{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-06T21:08:43Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.04615586, "turns": 2, "seconds": 336.5, "error": null }, "codex": { "seconds": 64.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a07888-3762-7813-b641-22f68f9a6636\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: knee\nRegistry id: vr.tr.knee\nPlane / domain: PHY / PHY.LIV\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA Vercy model s" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:12:48+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "revisions": [ { "at": "2026-10-07T11:31:22+00:00", "engine": "codex", "fields": [ "definition", "distinguishing_features", "in_scope", "scope_statement", "visual_identification" ], "answering_review": "689e7f48e4089d6937dad20005d52f93a2e7570a6ed0688eaa61c7e201cf2b1a" } ], "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T12:16:32+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "8 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q37425", "registryId": "vr.tr.knee", "name": "knee", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "PHY.LIV" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q37425/", "model": { "registry_id": "vr.tr.knee", "name": "knee", "purpose": "Enable an AI agent to recognise a knee, record its structural and functional state, and distinguish supported actions from actions requiring further assessment or authority.", "definition": "The knee is the anatomical region around the kneecap at the junction of the thigh and lower leg, encompassing the knee joint and surrounding skin, soft tissues and supporting structures.", "scope_statement": "This model owns an individual human knee as the anatomical region around the kneecap, including its identity, surface and deeper tissues, joint structures, movement, symptoms and intervention history; applicability to nonhuman knees remains unresolved.", "in_scope": [ "Left or right knee identity, anatomical boundaries and relationship to its person and limb are included.", "The kneecap and surrounding skin, subcutaneous tissues, bursae and other local soft tissues are included.", "Tibiofemoral and patellofemoral articulations and their local structural condition are included.", "Menisci, ligaments, capsule and the knee-related portions of the extensor mechanism are included.", "Knee movement, stability, loading and contribution to specific activities are included.", "Local symptoms, examination findings, investigations and changes over time are included.", "Knee-specific procedures, implants, restrictions and assessment needs are included." ], "out_of_scope": [ "The person's complete health history and systemic disease models", "Hip, ankle, and whole-limb conditions beyond their recorded effects on the knee", "Complete models of the femur, tibia, fibula, muscles, nerves, or blood vessels", "Whole-person gait, athletic performance, and rehabilitation programme management", "Implant product specifications, manufacturing records, and device inventory", "Independent models of injuries or diseases that may affect multiple anatomical sites" ], "distinguishing_features": [ "Locate the region around the kneecap at the junction of the thigh and lower leg, since a reference to the leg alone does not identify a knee.", "Determine whether a record concerns the knee region, the joint or only the patella, since neither the joint nor the patella alone constitutes the entire region.", "Distinguish surface tissues and surrounding soft tissues from the underlying articulations while retaining them within the same regional identity.", "Check whether 'knee pain' identifies only a reported symptom location or also establishes a local structural condition; the former does not establish the latter.", "Distinguish the anatomical knee from a knee replacement device; an implanted knee retains anatomical identity while relating to a separate device." ], "characteristics": [ { "name": "Laterality", "kind": "category", "unit_or_values": "left | right | unresolved", "why_it_matters": "Prevents observations, imaging, and actions from being assigned to the opposite knee." }, { "name": "Anatomical configuration", "kind": "state", "unit_or_values": "Recorded native, altered, reconstructed, or replaced structures, with unknowns explicit", "why_it_matters": "Determines which structures are present and how observations should be interpreted." }, { "name": "Affected articulation or compartment", "kind": "category", "unit_or_values": "medial tibiofemoral | lateral tibiofemoral | patellofemoral | multiple | unlocalised", "why_it_matters": "Localises findings without treating every knee condition as affecting the entire complex." }, { "name": "Flexion and extension range", "kind": "measurement", "unit_or_values": "degrees, with angle convention, active or passive method, position, and date", "why_it_matters": "Makes motion restriction and change interpretable and comparable." }, { "name": "Stability assessment", "kind": "state", "unit_or_values": "Direction, named assessment, result or grade, examiner, and assessment