William R. Post

West Virginia University, Morgantown, West Virginia, United States

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Publications (17)39.2 Total impact

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    ABSTRACT: An accurate physical examination of patients with patellar instability is an important aspect of the diagnosis and treatment. While previous studies have assessed the diagnostic accuracy of such physical examination tests, little has been undertaken to assess the inter- and intra-tester reliability of such techniques. The purpose of this study was to determine the inter- and intra-tester reliability of the physical examination tests used for patients with patellar instability. Five patients (10 knees) with bilateral recurrent patellar instability were assessed by five members of the International Patellofemoral Study Group. Each surgeon assessed each patient twice using 18 reported physical examination tests. The inter- and intra-observer reliability was assessed using weighted Kappa statistics with 95% confidence intervals. The findings of the study suggested that there were very poor inter-observer reliability for the majority of the physical tests, with only the assessments of patellofemoral crepitus, foot arch position and the J-sign presenting with fair to moderate agreement respectively. The intra-observer reliability indicated largely moderate to substantial agreement between the first and second tests performed by each assessor, with the greatest agreement seen for the assessment of tibial torsion, popliteal angle and the Bassett's sign. For the common physical examination tests used in the management of patients with patellar instability inter-observer reliability is poor, while intra-observer reliability is moderate. Standardization of physical exam assessments and further study of these results among different clinicians and more divergent patient groups is indicated.
    The Knee 06/2011; 19(4):404-10. DOI:10.1016/j.knee.2011.06.002 · 1.94 Impact Factor
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    Clinical Orthopaedics and Related Research 01/2009; 467(2). DOI:10.1007/s11999-008-0650-4 · 2.77 Impact Factor
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    ABSTRACT: The concept and need for a gender-specific or female-specific total knee prosthesis have generated interest and discussion in the orthopaedic community and the general public. This concept relies on the assumption of a need for such a design and the opinion that there are major anatomic differences between male and female knees. Most of the information regarding this subject has been disseminated through print and Internet advertisements, and through direct-to-patient television and magazine promotions. These sources and a recent article in a peer-reviewed journal, which support the need for a female-specific implant design, have proposed three gender-based anatomic differences: (1) an increased Q angle, (2) less prominence of the anterior medial and anterior lateral femoral condyles, and (3) reduced medial-lateral to anterior-posterior femoral condylar aspect ratio. We examined the peer-reviewed literature to determine whether women have had worse results than men after traditional TKAs. We found women have equal or better results than men. In addition, we reviewed the evidence presented to support these three anatomic differences. We conclude the first two proposed differences do not exist, and the third is so small that it likely has no clinical effect. Level of Evidence: Level IV, systematic review. See the Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 10/2008; 466(12):3059-65. DOI:10.1007/s11999-008-0536-5 · 2.77 Impact Factor
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    ABSTRACT: The purpose of this investigation was to determine current views regarding lateral release among experienced knee surgeons with a specific interest in the patellofemoral joint. Scientific survey. A questionnaire was developed and mailed to all members of an international group with a specific interest in disorders of the patellofemoral joint. Frequencies and percentages of responses were calculated for each question to determine surgeon consensus. We measured agreement among responses using the kappa statistic. This provided an indication of consistency for each question as well as correlation among the responses to different questions. The survey response rate was 60%. Isolated lateral release was estimated to account for only 1 to 5 surgical cases per respondent per year, or 2% of cases performed annually. In the setting of arthroscopy or exploration, 74% of respondents believed that lateral release calls for specific informed consent. Strong consensus was found that objective evidence is needed to justify lateral release, but agreement was poor as to what clinical evidence provides the most appropriate indication for the procedure. Even among experienced knee surgeons with a special interest in diseases of the patellofemoral articulation, isolated lateral release is rarely performed. Strong consensus was found that isolated lateral release should not be undertaken without prior planning in the form of objective clinical indications and preoperative informed consent. Level V.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2004; 20(5):463-8. DOI:10.1016/j.arthro.2004.03.002 · 3.21 Impact Factor
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    William R Post · Robert Teitge · Andrew Amis
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    ABSTRACT: A clear understanding of the pathophysiology of anterior knee pain is inhibited by the use of imprecise, poorly defined, and often interchanged words, such as malalignment, patellar alignment, maltracking, subluxation, dislocation, and congruence. The literature is filled with articles regarding the diagnosis, "malalignment of the patella," most of which give no precise diagnosis. This article presents a definition of malalignment and a plea for rational descriptive and scientific analysis. Much of what is described is based on theory, not facts. These ideas are supported by clinical experience and logical analysis, but very little in the way of scientific data. Most of the data involve radiographic images, which present only one piece of the puzzle.
