberg view and coronal stress radiographs provide similar assessments of articular cartilage height in the medial and lateral knee compartments of osteoarthritic knees.
Methods
A prospective diagnostic study, including 73 patients was performed. Inclusion criteria were enrollment for either a medial unicompartmental or a total knee replacement. Radiographs were taken as the Rosenberg view, and coronal stress radiography using the Telos stress device. Repeated measurements were performed. Experienced knee surgeons performed measurements of cartilage height at a standardized location of joint space width (JSW), and a rater-perceived location of minimal joint space width (mJSW), thus allowing for reliability and agreement analysesusing weighted kappa. Coronal stress measurements were ultimately compared to the Rosenberg view using Spearman’s rank correlation.
Results
A total of 12,264 measurements were performed. The radiographic methods proved substantial reliability. Intra- and interrater agreement showed substantial to almost perfect agreement. A very strong correlation was observed in the medial knee compartment (r = 0.91; CI = 0.84–0.95; p < 0.001), with a mean difference of 0.1 mm and limits of agreement of − 1.5 to 1.7 mm, when comparing JSW between the Rosenberg view and varus stress. Only a strong correlation was observed medially when using mJSW, and when using this measurementmore incidences of bone-on-bone were observed than when measuring with JSW. A Strong correlation was observed in the lateral knee compartment (r = 0.83; CI = 0.71–0.89; p < 0.001), with a mean difference of 0.62 mm and limits of agreement of − 1.5 to 2.7 mm, when comparing JSW between the Rosenberg view and valgus stress.
Conclusion
The Rosenberg view is similar to 20° coronal valgus–varus stress radiography for determining articular cartilage thickness. Both techniques can be used in a clinical setting. Therefore, extra radiographs, equipment and expertise could be saved, when solely utilizing the Rosenberg view which is simple to perform.
Level of evidence
III.
Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to ...determine the reliability of stress radiographs for flexion laxity using manual stress as well as a commercially available flexion stress device, with the hypothesis that a commercially available force device would provide increased translation compared to manual stress, and radiographic measurements would be reproducible.
Ten patients who previously underwent TKA with non-hinged components were prospectively and consecutively enrolled at a single center to undergo stress radiographs. Three lateral radiographs with the knee at 90° of flexion were obtained for each patient: rest, commercial stress device at 150N, and manual stress. Calibrated radiographs were evaluated by two raters, and inter-rater and intra-rater reliability were determined using intraclass correlation coefficients (ICC).
Ten patients (seven female) with mean age 72 (range 55-82) years and average duration from surgery 36 (range 12-96) months were evaluated. The commercial stress device provided significantly less anterior translation than manual stress (- 0.3 mm vs. 3.9 mm; p < 0.01). Two patients reported pain with use of the stress device. Inter-observer reliability of measurements was good for commercial stress (ICC = 0.86) and excellent for manual stress (ICC = 0.94). Eighty-five percent of measurements were within 1 mm between observers. Intra-observer reliability of measurements was good to excellent for both the stress device and manual stress.
Lateral stress radiographs may assist in the objective evaluation of flexion instability. A commercially available product provided less translation than manual stress; however, measurements were reliable and reproducible between observers. Further research is required to correlate translation with stress radiographs to patient outcomes following revision arthroplasty.
Purpose: To compare side-to-side difference (SSD) of anterior tibial translation in instrumented stress radiography for each series of anterior cruciate ligament (ACL)-injured subjects according to ...knee flexion angle.
Methods: Forty subjects who were suspected of having significant ACL injury by manual Lachman test and MRI were recruited for this prospective study. These subjects took stress radiographs for both knees with corresponding knee flexion of 10° (series M1) and 30° (series M2) using Telos stress device. Mean SSDs of M1 and M2 were compared. Sensitivities of M1 and M2 were assessed using the SSD ≥3mm or ≥ 5mm as a cutoff value.
Results: Mean SSDs in series M1 and M2 were 4.22 ± 3.72mm and 3.25 ± 3.30 mm, respectively (p < 0.001). When 3 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 47.5% (19/40) and 32.5% (13/40), respectively (p = 0.171). When 5mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 45.0% (18/40) and 22.5% (9/40), respectively (p = 0.033).
Conclusions: Anterior tibial translation on stress radiographs using a Telos device is more prominent when knee flexion angle is 10° compared to that when knee flexion angle is 30°. However, stress radiography using Telos device, either at 10° or 30° of knee flexion, might not be suitable to make decision on surgical treatment due to relatively low sensitivities.
This article explores one point of connection between the disciplines of theology and counselling: how a person becomes over time. Two concepts are explored: the theological anthropology of a person ...growing into becoming in imago Dei, and narrative therapy's notion of a person becoming over time in the light of their life purpose or telos. While both concepts see a person as potentially changing over time, differences appear between the God - and love-directed vision of imago Dei, and a person's self-chosen telos within narrative therapy. I explore each concept within its field, and examine it through the eyes of the other discipline. Looking at imago Dei through the eyes of therapy, I show how therapy can bring an acknowledgement of the jagged process of growing towards love. I then show how theology can critique an individualistic understanding of telos. While narrative therapy pioneer Michael White saw personhood as being socially shaped, the notion of telos in narrative therapy has been depicted as more of an individual project. A theological critique widens telos to envision a person as being embedded within more hopeful, communitarian stories. I find that both concepts mine rich seams of hope for personal change.