conditions", "why_it_matters": "Separates measured laxity from reported giving way and preserves the basis of the assessment." }, { "name": "Pain pattern", "kind": "state", "unit_or_values": "Location, onset, duration, provoking activity, rest symptoms, and named severity scale", "why_it_matters": "Connects symptoms to circumstances without converting symptoms into a diagnosis." }, { "name": "Swelling and effusion", "kind": "state", "unit_or_values": "Observed location, onset, assessment method, and present | absent | uncertain result", "why_it_matters": "Distinguishes joint fluid findings from other forms of local swelling." }, { "name": "Task-specific function", "kind": "state", "unit_or_values": "Task, assistance, tolerance, symptoms, and observed or reported performance", "why_it_matters": "Shows what the knee permits during activities such as stairs, kneeling, or rising from a chair." }, { "name": "Local tissue condition", "kind": "state", "unit_or_values": "Named structure, finding, assessment method, date, and certainty", "why_it_matters": "Keeps evidence about cartilage, menisci, ligaments, and tendons anatomically specific." }, { "name": "Intervention and restriction relationship", "kind": "relation", "unit_or_values": "Linked procedure, implant, clinical instruction, responsible professional, and effective dates", "why_it_matters": "Supports action decisions using the knee's actual treatment history and current instructions." } ], "affordances": [ "Associate symptoms, examination records, and imaging with the correct knee and local structure.", "Compare knee motion, swelling, symptoms, and task performance across dated assessments.", "Identify missing or conflicting evidence before attributing symptoms to a particular knee structure.", "Check a proposed knee-related activity against recorded restrictions and assessment requirements.", "Link knee procedures and implants to subsequent structural and functional observations.", "Flag recorded concerns for qualified review using an applicable clinical protocol." ], "agent_conduct": { "may": [ "Explain knee anatomy, common injuries and recovery from medical sources.", "Assist a person with exercises their physiotherapist has prescribed, at their request." ], "must_not": [ "Diagnose ligament tears, fractures or arthritis in a specific person without a clinician.", "Advise continuing sport on a swollen, locked or unstable knee.", "Move or load a person's limb beyond what their care plan allows.", "Share a patient's imaging or records beyond their care team." ], "requires_human": [ "Surgery, injection or other treatment decisions.", "Returning an injured athlete to play." ] }, "ethics": { "considerations": [ "Knee injuries can cause lifelong disability; rushed return to activity worsens them.", "Access to joint replacement and rehabilitation is unequal." ], "affected_parties": [ "Patients", "Athletes", "Older people" ] }, "owners": { "steward": "The person themselves with their clinicians; nobody owns the anatomical structure.", "master_systems": [ "Medical and imaging records" ] }, "visual_identification": [ "The knee region surrounds the kneecap at the junction of the thigh and lower leg.", "Images may show surface and deeper tissues around the patella and the meeting of the femur and tibia, depending on the imaging method." ], "failure_modes_and_hazards": [ "Ligament and meniscus tears cause instability and later arthritis.", "Falls onto the knee can fracture the kneecap." ], "what_it_is_for": [ "The knee is encountered in anatomy, movement assessment, rehabilitation and the evaluation of lower limb injuries.", "It supports body weight and enables movements involved in walking, climbing stairs, sitting and kneeling." ], "standards_and_regulation": [ "Terminologia Anatomica, issued by the Federative International Programme for Anatomical Terminology under the International Federation of Associations of Anatomists, standardizes names for the knee region and its anatomical structures." ] }, "sources": [ { "id": "kenhub-knee-joint", "title": "Knee joint: anatomy, ligaments and movements", "url": "https://www.kenhub.com/en/library/anatomy/the-knee-joint", "what_it_supports": "Joint type, bones, tibiofemoral versus patellofemoral articulations, ligaments and menisci, innervation, blood supply, and named movements.", "url_status": "live" }, { "id": "radiopaedia-knee-joint", "title": "Knee joint", "url": "https://radiopaedia.org/articles/knee-joint-1", "what_it_supports": "Modified-hinge classification, largest synovial joint, compartment geometry, menisci, and published flexion/extension/rotation ranges used in imaging.", "url_status": "unverified" }, { "id": "iqwig-knee-work", "title": "In brief: How does the knee work?", "url": "https://www.ncbi.nlm.nih.gov/books/NBK561512/", "what_it_supports": "Three-compartment model, typical flexion to about 150°, and rotation of a flexed knee (about 10° inward, 30° outward).", "url_status": "live" }, { "id": "iso-21536-2023", "title": "ISO 21536:2023 Non-active surgical implants - Joint replacement implants - Specific requirements for knee-joint replacement