Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study
Purpose Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion. Me...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2015-07, Vol.23 (7), p.1986-1992 |
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| container_end_page | 1992 |
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| container_issue | 7 |
| container_start_page | 1986 |
| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| container_volume | 23 |
| creator | Minoda, Yukihide Iwaki, Hiroyoshi Ikebuchi, Mitsuhiko Yoshida, Taku Mizokawa, Shigekazu Itokazu, Maki Nakamura, Hiroaki |
| description | Purpose
Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion.
Methods
A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau.
Results
The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (
p
= 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (
R
= 0.603,
p
|
| doi_str_mv | 10.1007/s00167-014-2838-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1690212763</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3718579261</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-9db40d8cd3560730f407174a367da4bb9e5604666c4eb3a568a34936fc1f940c3</originalsourceid><addsrcrecordid>eNp1kctu1TAQhi0EoofCA7BBltiwMfVlYifsUMVNasUG1pZjT4pLThzspKI8QJ8bp6cgVImVR9Y338zoJ-S54K8F5-akcC60YVwAk61qmXpAdgKUYkaBeUh2vAPJJG_0EXlSyiXntYTuMTmSAKqRUu7IzXnq44isR5fjdEHnnMryDUss1E2BxmnJLs2Y3RKvkF64mfZudJPfWJeRTmmpPRiiX1IuNA20rBWPKdPvEyIdRvwZ0_SGulv1jP5WlKs87eMvDLQsa7h-Sh4Nbiz47O49Jl_fv_ty-pGdff7w6fTtGfMAcmFd6IGH1gfVaG4UH4AbYcApbYKDvu-w_oPW2gP2yjW6dQo6pQcvhg64V8fk1cFbl_mxYlnsPhaPYz0J01qs0B2XQhqtKvryHnqZ1jzV7SrVdk3TtmAqJQ6Ur9eVjIOdc9y7fG0Ft1tI9hCSrSHZLSS7mV_cmdd-j-Fvx59UKiAPQJm3UDD_M_q_1t-CQZ5D</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1689558847</pqid></control><display><type>article</type><title>Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study</title><source>MEDLINE</source><source>Wiley Online Library</source><source>SpringerNature Journals</source><creator>Minoda, Yukihide ; Iwaki, Hiroyoshi ; Ikebuchi, Mitsuhiko ; Yoshida, Taku ; Mizokawa, Shigekazu ; Itokazu, Maki ; Nakamura, Hiroaki</creator><creatorcontrib>Minoda, Yukihide ; Iwaki, Hiroyoshi ; Ikebuchi, Mitsuhiko ; Yoshida, Taku ; Mizokawa, Shigekazu ; Itokazu, Maki ; Nakamura, Hiroaki</creatorcontrib><description>Purpose
Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion.
Methods
A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau.
Results
The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (
p
= 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (
R
= 0.603,
p
< 0.001).
Conclusions
Mobile-bearing prosthesis and optimal gap balancing did not result in superior postoperative flexion angle. Better preoperative and intraoperative flexion angles and lower BMI were the significant predictors for better postoperative flexion angle.
Level of evidence
Therapeutic study, Level I.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-014-2838-3</identifier><identifier>PMID: 24435222</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Arthritis ; Arthroplasty, Replacement, Knee - methods ; Body mass index ; Female ; Genu Varum - surgery ; Humans ; Joint replacement surgery ; Knee ; Knee Joint - physiopathology ; Knee Joint - surgery ; Knee Prosthesis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Orthopedics ; Osteoarthritis ; Osteoarthritis, Knee - surgery ; Patient satisfaction ; Polyethylene ; Prospective Studies ; Prostheses ; Prosthesis Design ; Range of motion ; Range of Motion, Articular ; Tibia - surgery</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2015-07, Vol.23 (7), p.1986-1992</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-9db40d8cd3560730f407174a367da4bb9e5604666c4eb3a568a34936fc1f940c3</citedby><cites>FETCH-LOGICAL-c442t-9db40d8cd3560730f407174a367da4bb9e5604666c4eb3a568a34936fc1f940c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-014-2838-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-014-2838-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24435222$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Minoda, Yukihide</creatorcontrib><creatorcontrib>Iwaki, Hiroyoshi</creatorcontrib><creatorcontrib>Ikebuchi, Mitsuhiko</creatorcontrib><creatorcontrib>Yoshida, Taku</creatorcontrib><creatorcontrib>Mizokawa, Shigekazu</creatorcontrib><creatorcontrib>Itokazu, Maki</creatorcontrib><creatorcontrib>Nakamura, Hiroaki</creatorcontrib><title>Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion.
Methods
A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau.
Results
The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (
p
= 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (
R
= 0.603,
p
< 0.001).
Conclusions
Mobile-bearing prosthesis and optimal gap balancing did not result in superior postoperative flexion angle. Better preoperative and intraoperative flexion angles and lower BMI were the significant predictors for better postoperative flexion angle.
