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Sample records for healthy articular knee

  1. Implementation of a gait cycle loading into healthy and meniscectomised knee joint models with fibril-reinforced articular cartilage.

    Science.gov (United States)

    Mononen, Mika E; Jurvelin, Jukka S; Korhonen, Rami K

    2015-01-01

    Computational models can be used to evaluate the functional properties of knee joints and possible risk locations within joints. Current models with fibril-reinforced cartilage layers do not provide information about realistic human movement during walking. This study aimed to evaluate stresses and strains within a knee joint by implementing load data from a gait cycle in healthy and meniscectomised knee joint models with fibril-reinforced cartilages. A 3D finite element model of a knee joint with cartilages and menisci was created from magnetic resonance images. The gait cycle data from varying joint rotations, translations and axial forces were taken from experimental studies and implemented into the model. Cartilage layers were modelled as a fibril-reinforced poroviscoelastic material with the menisci considered as a transversely isotropic elastic material. In the normal knee joint model, relatively high maximum principal stresses were specifically predicted to occur in the medial condyle of the knee joint during the loading response. Bilateral meniscectomy increased stresses, strains and fluid pressures in cartilage on the lateral side, especially during the first 50% of the stance phase of the gait cycle. During the entire stance phase, the superficial collagen fibrils modulated stresses of cartilage, especially in the medial tibial cartilage. The present computational model with a gait cycle and fibril-reinforced biphasic cartilage revealed time- and location-dependent differences in stresses, strains and fluid pressures occurring in cartilage during walking. The lateral meniscus was observed to have a more significant role in distributing loads across the knee joint than the medial meniscus, suggesting that meniscectomy might initiate a post-traumatic process leading to osteoarthritis at the lateral compartment of the knee joint.

  2. Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults.

    Directory of Open Access Journals (Sweden)

    Sam Van Rossom

    Full Text Available Cartilage is responsive to the loading imposed during cyclic routine activities. However, the local relation between cartilage in terms of thickness distribution and biochemical composition and the local contact pressure during walking has not been established. The objective of this study was to evaluate the relation between cartilage thickness, proteoglycan and collagen concentration in the knee joint and knee loading in terms of contact forces and pressure during walking. 3D gait analysis and MRI (3D-FSE, T1ρ relaxation time and T2 relaxation time sequence of fifteen healthy subjects were acquired. Experimental gait data was processed using musculoskeletal modeling to calculate the contact forces, impulses and pressure distribution in the tibiofemoral joint. Correlates to local cartilage thickness and mean T1ρ and T2 relaxation times of the weight-bearing area of the femoral condyles were examined. Local thickness was significantly correlated with local pressure: medial thickness was correlated with medial condyle contact pressure and contact force, and lateral condyle thickness was correlated with lateral condyle contact pressure and contact force during stance. Furthermore, average T1ρ and T2 relaxation time correlated significantly with the peak contact forces and impulses. Increased T1ρ relaxation time correlated with increased shear loading, decreased T1ρ and T2 relaxation time correlated with increased compressive forces and pressures. Thicker cartilage was correlated with higher condylar loading during walking, suggesting that cartilage thickness is increased in those areas experiencing higher loading during a cyclic activity such as gait. Furthermore, the proteoglycan and collagen concentration and orientation derived from T1ρ and T2 relaxation measures were related to loading.

  3. Changes in Knee Kinematics Reflect the Articular Geometry after Arthroplasty

    OpenAIRE

    Bull, AMJ; Kessler, O.; Alam, M; Amis, AA

    2008-01-01

    We hypothesized changes in rotations and translations after TKA with a fixed-bearing anterior cruciate ligament (ACL)-sacrificing but posterior cruciate ligament (PCL)-retaining design with equal-sized, circular femoral condyles would reflect the changes of articular geometry. Using 8 cadaveric knees, we compared the kinematics of normal knees and TKA in a standardized navigated position with defined loads. The quadriceps was tensed and moments and drawer forces applied during knee flexion-ex...

  4. Secondary knee instability caused by fracture of the stabilizing insert in a dual-articular total knee

    DEFF Research Database (Denmark)

    Boesen, Morten P; Jensen, Tim Toftgaard; Husted, Henrik

    2004-01-01

    A case of a fractured polyethylene stabilizing insert causing secondary knee instability in a Dual-articular total knee arthroplasty (TKA) is presented. A 65-year-old woman who underwent surgery with a Dual-articular TKA 4 years earlier had a well-functioning prosthesis until a fall, after which......-articular knee....