implants", "url": "https://www.iso.org/standard/77045.html", "what_it_supports": "That total and partial knee replacements, with or without patellofemoral replacement, are a regulated implant class with specified performance, materials and test methods.", "url_status": "blocked" }, { "id": "cismef-knee-joint", "title": "knee joint", "url": "https://www.cismef.org/page/detail/en/RAD_CO_RID2751", "what_it_supports": "Cross-walk of the joint into SNOMED CT, FMA, MeSH, UBERON, NCIt, ICD-11 extension, ICF, RadLex and related anatomy codes.", "url_status": "live" }, { "id": "loinc-100165-0", "title": "LOINC 100165-0 Knee range of motion", "url": "https://loinc.org/100165-0", "what_it_supports": "A standard observation identifier for quantitative knee range of motion in degrees, including use in Knee Society Score panels.", "url_status": "live" }, { "id": "jama-knee-pain-2023", "title": "Evaluation and Treatment of Knee Pain: A Review", "url": "https://doi.org/10.1001/jama.2023.19675", "what_it_supports": "Population-scale osteoarthritis burden, patellofemoral pain and meniscal-tear prevalence, and first-line versus surgical management.", "url_status": "blocked" }, { "id": "acr-af-oa-2019", "title": "2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11488261/", "what_it_supports": "Joint-specific OA treatment recommendations, including tibiofemoral versus patellofemoral bracing.", "url_status": "live" }, { "id": "icd10cm-2022-m17", "title": "ICD-10-CM order file (2022) - M17 Osteoarthritis of knee and related deformity codes", "url": "https://ftp.cdc.gov/pub/health_statistics/nchs/publications/ICD10CM/2022/icd10cm_order_2022.txt", "what_it_supports": "US clinical coding of knee osteoarthritis and knee deformity with mandatory laterality.", "url_status": "live" }, { "id": "wikidata", "title": "Wikidata item Q37425: knee", "url": "https://www.wikidata.org/wiki/Q37425", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Knee", "url": "https://en.wikipedia.org/wiki/Knee", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "knee-identity-and-boundaries", "name": "Knee identity and boundaries", "description": "Establish which knee is represented and which anatomical structures its records concern.", "rationale": "Laterality mistakes and confusion between a joint, a component, and a symptom location undermine every subsequent decision.", "layers": [ { "id": "person-limb-and-side", "name": "Person, limb, and side", "description": "Bind the knee to its anatomical owner and side.", "findings": [ { "id": "identified-knee", "name": "Identified knee", "description": "Record the person, limb, and laterality, including unresolved or conflicting identification.", "questions": [ { "text": "Which person's knee is this, and what establishes its left or right side?", "kind": "definition", "id": "identified-knee-q01" }, { "text": "Do examination notes, images, and procedure records agree on the knee's identity?", "kind": "provenance", "id": "identified-knee-q02" } ] } ] }, { "id": "joint-complex-boundary", "name": "Joint complex boundary", "description": "Separate the knee complex from individual components and neighbouring anatomy.", "findings": [ { "id": "anatomical-coverage", "name": "Anatomical coverage", "description": "Identify the articulations and local supporting structures covered by each observation.", "questions": [ { "text": "Does this observation concern the tibiofemoral articulation, patellofemoral articulation, supporting tissues, or an unlocalised knee region?", "kind": "definition", "id": "anatomical-coverage-q01" }, { "text": "Where should this record link to a neighbouring bone, tendon, joint, or limb model instead of extending the knee's ownership?", "kind": "boundary", "id": "anatomical-coverage-q02" } ] } ] } ] }, { "id": "articulations-and-supporting-tissues", "name": "Articulations and supporting tissues", "description": "Represent the knee's articular surfaces, menisci, stabilising structures, and extensor mechanism.", "rationale": "Different knee structures can produce overlapping symptoms while requiring distinct evidence and action constraints.", "layers": [ { "id": "articular-and-meniscal-condition", "name": "Articular and meniscal condition", "description": "Localise observations to joint compartments, cartilage, and menisci.", "findings": [ { "id": "surface-and-meniscus-findings", "name": "Surface and meniscus findings", "description": "Record compartment-specific structural observations without assuming that an imaging finding explains symptoms.", "questions": [ { "text": "Which articular surface or meniscus is described, and what condition was observed?", "kind": "definition", "id": "surface-and-meniscus-findings-q01" }, { "text": "Which examination, imaging study, or procedure supports the observation, and when was it obtained?", "kind": "provenance", "id": "surface-and-meniscus-findings-q02" } ] } ] }, { "id": "stabilisers-and-extensor-mechanism", "name": "Stabilisers and extensor mechanism", "description": "Represent knee ligaments, capsule, and the structures involved in active extension.", "findings": [ { "id": "supporting-tissue-integrity", "name": "Supporting