    Clinics in Sports Medicine 08/2002; 21(3):521-46, x. DOI:10.1016/S0278-5919(02)00011-X · 1.22 Impact Factor
  • William R. Post · Stephen S. King
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    ABSTRACT: PURPOSE: As the use of soft-tissue anterior cruciate ligament (ACL) grafts, including hamstring grafts, has become more prominent and the benefits of aggressive rehabilitation have become clear, maximizing fixation with screw and spiked washers is important. Bicortical fixation may be superior. We were concerned about potential neurovascular risks and designed this study to define the posterior neurovasculature structures at risk when drilling for bicortical tibial screw fixation during ACL reconstruction. Type of Study: Consecutive sample. METHODS: We placed the tibial tunnel arthroscopically in 10 cadaveric knees using a standard tibial drill guide. Accurate tibial tunnel position was documented in each knee by lateral radiograph. A 4.5-mm bicortical drill hole was placed perpendicular to the tibial surface 1 cm distal to the tibial tunnel. The distances from the posterior tibial drill exit point to nearby neurovascular structures were measured with a caliper. RESULTS: The closest structure to the exit point was the bifurcation of the popliteal artery/vein (11.4 +/- 0.6 mm; range, 8.4 to 14.0 mm). The next closest was the anterior tibial vein (11.7 +/- 1.6 mm; range, 3.5 to 22.8 mm). The closest any individual hole came to a neurovascular structure was 3.5 mm from the anterior tibial vein. CONCLUSIONS: Bicortical drilling for fixation of soft tissue grafts appears reasonably safe. The structures at greatest risk for injury are the bifurcation of the popliteal artery/vein and the anterior tibial vein.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 04/2001; 17(3):244-247. DOI:10.1053/jars.2001.21539 · 3.21 Impact Factor
  • William R. Post
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    ABSTRACT: Accurate clinical evaluation of patients with patellofemoral disorders is the cornerstone of effective treatment. This article defines how a careful history and physical examination can direct strategies for nonoperative and operative management. A critical analysis of traditional methods of evaluation and a streamlined rational approach to clincial evaluation is presented. Key questions and important physical findings that affect treatment decisions are emphasized.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 8 (November), 1999: pp 841–851
    Arthroscopy The Journal of Arthroscopic and Related Surgery 11/1999; 15(8):841-851. DOI:10.1053/ar.1999.v15.015084 · 3.21 Impact Factor
  • W R Post
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    ABSTRACT: Accurate clinical evaluation of patients with patellofemoral disorders is the cornerstone of effective treatment. This article defines how a careful history and physical examination can direct strategies for nonoperative and operative management. A critical analysis of traditional methods of evaluation and a streamlined rational approach to clinical evaluation is presented. Key questions and important physical findings that affect treatment decisions are emphasized.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/1999; 15(8):841-51. · 3.21 Impact Factor
  • M Powell · W R Post · J Keener · S Wearden
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    ABSTRACT: Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed. Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System and the Mayo Clinical Scoring System demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients.
    Foot & Ankle International 02/1998; 19(1):10-8. DOI:10.1177/107110079801900103 · 1.51 Impact Factor
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    W R Post
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    ABSTRACT: The complex causes of patellofemoral disorders are most effectively identified through a systematic evaluation of a patient's lower-extremity alignment, patellar mobility, muscle flexibility, strength, and coordination as well as an assessment of soft-tissue and articular pain. By combining information from such an exam with a careful history and appropriate radiographic studies, the physician can make a specific diagnosis. This sets the stage for an optimal rehabilitation prescription, which usually will involve some combination of muscle flexibility and strength training, taping, orthoses, analgesics, and therapy with heat and ice.
    The Physician and sportsmedicine 01/1998; 26(1):68-78. DOI:10.3810/psm.1998.01.977 · 1.09 Impact Factor
  • William R. Post · Scott R. Akers · Vincent Kish
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    ABSTRACT: Success of meniscal repair with early or immediate motion depends on the ability of the suture fixation to withstand the loads applied. Vertical and horizontal mattress suture techniques were tested using 2-0 Ethibond, and 0-PDS and 1-PDS sutures (Ethicon, Somerville, NJ). Mulberry knot technique was tested with 0-PDS and 1-PDS sutures. Twenty menisci (60 sutures) were tested for each suture material. Sutures were placed 3 to 4 mm from the peripheral edge of the meniscus with double barreled cannulas for vertical and horizontal mattress techniques or a spinal needle for the mulberry knot technique, reproducing clinical techniques of meniscal repair. Mechanical testing of suture fixation was performed to failure at a rate of 10 mm/min on a MTS material testing system (MTS Systems Corp, Minneapolis, MN). Suture pullouts were reported as the load displacement to failure from the inner fragment only, because clinical failure would ensue should a suture pull through the inner fragment of a tear. Vertical mattress technique with 1-PDS suture had significantly greater load to failure than any other combination (P < .05). Analysis of variance showed that the vertical mattress technique had statistically superior pullout strength (P < .0001) compared with the horizontal mattress and mulberry knot techniques, which were statistically similar. There were significant differences (P < .0001) between suture types, with 1-PDS proving best compared with 0-PDS, which was stronger than 2-0 Ethibond. Selection of suture material had the greatest impact on vertical mattress load to failure and was not important to the strength of the other techniques.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 12/1997; 13(6):731-6. DOI:10.1016/S0749-8063(97)90008-6 · 3.21 Impact Factor