  5. Intra-articular temperatures of the knee in sports - an in-vivo study of jogging and alpine skiing.

    Science.gov (United States)

    Becher, Christoph; Springer, Jan; Feil, Sven; Cerulli, Guiliano; Paessler, Hans H

    2008-04-11

    Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19 degrees C room temperature and skiing in a ski resort at -3 degrees C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Median intra-articular temperatures increased from 31.4 degrees C before activity by 2.1 degrees C, 4 degrees C, 5.8 degrees C and 6.1 degrees C after 15, 30, 45 and 60 min of jogging (all p skiing (all n.s.). After 60 minutes of skiing (jogging), the median intra-articular temperature was 19.6% (8.7%) higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

  6. Intra-articular analgesia and steroid reduce pain sensitivity in knee OA patients

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

    2014-01-01

    Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded ...

  7. Changes in knee kinematics reflect the articular geometry after arthroplasty.

    Science.gov (United States)

    Bull, Anthony M J; Kessler, Oliver; Alam, Mahbub; Amis, Andrew A

    2008-10-01

    We hypothesized changes in rotations and translations after TKA with a fixed-bearing anterior cruciate ligament (ACL)-sacrificing but posterior cruciate ligament (PCL)-retaining design with equal-sized, circular femoral condyles would reflect the changes of articular geometry. Using 8 cadaveric knees, we compared the kinematics of normal knees and TKA in a standardized navigated position with defined loads. The quadriceps was tensed and moments and drawer forces applied during knee flexion-extension while recording the kinematics with the navigation system. TKA caused loss of the screw-home; the flexed tibia remained at the externally rotated position of normal full knee extension with considerably increased external rotation from 63 degrees to 11 degrees extension. The range of internal-external rotation was shifted externally from 30 degrees to 20 degrees extension. There was a small tibial posterior translation from 40 degrees to 90 degrees flexion. The varus-valgus alignment and laxity did not change after TKA. Thus, navigated TKA provided good coronal plane alignment but still lost some aspects of physiologic motion. The loss of tibial screw-home was related to the symmetric femoral condyles, but the posterior translation in flexion was opposite the expected change after TKA with the PCL intact and the ACL excised. Thus, the data confirmed our hypothesis for rotations but not for translations. It is not known whether the standard navigated position provides the best match to physiologic kinematics.

  8. Intra-articular temperatures of the knee in sports – An in-vivo study of jogging and alpine skiing

    Science.gov (United States)

    Becher, Christoph; Springer, Jan; Feil, Sven; Cerulli, Guiliano; Paessler, Hans H

    2008-01-01

    Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05). Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.). After 60 minutes of skiing (jogging), the median intra-articular temperature was 19.6% (8.7%) higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature. PMID:18405365

  9. Intra-articular temperatures of the knee in sports – An in-vivo study of jogging and alpine skiing

    Directory of Open Access Journals (Sweden)

    Cerulli Guiliano

    2008-04-01

    Full Text Available Abstract Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05. Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.. After 60 minutes of skiing (jogging, the median intra-articular temperature was 19.6% (8.7% higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

  10. High Kinesiophobia and Pain Catastrophizing in People with Articular Cartilage Defects in the Knee

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    Thoma, Louise M.; Flanigan, David C.; Best, Thomas M.; Schmitt, Laura

    2017-01-01

    Objectives: Psychosocial factors, including kinesiophobia and pain catastrophizing, are increasingly recognized for the role they play in knee function and quality of life for people with anterior cruciate ligament reconstruction (ACLR), knee osteoarthritis (OA), and total knee arthroplasties (TKA). People with articular cartilage defects in the knee have impaired function and poor quality of life, however the extent to which they present with kinesiophobia and pain catastrophizing is not known. The purpose of this study is to compare kinesiophobia, i.e. fear of movement-related pain/reinjury, and pain catastrophizing of people with articular cartilage defects (ACD) in the knee to healthy controls. Methods: Thirty-five individuals (19M:16F, Age mean ± 95%CI 29.8 ± 2.8 years old, BMI 28.1 ± 1.44) seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls (9M:9F, Age 29.8 ± 3.0 years old, BMI 24.9 ± 1.3) without history of knee injury participated in the study. Exclusion criteria included; age >55 years, BMI >35kg/m2, recent surgery, current low back pain or unrelated lower extremity pain, and history of spine surgery or neurological injury and pathology. Kinesiophobia for all 53 subjects was measured with the Tampa Scale of Kinesiophobia (TSK). The TSK was scored using the original 17-item (TSK-17, Min 17 - Max 68) and modified 11-item (TSK-11, Min 11 - Max 44) scoring systems as both have been commonly used in the literature. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS, Min 0 - Max 52). Higher scores on these measures indicate greater kinesiophobia and pain catastrophizing. Independent t-tests were used to compare the ACD group to the healthy controls (α=0.05). Mean TSK and PCS scores (± 95% CI) were plotted alongside values published in samples with other knee pathologies for reference. Results: Participants with ACDs reported higher kinesiophobia (TSK-17 mean score ± 95%CI [range]: ACD 40