Level of evidence
Therapeutic study, Level I.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthritis</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Body mass index</subject><subject>Female</subject><subject>Genu Varum - surgery</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Knee Joint - physiopathology</subject><subject>Knee Joint - surgery</subject><subject>Knee Prosthesis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Patient satisfaction</subject><subject>Polyethylene</subject><subject>Prospective Studies</subject><subject>Prostheses</subject><subject>Prosthesis Design</subject><subject>Range of motion</subject><subject>Range of Motion, Articular</subject><subject>Tibia - surgery</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kctu1TAQhi0EoofCA7BBltiwMfVlYifsUMVNasUG1pZjT4pLThzspKI8QJ8bp6cgVImVR9Y338zoJ-S54K8F5-akcC60YVwAk61qmXpAdgKUYkaBeUh2vAPJJG_0EXlSyiXntYTuMTmSAKqRUu7IzXnq44isR5fjdEHnnMryDUss1E2BxmnJLs2Y3RKvkF64mfZudJPfWJeRTmmpPRiiX1IuNA20rBWPKdPvEyIdRvwZ0_SGulv1jP5WlKs87eMvDLQsa7h-Sh4Nbiz47O49Jl_fv_ty-pGdff7w6fTtGfMAcmFd6IGH1gfVaG4UH4AbYcApbYKDvu-w_oPW2gP2yjW6dQo6pQcvhg64V8fk1cFbl_mxYlnsPhaPYz0J01qs0B2XQhqtKvryHnqZ1jzV7SrVdk3TtmAqJQ6Ur9eVjIOdc9y7fG0Ft1tI9hCSrSHZLSS7mV_cmdd-j-Fvx59UKiAPQJm3UDD_M_q_1t-CQZ5D</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Minoda, Yukihide</creator><creator>Iwaki, Hiroyoshi</creator><creator>Ikebuchi, Mitsuhiko</creator><creator>Yoshida, Taku</creator><creator>Mizokawa, Shigekazu</creator><creator>Itokazu, Maki</creator><creator>Nakamura, Hiroaki</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150701</creationdate><title>Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study</title><author>Minoda, Yukihide ; Iwaki, Hiroyoshi ; Ikebuchi, Mitsuhiko ; Yoshida, Taku ; Mizokawa, Shigekazu ; Itokazu, Maki ; Nakamura, Hiroaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-9db40d8cd3560730f407174a367da4bb9e5604666c4eb3a568a34936fc1f940c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthritis</topic><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Body mass index</topic><topic>Female</topic><topic>Genu Varum - surgery</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Knee Joint - physiopathology</topic><topic>Knee Joint - surgery</topic><topic>Knee Prosthesis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Patient satisfaction</topic><topic>Polyethylene</topic><topic>Prospective Studies</topic><topic>Prostheses</topic><topic>Prosthesis Design</topic><topic>Range of motion</topic><topic>Range of Motion, Articular</topic><topic>Tibia - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Minoda, Yukihide</creatorcontrib><creatorcontrib>Iwaki, Hiroyoshi</creatorcontrib><creatorcontrib>Ikebuchi, Mitsuhiko</creatorcontrib><creatorcontrib>Yoshida, Taku</creatorcontrib><creatorcontrib>Mizokawa, Shigekazu</creatorcontrib><creatorcontrib>Itokazu, Maki</creatorcontrib><creatorcontrib>Nakamura, Hiroaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Source (ProQuest)</collection><collection>Physical Education Index</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Minoda, Yukihide</au><au>Iwaki, Hiroyoshi</au><au>Ikebuchi, Mitsuhiko</au><au>Yoshida, Taku</au><au>Mizokawa, Shigekazu</au><au>Itokazu, Maki</au><au>Nakamura, Hiroaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>23</volume><issue>7</issue><spage>1986</spage><epage>1992</epage><pages>1986-1992</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion.
Methods
A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau.
Results
The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (
p
= 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (
R
= 0.603,
p
< 0.001).
Conclusions
Mobile-bearing prosthesis and optimal gap balancing did not result in superior postoperative flexion angle. Better preoperative and intraoperative flexion angles and lower BMI were the significant predictors for better postoperative flexion angle.
Level of evidence
Therapeutic study, Level I.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>24435222</pmid><doi>10.1007/s00167-014-2838-3</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2015-07, Vol.23 (7), p.1986-1992 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1690212763 |
| source | MEDLINE; Wiley Online Library; SpringerNature Journals |
| subjects | Aged Aged, 80 and over Arthritis Arthroplasty, Replacement, Knee - methods Body mass index Female Genu Varum - surgery Humans Joint replacement surgery Knee Knee Joint - physiopathology Knee Joint - surgery Knee Prosthesis Male Medicine Medicine & Public Health Middle Aged Orthopedics Osteoarthritis Osteoarthritis, Knee - surgery Patient satisfaction Polyethylene Prospective Studies Prostheses Prosthesis Design Range of motion Range of Motion, Articular Tibia - surgery |
| title | Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study |
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