  • D. Scott Davis · William R. Post
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    ABSTRACT: Recently, there has been an emphasis placed on incorporating fundamental radiology in graduate level physical therapy curricula; however, the majority of practicing physical therapists never received formal radiology instruction. As health care changes, so must the role of the physical therapist. In a managed care environment, it is essential that physical therapists recognize basic radiographic findings and understand their clinical ramifications. The purpose of this article is to review the literature and provide commentary on avulsion fractures of the lateral tibial condyle, known as Segond fractures. Segond fractures typically occur by forced internal tibial rotation with the knee flexed. This mechanism placed tremendous force on the middle portion of the lateral capsule and associated meniscotibial ligament and results in a small bony avulsion. The Segond fracture is an important radiographic sign that is critical to recognize because it is generally associated with anterior cruciate ligament disruption.
    Journal of Orthopaedic and Sports Physical Therapy 03/1997; 25(2):103-6. DOI:10.2519/jospt.1997.25.2.103 · 3.01 Impact Factor
  • Danny H. Ford · William R. Post
    Clinics in Sports Medicine 01/1997; 16(1):29-49. DOI:10.1016/S0278-5919(05)70006-5 · 1.22 Impact Factor
  • William R. Post
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    ABSTRACT: Tensioning of the inferior glenohumeral ligament complex (IGLC) before arthroscopic repair is a critical step in restoring stability. This article describes a simple surgical technique to tension the IGLC percutaneously before arthroscopic fixation. This technique eliminates the need for grasping instruments and a second anterior portal.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 03/1996; 12(1):116-9. DOI:10.1016/S0749-8063(96)90232-7 · 3.21 Impact Factor
  • William R. Post · John Fulkerson
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    ABSTRACT: All new patients who presented with knee problems were asked to fill out standard knee pain diagrams before being evaluated. Completed diagrams were not seen by the examining physicians. After obtaining the history and performing the physical examination, one of four physicians marked an identical diagram with the areas of tenderness. Ninety patients with a provisional diagnosis of patellofemoral pain completed 109 (19 bilateral) pain diagrams. Evaluation of the diagrams was quantitated by division of the diagrams into nine zones. The researcher grading the diagrams was blind to whether the diagrams were drawn by the patient or physician. Patients marked an average of 4.23 zones per knee compared with 2.66 zones for physicians. In 88% (96 of 109) of the knees, the physician diagram included all or some of the zones marked by the patients. Eighty-five percent of all zones marked by physicians were included in patient diagrams. Eighty-six percent of negative patient zones correctly predicted a negative examination. Overall frequency of positive findings in each of the nine zones was consistent between patient and physician diagrams. A physician can be confident that findings of tenderness will likely be within zones marked by a patient on a standard diagram of the knee. Pain diagrams facilitate proper diagnosis by correctly directing attention to areas of tenderness in a large percentage of cases and provide an inexpensive and highly useful prediction of areas of anterior knee tenderness in patients with patellofemoral pain.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/1995; 10(6):618-23. DOI:10.1016/S0749-8063(05)80058-1 · 3.21 Impact Factor
  • W R Post · J P Fulkerson
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    ABSTRACT: A careful history and physical examination are the cornerstones of consistently successful diagnosis and treatment of anterior knee pain symptoms. Nonoperative treatment must be based on physical examination findings and should include both flexibility and strengthening. If an extended conscientious trial of nonoperative therapy fails to produce improvement, properly selected surgical procedures produce improvement in over 80% of cases. Realignment procedures, including lateral release, should only be proposed when malalignment can be documented. Although anterior knee pain has been called the "low back pain of the knee" by frustrated clinicians, effective treatment is likely when these principles are employed.
    Bulletin on the rheumatic diseases 05/1993; 42(2):5-7.
  • W R Post · J P Fulkerson
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    ABSTRACT: Effective treatment of patellofemoral malalignment is possible with precise diagnosis. This precision must begin with a thorough history and physical examination. Both nonoperative and operative treatment are guided by the specific patterns identified. Distal realignment procedures including anteromedial tibial tubercle transfer necessitate meticulous surgical technique to achieve maximal benefit with a low rate of complications.
    Orthopedic Clinics of North America 11/1992; 23(4):631-43. · 1.25 Impact Factor

Publication Stats

526 Citations
39.20 Total Impact Points


  • 1993–2004
    • West Virginia University
      • Department of Orthopaedics
      Morgantown, West Virginia, United States
  • 2001
    • Marshall University
      Хантингтон, West Virginia, United States
  • 1996
    • University of Virginia
      Charlottesville, Virginia, United States