tissue integrity", "description": "Record structure-specific integrity, prior repair or reconstruction, and the limits of available evidence.", "questions": [ { "text": "Which ligament, capsular structure, or extensor mechanism component is intact, altered, repaired, or uncertain?", "kind": "definition", "id": "supporting-tissue-integrity-q01" }, { "text": "What evidence supports that assessment, and does it describe tissue appearance, mechanical function, or both?", "kind": "provenance", "id": "supporting-tissue-integrity-q02" } ] } ] } ] }, { "id": "motion-stability-and-load", "name": "Motion, stability, and load", "description": "Describe how the knee moves and behaves under specified assessment and activity conditions.", "rationale": "Structural descriptions alone do not establish available movement, stability, or functional capacity.", "layers": [ { "id": "range-and-stability-assessment", "name": "Range and stability assessment", "description": "Capture reproducible motion and stability observations.", "findings": [ { "id": "measured-knee-mechanics", "name": "Measured knee mechanics", "description": "Record flexion, extension, and assessed laxity with methods and conditions.", "questions": [ { "text": "What active and passive flexion and extension were measured, using which angle convention and position?", "kind": "measurement", "id": "measured-knee-mechanics-q01" }, { "text": "What directional stability assessments were performed, and what results, symptoms, or assessment limitations were recorded?", "kind": "measurement", "id": "measured-knee-mechanics-q02" } ] } ] }, { "id": "loaded-task-performance", "name": "Loaded task performance", "description": "Connect knee behaviour to activities and external support.", "findings": [ { "id": "activity-dependent-capacity", "name": "Activity-dependent capacity", "description": "Record performance during walking, stairs, chair rise, squatting, kneeling, or other relevant tasks.", "questions": [ { "text": "During which task, load, and assistance conditions were pain, giving way, catching, or movement limitation observed or reported?", "kind": "measurement", "id": "activity-dependent-capacity-q01" }, { "text": "Which task limitations are attributed to the knee, and which may involve the hip, ankle, balance, or another condition?", "kind": "boundary", "id": "activity-dependent-capacity-q02" } ] } ] } ] }, { "id": "symptoms-and-state-assessment", "name": "Symptoms and state assessment", "description": "Track local symptoms, examination signs, temporal changes, and the strength of proposed explanations.", "rationale": "A knee model must distinguish what a person experiences, what an assessor observes, and what has actually been established.", "layers": [ { "id": "symptom-location-and-course", "name": "Symptom location and course", "description": "Describe pain, swelling, stiffness, and mechanical symptoms over time.", "findings": [ { "id": "dated-knee-symptom-pattern", "name": "Dated knee symptom pattern", "description": "Record onset, location, triggers, duration, and change while preserving the reporter's meaning.", "questions": [ { "text": "Where and when do pain, swelling, or stiffness occur, and how have they changed relative to an injury, procedure, or activity?", "kind": "measurement", "id": "dated-knee-symptom-pattern-q01" }, { "text": "When someone reports locking or giving way, what precisely happened, and was it reported, witnessed, or reproduced during assessment?", "kind": "provenance", "id": "dated-knee-symptom-pattern-q02" } ] } ] }, { "id": "evidence-and-clinical-interpretation", "name": "Evidence and clinical interpretation", "description": "Keep observed signs, investigation results, and clinical conclusions distinguishable.", "findings": [ { "id": "supported-state-judgement", "name": "Supported state judgement", "description": "Link any conclusion about the knee's state to dated evidence and explicitly retain unresolved explanations.", "questions": [ { "text": "Which local signs and investigation findings support the recorded interpretation, and who made that interpretation?", "kind": "provenance", "id": "supported-state-judgement-q01" }, { "text": "What remains unresolved about a local knee cause, a referred symptom, or a systemic contributor?", "kind": "boundary", "id": "supported-state-judgement-q02" } ] } ] } ] }, { "id": "interventions-and-action-constraints", "name": "Interventions and action constraints", "description": "Connect prior knee interventions and current clinical instructions to proposed actions.", "rationale": "Repairs, reconstructions, replacements, and current restrictions can change how knee findings should guide activity and assessment.", "layers": [ { "id": "altered-anatomy-and-procedure-history", "name": "Altered anatomy and procedure history", "description": "Record procedures that changed the knee and link any implanted components.", "findings": [ { "id": "post-intervention-configuration", "name": "Post-intervention configuration", "description": "Identify treated structures, procedure dates, and resulting anatomical changes without substituting