  11. Clinical characteristics of pain originating from intra-articular structures of the knee joint in patients with medial knee osteoarthritis

    OpenAIRE

    Ikeuchi, Masahiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Tani, Toshikazu

    2013-01-01

    Purpose Although disease progression of osteoarthritis has been well documented, pain pathophysiology is largely unknown. This study was designed with two purposes: 1) to characterize patients with knee pain predominantly originating from intra-articular structures and 2) to describe the location and pattern of their pain. Materials and methods 103 patients with medial knee osteoarthritis underwent an intra-articular injection of local anesthetics (joint block). At least 70% pain relief was d...

  12. Autologous cartilage implantation for full thickness articular cartilage defects of the knee.

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    Wasiak, J; Villanueva, E

    2002-01-01

    A variety of strategies have been employed for managing articular cartilage defects of the knee, including drilling and abrasion arthroplasty. These treatments are not always effective and when they are, the benefits may only be transitory. Unsuccessfully treated cartilage damage may progress to degenerative disease states and result in the need for a total knee replacement. In recent years the surgical implantation of healthy cartilage cells (autologous cartilage implantation [ACI] ) into damaged areas has been seen as an alternative option and is currently under investigation as a potential improvement over the current strategies for the management and treatment of articular cartilage defects. To determine the effectiveness of ACI in patients with full thickness articular cartilage defects of the knee. We searched the Cochrane Musculoskeletal Injuries Group specialised register (May 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to June Week 4 2001), CINAHL (1982 to July Week 2 2001), EMBASE (1980 to 2001 Week 27), SPORTDiscus (1949 to June 2001), Current Contents (1993 Week 26 to 2001 Week 30) and the National Research Register (Issue 2, May 2002). Randomised and quasi-randomised trials comparing ACI with any other type of treatment (including no treatment or placebo) for symptomatic cartilage defects of the medial or lateral femoral condyle, trochlea or patella. Two independent reviewers applied the entry criteria to identified studies. No completed randomised controlled trials investigating this treatment were identified through the above searches. One possible trial has been placed in Studies Awaiting Assessment, awaiting translation of the full trial report. Ongoing trials currently underway will be incorporated in future updates of this review. No information is available from RCTs which can influence current practice. Therefore, since current evidence is subject to the inherent weaknesses of case series or

  13. Mechanical Analysis of Extra-Articular Knee Ligaments. Part One: Native knee ligaments.

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    Smeets, Kristof; Slane, Joshua; Scheys, Lennart; Claes, Steven; Bellemans, Johan

    2017-10-01

    The aim of this study was to provide a characterization of the tensile properties of the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterolateral ligament (ALL) and medial patellofemoral ligament (MPFL). Our hypothesis was that extra-articular knee ligaments are heterogeneous in nature and possess distinct material properties. MCL (n=12), LCL (n=11), MPFL (n=12) and ALL (n=19) samples from fresh frozen human cadaveric knees were subjected to uniaxial tensile testing to failure and analyzed for their material properties. The elastic modulus (slope of the linear portion of the stress/strain curve), ultimate stress (stress at failure), ultimate strain (strain at failure) and strain energy density (area under the stress/strain curve) were calculated. The MCL had the highest elastic modulus (441.8±117.2MPa) and was significantly greater than the MPFL (294.6±190.4MPa) and LCL (289.0±159.7MPa) (Pligaments (ALL 7.8±3.1MPa, MCL 7.5±2.9MPa and MPFL 5.0±2.9MPa). Extra-articular knee ligaments are a heterogeneous group with respect to material characteristics. Each ligament has tensile properties that are significantly different from others and treatment strategies should take these findings into account. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Black Colouration of the Knee Articular Cartilage after Spontaneously Recurrent Haemarthrosis

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    Kazu Matsumoto

    2016-01-01

    Full Text Available Mild discolouration of the articular cartilage is known to gradually occur during aging. However, pathological tissue pigmentation is occasionally induced under several specific conditions. In the present case, we performed total knee replacement in a patient with recurrent haemarthrosis. However, during the operation, we observed severe black colouration of the knee articular cartilage, due to the deposition of hemosiderin and lipofuscin. To our knowledge, this is the first report of severe cartilage pigmentation, due to hemosiderin and lipofuscin deposition in articular cartilage.

