MEMOIRE FRANK new1

Osteoarthritis is the most prevalent chronic rheumatic disease in the World and Physiotherapy careis an integral part in its care. The main objective of this study was to evaluate the effectiveness ofadditional Krishna’s Kinetikinetic Manual Therapy (KKMT) Mobilization in patients with kneeosteoarthritis in the National Rehabilitation Center for Persons with Disabilities within the periodfrom June 14th to September 9th, 2016.

A controlled single blinded experimental study was undertaken on 14 patients with knee
Osteoarthritis. The non-probability sampling was used to recruit patients into two groups:
intervention (KKMT and conventional physiotherapy) and control (conventional physiotherapy
alone). Both groups received treatment protocols for 5 weeks: 3 sessions per week. The WOMAC(Western Ontario and McMaster Universities Index), VAS (Visual Analogue Scale) andGoniometer were the tools used for data collection before and after treatment. Analysis of datawithin and between groups was done using SPSS (Statistical Package for the Social Sciences) 20and Excel 2010.

A total of 14 patients undertook this study, 5 males and 9 females. They were recruited to two
groups of 7 each. In the intervention group, the mean score before treatment for WOMAC, VASand ROM (Range of Motion) were respectively 52.43 on 96, 77.86 on 100, and 107.14°. Aftertreatment they were 17.86, 26.86 and 117.21° respectively. In the control group, before
treatment, they were respectively 50.00, 64.29, and 95.07°. After treatment, they were; 26.00;
38.86 and 104.28° respectively. The difference between the two groups was not significant for
WOMAC (p=0.101) and VAS (p=0.089) but significant for knee ROM (p=0.011).

KKMT mobilization added to conventional therapy was found to improve the treatment of
symptoms in patients with knee osteoarthritis. It was also found to enhance knee joint ROM. Morestudies with larger and randomized sample sizes, and longer periods of treatment should be doneto better assess this new technique.

Key words: Knee Osteoarthritis, Physiotherapy, KKMT Mobilization.

TABLE OF CONTENTS
CERTIFICATION......................................................................................................................... i
ABBREVIATIONS AND ACRONYMS................................................................................. viii
LIST OF FIGURES .................................................................................................................... ix
LIST OF TABLES ....................................................................................................................... x
ABSTRACT.................................................................................................................................. xi
RESUME .................................................................................................................................... xii
CHAPTER I: LITERATURE REVIEW……………………………………….………………3
I-1) Anatomy of the Knee Joint................................................................................................... 3
I-1-1. Osteology .............................................................................................................................3
I.1.2. Articular Surfaces of the Knee Joint......................................................................................6
I.1.3. Joint Capsule of the Knee Joint .............................................................................................7
I.1.4. Extra-capsular Ligaments of the Knee Joint...........................................................................7
I.1.5. Intra-Articular Ligaments ......................................................................................................8
I.1.7. Muscles of the Knee Joint....................................................................................................10
I.1.8. Vascularization and Innervation of the Knee ......................................................................12
I.2. Biomechanics of the Knee Joint ......................................................................................... 13
I.3. Brief notions on Knee Osteoarthritis .................................................................................. 17
I.3.1. Risk Factors .........................................................................................................................18
I.3.2. Classification of Knee OA…………………………………………………………….18
I.3.3. Clinical Features of Knee OA..............................................................................................19
I.3.5. Pathogenesis of Osteoarthritis .............................................................................................20
1.3.6. Diagnosis of knee OA..........................................................................................................22
I.3.7. Management of Knee Osteoarthritis ....................................................................................26
I.4. Epidemiology of Knee OA ................................................................................................. 28
I.5. Physiotherapy Intervention ................................................................................................. 29
CHAPTER II: MATERIALS AND METHODS……………………………………………..32
II.1. Study Design...................................................................................................................... 32
II.2. Study site ........................................................................................................................... 32
II.3. Study period....................................................................................................................... 33
II.4. Study population................................................................................................................ 33
II.5. Selection criteria................................................................................................................ 33
II.6. Variables of interest........................................................................................................... 33
II.6.1. Independent variables..........................................................................................................33
II.6.2. Outcomes (dependent variables) ........................................................................................34
II.7. Instruments and Tools ....................................................................................................... 41
II.8. Determination of Sample size............................................................................................ 42
II.9. Procedure for Implementation of Research ....................................................................... 42
II.10. Data management and Analysis ...................................................................................... 45
II.11. Ethical Consideration of Research .................................................................................. 46
CHAPTER III: RESULTS AND DISCUSSION…………………………………………...…47
A) RESULTS ......................................................................................................................... 47
III.1. Socio-demographic Profile of Participants ...................................................................... 47
III.2. Clinical Features of Participants ...................................................................................... 49
III.3. Effectiveness of Conventional physiotherapy alone on pain, stiffness and function in
patients with knee osteoarthritis,............................................................................................... 52
III.4. Effectiveness of conventional Physiotherapy and KKMT mobilization on pain, stiffness
and function in patients with knee OA...................................................................................... 54
III.5. Effectiveness of Conventional physiotherapy and KKMT mobilization versus
Conventional physiotherapy alone on pain, stiffness and function in patients with knee OA.. 58
B) DISCUSSION….……………………………………………………………..………….61
CONCLUSION .......................................................................................................................... 64
RECOMMENDATIONS/PERSPECTIVES…………………………………………………65
APPENDICES……………………………………………………………………………….75
Appendix I. Letter for research authorization from the University of Dschang to the Regional
Delegation of Public Health for the Central Region. ................................................................ 74

Appendix II. Authorization to carry out Research in the CNRPH ............................................. 75
Appendix III. Ethical Clearance................................................................................................ 76
Appendix IV. Western Ontario and McMaster Universities Index (WOMAC) ....................... 77
Appendix V. Socio-demographic profile of participant and some Clinical aspects of knee
OA……………………………………………………………………………………………..80
Appendix VI. Measurement of knee ROM with Goniometer and Pain with VAS................... 81
Appendix VII. Information Notice............................................................................................ 82
Appendix VIII. Informed Consent ............................................................................................ 83
Appendix IX. Images and radiographs of the knees of two patients with valgus and varum
deformities................................................................................................................................. 84
Appendix X. Instruments used for data collection. ............................................................. 85
Appendix XI. Muscles of the Knee Joint. ................................................................................. 86
Appendix XII. The Knee joint................................................................................................... 87
Appendix XIII: Goniometric measurement of the Knee Joint. .......................................... 88