a device record for the knee.", "questions": [ { "text": "Which knee structures were repaired, reconstructed, removed, or replaced, and on what dates?", "kind": "provenance", "id": "post-intervention-configuration-q01" }, { "text": "Which details describe the anatomical knee, and which belong in linked procedure or implant records?", "kind": "boundary", "id": "post-intervention-configuration-q02" } ] } ] }, { "id": "current-permissions-and-review-needs", "name": "Current permissions and review needs", "description": "Represent applicable restrictions, their authority, and conditions requiring further assessment.", "findings": [ { "id": "supported-next-action", "name": "Supported next action", "description": "Evaluate proposed knee-related actions against documented instructions, evidence gaps, and applicable review protocols.", "questions": [ { "text": "What current instructions govern weight bearing, knee motion, bracing, or activity, and who issued them for what period?", "kind": "action", "id": "supported-next-action-q01" }, { "text": "Does the proposed action require additional assessment or qualified review under the applicable protocol, given this knee's recorded condition?", "kind": "action", "id": "supported-next-action-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "tibiofemoral joint (medial and lateral condylar articulations)", "patellofemoral joint", "medial tibiofemoral compartment", "lateral tibiofemoral compartment", "native (unreplaced) knee", "total knee replacement (total knee arthroplasty)", "unicompartmental / partial knee replacement", "laterality: right knee versus left knee" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "Terminologia Anatomica / Latin", "value_or_pattern": "articulatio genus (also articulatio genu); articulatio patellofemoralis", "note": "Preferred anatomical names used in TA-aligned teaching sources; numeric TA98/TA2 codes for the joint as a whole were not retrieved in this pass." }, { "scheme": "SNOMED CT", "value_or_pattern": "Knee joint structure (body structure); Entire knee joint (body structure)", "note": "Preferred terms from CISMeF mappings; numeric SCTIDs were not retrieved." }, { "scheme": "FMA", "value_or_pattern": "Knee joint", "note": "Entity name from CISMeF; numeric FMAID not retrieved." }, { "scheme": "MeSH", "value_or_pattern": "Knee joint", "note": "Descriptor name from CISMeF; MeSH Unique ID not retrieved." }, { "scheme": "UBERON", "value_or_pattern": "knee joint", "note": "Concept name from CISMeF; numeric UBERON ID not retrieved." }, { "scheme": "ICD-11", "value_or_pattern": "Knee joint (anatomy extension code)", "note": "Used to locate findings and procedures; the exact extension-code string was not retrieved." }, { "scheme": "ICD-10-CM", "value_or_pattern": "M17* (osteoarthritis of knee); S83* (dislocation, sprain and strain of joints and ligaments of knee); M21.06* / M21.26* (valgus / flexion deformity of knee)", "note": "Disease, injury and deformity codes that take the knee as the site, with right/left/unspecified laterality in ICD-10-CM." }, { "scheme": "LOINC", "value_or_pattern": "100165-0", "note": "Knee range of motion, quantitative, in degrees; a measurement of the joint rather than an identifier of the organ." }, { "scheme": "NCIt", "value_or_pattern": "Knee Joint", "note": "Concept name from CISMeF." }, { "scheme": "RadLex", "value_or_pattern": "knee joint (constitutional part of knee)", "note": "RID code not retrieved; CISMeF treats the joint as a part of the knee region." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "ISO 21536:2023 - Non-active surgical implants - Joint replacement implants - Specific requirements for knee-joint replacement implants (International Organization for Standardization, ISO/TC 150/SC 4).", "EN ISO 21536:2024 - same title, European adoption of ISO 21536:2023 (CEN).", "ISO 21534 and ISO 7207-1 - general joint-replacement and knee-implant vocabulary referenced by ISO 21536 (International Organization for Standardization).", "2019 American College of Rheumatology / Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee (ACR and Arthritis Foundation).", "Surgical Management of Osteoarthritis of the Knee, clinical practice guideline (American Academy of Orthopaedic Surgeons).", "ICD-10-CM (National Center for Health Statistics / CMS) for laterality-specific coding of knee disease, injury and deformity in US records.", "Terminologia Anatomica (FIPAT / IFAA) for the official anatomical names of the joint and its parts." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Primary load-bearing joint of gait, standing, sitting, stair climbing and squatting; examined clinically for effusion, alignment, ligament laxity and range of motion.", "Imaged with standing radiographs and MRI as the default work-up for pain, locking, instability and osteoarthritis.", "Common site of sports injury (ACL, meniscus, collateral ligaments) and of arthroscopic repair or reconstruction.", "End-stage tibiofemoral osteoarthritis is treated by total or unicompartmental knee arthroplasty under ISO 21536-class implants; patellofemoral pain is usually managed with exercise, taping or orthoses rather than surgery.", "Outcome is scored with instruments such as KOOS and the Knee Society Score, which include LOINC-coded range-of-motion items." