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>Your encounter is definitely unusual. Throughout my practice, I have never >come across cases like that. Do you routinely check ANT in knee replacements with post operative pain, if not it may not be that they are unusual, but that they are undiagnosed. >Bear in mind that whatever symptoms complained by the patients might be >due to some degree of compensation to the weight bearing of their lower >limbs before their operations. To rule out that their gait is not a factor >for such symptoms, pre-operative assessment should be carried out. These patients both had poor gait, nut pain was not just produced on walking but also on long sitting and lying. >In addition to the above, the operation procedure should be another area >to look into. How much bone is being cut away for the replacement and to >what degree did the surgeon pull the knee apart to get a better approach? >All these can cause a certain degree of ligamentous tear. The adhesion of >the peroneal nerve sounded far-fetched. I tested the knee for ligamentous problems thoroughly and found no evidence of this. The two positive objective findings were tenderness at fibular head (1 patient) positive ANT tests. Both responded well to inferior and superior tib-fib jt. mobs and resolved in 3 sessions to have normal gait, full SLR, no tenderness and good RoM for TKR. How could this treatment outcome have been obtained if it were a different pathology? Yours sincerely, John Willenbruch