The most specific psychological literature associates joy with goodness; however, psychological science has no clear means to distinguish one good thing from another or to decipher the degree of ...goodness required to designate joy beyond subjective or conventional opinion. In order to provide a framework for a science of joy that identifies both the psychological processes that comprise joy and a means of understanding and operationalizing goodness, I conceptualize joy as a virtue of knowing, feeling, and doing what matters most and propose a teleological framework to conceptualize goodness. Such a multidimensional understanding of joy informed by characteristic adaptations given meaning by a transcendent narrative identity and a developmental, contextual telos of the reciprocating self sheds light on the potential power of joy as a psychological phenomenon favorable for sustained positive affect that is animating and expansive, yet simultaneously has moral and spiritual heft to guide people in lives worth living.
At the beginning of Book I of the Nicomachean Ethics, Aristotle says that “the good is the same for an individual as for a city”. The good in question is εὐδαιμονία – the highest good achievable for ...human beings. In Book X, we learn that contemplative activity (θεωρητική) meets best the requirements set for eudaimonia. Even if we agree that contemplative activity is the good for an individual, how should we understand the claim that contemplation is also the good for a city? I start by reminding readers that for Aristotle the Nicomachean Ethics is essentially a political enquiry and should be read together with his Politics. I focus on the teleological character of his political philosophy and the interlinking of the concepts of the good (τἀγαθόν), nature (φύσις), form (τὸ εἶδος, τὸ τί ἐστι, ἡ μορφή), end (τέλος, τὸ οὗ ἕνεκα) and function (ἔργον). Then, I look at Aristotle’s two closely-connected statements that polis exists by nature and that men are political animals. Having taken into account Aristotle’s opinion regarding the imperfection of this world, which is exemplified by the vulnerability of human lives to fortune, luck and accidents, I conclude that Alasdair MacIntyre’s concept of the political community as a common project explains well how contemplation could be the end of polis. Only very few individuals can achieve the highest good and they can do it only if they have the support of the political community. But all the inhabitants of a polis structured towards achieving the highest good benefit from living in a well-ordered community whose constitution reflects the objective hierarchy of goods.
Феофил Коридаллевс (1574–1646), глава Патриаршей школы в Константинополе, был одним из ярких представителей одновременно как падуанской, так и греческой школы. Первое сочинение в своём логическом ...компендиуме Коридаллевс целиком посвящает исследованию природы логики. В первую очередь, он доказывает, что логика не может являться эпистеме (ἐπιστήμη / scientia), а только техне (τέχνη / ars). Для этого он делает подробный обзор значения данных понятий у Аристотеля, чем показывает различие в их понимании современными и латинскими авторами. Коридаллевс не признаёт выделения практической (utens) и теоретической (docens) логики, что позволяло схоластам относить последнюю к scientia. Коридаллевс также не соглашается с положением стоиков, согласно которому логика является частью философии, он считает её инструментом философии. Подробным образом он останавливается на предмете (ὑποκείμενον) логики, а точнее — её материи (поскольку логика является техне, то она имеет материю), а также её целях, т.е. родительном и дательном телосе (τέλος), которые выделял Аристотель на основании грамматических особенностей греческого языка. Таким образом, Коридаллевс пришёл к выводу, что логика — это инструментальная техне философии, чью материю составляют понятия (νοήματα), выраженные словами (φωναί), означающими вещи; она даёт нам правила, с помощью которых из значащих слов составляются логические инструменты — это и есть её родительный телос, в свою очередь этими инструментами пользуется философия, что позволяет реализовать дательный телос — различение истины от лжи. Риторика, чью материю также составляют слова, отличается образом действия, узостью предмета и иной целью, которой является убеждение аудитории. Отсюда риторика, выходящая из «Топики», является инструментом практической философии, целью которой является благо, тогда как логика — это инструмент теоретической философии, целью которой является познание истины.
This article intends to make a scholarly contribution by mapping the main developments in the field of eschatology. Such an attempt could deepen reflection in a multidisciplinary conversation with, ...for example, Missiology. Exciting and constructive shifts have taken place in eschatology, and five such trends are briefly highlighted. Eschatology is not a mere appendix to the Christian vision, but belongs to its very nature, and requires careful hermeneutical exploration and articulation. The recent appreciation of marginalised voices have wrought exciting new sensibilities and should be cautiously heeded. Attempts are underway to expand the notion of a singular final telos, based on a broadened notion of the divine. Finally, the performative effects of eschatological discourse, especially the political, should be explicitly accounted for. The article concludes with seven guidelines that identify scholarly gains and areas for special future attention.
Current definitions of joy are afflicted by jingle-jangle fallacies. Definitions fail to distinguish joy from other positive emotions (e.g. happiness), explanatory styles (e.g. optimism), and traits ...(e.g. positive emotionality facet of extraversion), or they are low in scientific utility because they require normative standards by which to judge if people feel 'rightly' that are difficult to operationalize. We propose researchers should abandon attempts to define joy primarily as an emotion or disposition. Instead, we propose two alternative conceptualizations. First, joy might be defined as a virtue whereby it entails characteristic adaptations (i.e. habits) that support the regular occurrence of positive emotions connected to a narrative identity that values something transcendent (e.g. beyond-the-self). Second, joy might be conceptualized as a telos, or outcome, of the virtuous life. Additional data are needed to adjudicate which definition of joy most useful for scientific inquiry.
Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP ...remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P,
= 43) or without (Group N,
= 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (-0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) (
= 0.019), as well as in the Group N patients (
= 0.019). The degree of synovial coverage of the anteromedial (
= 0.0064) and posterolateral (
= 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal (
= 0.049), middle, and distal (
= 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.
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