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "knee flexion range of motion", "typical_range": "120 to 150 (from 0° extension; soft-tissue bulk and age dependent)", "unit": "degree" }, { "quantity": "knee extension, including physiologic hyperextension", "typical_range": "0; some people 5 to 10 of hyperextension; beyond about 10 is often treated as genu recurvatum", "unit": "degree" }, { "quantity": "internal (medial) rotation with the knee flexed", "typical_range": "about 10", "unit": "degree" }, { "quantity": "external (lateral) rotation with the knee flexed", "typical_range": "about 10 active to about 30; up to about 60 reported as passive", "unit": "degree" }, { "quantity": "patellar articular-cartilage thickness (adult, central)", "typical_range": "up to about 6 at peak (around age 30)", "unit": "millimetre" }, { "quantity": "patellar articular surface area (adult)", "typical_range": "about 12", "unit": "square centimetre" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Knee osteoarthritis (gonarthrosis): activity-related pain, stiffness under 30 minutes, joint-space loss; estimated 654 million people worldwide; may progress to arthroplasty.", "Meniscal tear: traumatic (often under 40, twisting) or degenerative (often with OA over 40); about 12% of adults; displaced bucket-handle tears can lock the joint.", "Cruciate or collateral ligament rupture or sprain (especially ACL), producing instability, giving-way and secondary meniscal or chondral damage.", "Patellofemoral pain: anterior pain in active people under 40; lifetime prevalence about 25%; squat-related pain is sensitive but not specific.", "Alignment failure: genu varum, genu valgum, flexion contracture, genu recurvatum (hyperextension beyond about 10°).", "Intra-articular fracture (tibial plateau, distal femur, patella), dislocation, haemarthrosis, bursitis and septic arthritis.", "After replacement: implant wear, loosening, infection, stiffness, instability and the higher rate of serious adverse events seen with total knee replacement versus continued non-surgical care." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Clinical and ICD language: English 'osteoarthritis of the knee' versus 'gonarthrosis' / 'gonarthrose' in ICD-derived European usage.", "Nerve and ligament English: 'common peroneal' remains common in radiology; TA-aligned sources prefer 'common fibular'.", "US ICD-10-CM requires right/left/unspecified laterality on knee OA and deformity codes (e.g. M17.11 versus M17.12); WHO ICD-10 often does not.", "Implant practice splits total versus unicompartmental replacement and cruciate-retaining versus posterior-stabilized designs; ISO 21536 now defines 'maximum claimed flexion' because demanded flexion is not uniform across patients and markets." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "knee region (regio genus)", "difference": "The region is a body-location class (skin, bursae, popliteal fossa, extra-articular fat); the knee joint is the synovial articulations. Test: presence of articular surfaces and a joint cavity, not merely a topographic landmark." }, { "name": "proximal tibiofibular joint", "difference": "A separate synovial joint at the fibular head, not one of the three knee compartments. Test: the articulation is fibular head to lateral tibial condyle, outside the tibiofemoral meniscal cavity." }, { "name": "patella (kneecap)", "difference": "A sesamoid bone in the quadriceps-patellar tendon, not the joint. Test: bone continuity and sesamoid position versus the two synovial articulations that use its posterior surface." }, { "name": "hip joint", "difference": "Proximal neighbour whose pain is often referred to the knee. Test: groin or greater-trochanter pain and hip rotation reproducing symptoms, with a quiet knee examination and imaging." }, { "name": "temporomandibular joint", "difference": "Another diarthrodial hinge with a fibrocartilage disc, sometimes analogized to the knee; different bones, load and surgical frequency. Test: mandible-temporal articulation versus femur-tibia-patella." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of knee this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does vr.tr.knee cover human knees only, or must species-specific knee anatomy and terminology be represented?", "What precise regional boundary should govern ownership of bursae, the proximal tibiofibular joint, the popliteal region, and adjacent tendon segments?", "Which established Vercy models already own anatomical joints, knee disorders, procedures, and implants, and how should this entry link to them?", "Which validated assessment methods, grading systems, and measurement conventions should be supported for different ages and clinical contexts?", "Which authoritative clinical protocols should govern review triggers and action constraints, including after repair, reconstruction, or replacement?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }