Cargando…

The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized

CATEGORY: Trauma; Other INTRODUCTION/PURPOSE: Knee flexion has been demonstrated to impede popliteal venous return with large effect size among patients lying supine for surgery. Passive popliteal flow impedance has also been suggested to occur with knee scooter usage due to knee flexion. This study...

Descripción completa

Detalles Bibliográficos
Autores principales: Reb, Christopher W., Haupt, Edward T., Berlet, Gregory C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705592/
http://dx.doi.org/10.1177/2473011420S00073
_version_ 1784621984603176960
author Reb, Christopher W.
Haupt, Edward T.
Berlet, Gregory C.
author_facet Reb, Christopher W.
Haupt, Edward T.
Berlet, Gregory C.
author_sort Reb, Christopher W.
collection PubMed
description CATEGORY: Trauma; Other INTRODUCTION/PURPOSE: Knee flexion has been demonstrated to impede popliteal venous return with large effect size among patients lying supine for surgery. Passive popliteal flow impedance has also been suggested to occur with knee scooter usage due to knee flexion. This study compared the effect of knee flexion angles on popliteal venous return between upright, crutch and knee scooter positioning when immobilized. Further, the countervailing effect of standardized hallux musculovenous pump activation was observed. METHODS: This was an IRB approved study of young, healthy volunteers. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography and compared between straight leg, crutch, and knee scooter positioning while wearing a walking boot and nonweightbearing. Flow was assessed with muscles at rest and with hallux musculovenous pump activation via active oscillation between hallux metatarsophalangeal joint extension and flexion at one motion per second (0.5 Hz) as paced by a metronome. Observer consistency was assessed. Paired-sample Student’s t-test and the Wilcoxon signed rank tests were used to assess within-subject differences for diameter and venous flow parameters, respectively. Knee flexion and musculovenous pump activation effects sizes were calculated. A priori sample size indicated 24 subjects were needed to achieve 80% power to detect a significant ( p < 0.006 ) difference in medial flow for any of 8 comparisons, assuming large effect sizes. RESULTS: 16 of 24 (67%) subjects were female. Twelve limbs (50%) were right sided. The mean age was 21.9 years (SD 3.0 years) and the mean body mass index was 21.9 (SD 1.9). Observer consistencies were excellent (0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred. Corresponding knee flexion effect sizes were small (range -0.04 to -0.26). A significant decrease (-24%) in active median time-averaged peak velocity (TAPV) occurred between upright and crutch position (20.89 cm/s vs. 15.92 cm/s, p < 0.001) with a medium effect size (-0.51). Hallux musculovenous pump increased all flow parameters (all p< 0.001) and effect sizes were comparatively larger (>0.6) across all knee flexion positions. CONCLUSION: Compared to values reported for supine individuals, upright passive popliteal venous return was observed to be markedly diminished at all knee flexion angles. Knee flexion had minimal effect on diameter, a small effect in further diminishing TAMV and TVF and a medium effect on diminishing TAPV. Hallux musculovenous pump activiation had a large effect on increasing flow at all knee flexion angles. Patients may well be counseled to use toe motion to counter the negative effects of gravity, and to a lesser extent knee flexion, when using crutches and knee scooters while their ankle is immobilized.
format Online
Article
Text
id pubmed-8705592
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-87055922022-01-28 The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized Reb, Christopher W. Haupt, Edward T. Berlet, Gregory C. Foot Ankle Orthop Article CATEGORY: Trauma; Other INTRODUCTION/PURPOSE: Knee flexion has been demonstrated to impede popliteal venous return with large effect size among patients lying supine for surgery. Passive popliteal flow impedance has also been suggested to occur with knee scooter usage due to knee flexion. This study compared the effect of knee flexion angles on popliteal venous return between upright, crutch and knee scooter positioning when immobilized. Further, the countervailing effect of standardized hallux musculovenous pump activation was observed. METHODS: This was an IRB approved study of young, healthy volunteers. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography and compared between straight leg, crutch, and knee scooter positioning while wearing a walking boot and nonweightbearing. Flow was assessed with muscles at rest and with hallux musculovenous pump activation via active oscillation between hallux metatarsophalangeal joint extension and flexion at one motion per second (0.5 Hz) as paced by a metronome. Observer consistency was assessed. Paired-sample Student’s t-test and the Wilcoxon signed rank tests were used to assess within-subject differences for diameter and venous flow parameters, respectively. Knee flexion and musculovenous pump activation effects sizes were calculated. A priori sample size indicated 24 subjects were needed to achieve 80% power to detect a significant ( p < 0.006 ) difference in medial flow for any of 8 comparisons, assuming large effect sizes. RESULTS: 16 of 24 (67%) subjects were female. Twelve limbs (50%) were right sided. The mean age was 21.9 years (SD 3.0 years) and the mean body mass index was 21.9 (SD 1.9). Observer consistencies were excellent (0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred. Corresponding knee flexion effect sizes were small (range -0.04 to -0.26). A significant decrease (-24%) in active median time-averaged peak velocity (TAPV) occurred between upright and crutch position (20.89 cm/s vs. 15.92 cm/s, p < 0.001) with a medium effect size (-0.51). Hallux musculovenous pump increased all flow parameters (all p< 0.001) and effect sizes were comparatively larger (>0.6) across all knee flexion positions. CONCLUSION: Compared to values reported for supine individuals, upright passive popliteal venous return was observed to be markedly diminished at all knee flexion angles. Knee flexion had minimal effect on diameter, a small effect in further diminishing TAMV and TVF and a medium effect on diminishing TAPV. Hallux musculovenous pump activiation had a large effect on increasing flow at all knee flexion angles. Patients may well be counseled to use toe motion to counter the negative effects of gravity, and to a lesser extent knee flexion, when using crutches and knee scooters while their ankle is immobilized. SAGE Publications 2020-11-06 /pmc/articles/PMC8705592/ http://dx.doi.org/10.1177/2473011420S00073 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Reb, Christopher W.
Haupt, Edward T.
Berlet, Gregory C.
The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title_full The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title_fullStr The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title_full_unstemmed The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title_short The Effect of Knee Flexion on Active and Passive Popliteal Venous Flow When Using Crutches or Knee Scooter While Immobilized
title_sort effect of knee flexion on active and passive popliteal venous flow when using crutches or knee scooter while immobilized
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705592/
http://dx.doi.org/10.1177/2473011420S00073
work_keys_str_mv AT rebchristopherw theeffectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized
AT hauptedwardt theeffectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized
AT berletgregoryc theeffectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized
AT rebchristopherw effectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized
AT hauptedwardt effectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized
AT berletgregoryc effectofkneeflexiononactiveandpassivepoplitealvenousflowwhenusingcrutchesorkneescooterwhileimmobilized