  15. Rehabilitation after Articular Cartilage Repair of the Knee in the Football (Soccer) Player

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    Silvers, Holly Jacinda; Steinwachs, Matthias

    2012-01-01

    Background: Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to nonathletes. The management of chondral defects in the football player is complex and multifactorial. Objective: The aim of this study is to provide an overview of the current strategies for rehabilitation after articular cartilage repair of the knee in the football player. Design: A review of current literature and the scientific evidence for rehabilitation after articular cartilage repair of the knee. Conclusions: Articular cartilage repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after articular cartilage repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation, especially in the transition from therapy to performance care. It should be recognized that not all players will return to football after articular cartilage repair. The evidence base for rehabilitative practice after articular cartilage repair is increasing but remains sparse in areas. PMID:26069608

  16. Lipoma arborescens arising in the extra-articular bursa of the knee joint

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    Minami, Shinji; Miyake, Yusuke; Kinoshita, Hirofumi

    2016-01-01

    Lipoma arborescens arising in the extra-articular bursa of the knee joint is extremely rare. We describe an 11-year-old boy who complained of a gradual swelling mass of the lateral knee joint. Magnetic resonance imaging (MRI) showed a high signal intensity tumor on T1- and T2-weighted images with a thickened septa and nodular lesion that showed low signal intensity. The radiologist suggested the possible differential diagnosis of well-differentiated liposarcoma. At operation, the tumor was found under the iliotibial tract and was not in contact with the knee joint. Histopathologically, this lesion was diagnosed as lipoma arborescens arising in the extra-articular bursa of the knee joint. On MRI, the appearance of lipoma arborescens arising in the extra-articular bursa of the knee joint differed from that of conventional intra-articular lipoma arborescens. In this report, we describe a case of extra-articular lipoma arborescens of the knee joint bursa and discuss the diagnosis and etiology. PMID:27382924

  17. Development of methods for analysis of knee articular cartilage degeneration by magnetic resonance imaging data

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    Suponenkovs, Artjoms; Glazs, Aleksandrs; Platkajis, Ardis

    2017-03-01

    The aim of this paper is to describe the new methods for analyzing knee articular cartilage degeneration. The most important aspects regarding research about magnetic resonance imaging, knee joint anatomy, stages of knee osteoarthritis, medical image segmentation and relaxation times calculation. This paper proposes new methods for relaxation times calculation and medical image segmentation. The experimental part describes the most important aspect regarding analysing of articular cartilage relaxation times changing. This part contains experimental results, which show the codependence between relaxation times and organic structure. These experimental results and proposed methods can be helpful for early osteoarthritis diagnostics.

  18. Pain perception in knees with circumscribed cartilage lesions is associated with intra-articular IGF-1 expression.

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    Schmal, Hagen; Niemeyer, Philipp; Südkamp, Norbert P; Gerlach, Ulrike; Dovi-Akue, David; Mehlhorn, Alexander T

    2011-09-01

    Circumscribed cartilage defects are considered as prearthritic lesions and lead to differential intra-articular cytokine expression. Mechanisms of associated pain development and influence of smoking behavior are not yet fully understood in humans. This study aimed to reveal relations between synovial cytokine levels in knees with circumscribed cartilage defects and pain sensation. Descriptive laboratory study. In a clinical trial, knee lavage fluids of 42 patients with circumscribed cartilage lesions treated by either microfracturing (n = 19) or by autologous chondrocyte implantation (n = 23) and fluids of 5 healthy control individuals were prospectively collected. Preoperative knee pain was evaluated according to frequency and strength; subjective knee function was assessed using a visual analog scale and the International Knee Documentation Committee (IKDC) score. Synovial concentrations of aggrecan, insulin-like growth factor (IGF)-I, basic fibroblast growth factor (bFGF), interleukin (IL)-1β, bone morphogenetic protein (BMP)-2, and BMP-7 were determined by enzyme-linked immunosorbent assay. Pain strength showed a highly significant association with intra-articular IGF-1 levels (ρ = .48, P < .01), but no correlation with synovial concentrations of aggrecan, bFGF, IL-1β, BMP-2, and BMP-7. Although pain strength and frequency demonstrated a statistically significant relationship, no substantial association between pain frequency and any of the examined cytokine levels was found. Intra-articular IGF-1 concentrations significantly correlated with the area of cartilage damage (ρ = .35, P < .02); the other investigated cytokines failed to show this association. Neither of the determined intra-articular mediators demonstrated statistically significant correlations with subjective knee function or IKDC score. Only intra-articular concentrations of IGF-1 and BMP-2 statistically significantly correlated with age; total protein content was negatively associated with

  19. Simultaneous femoral and tibial osteotomies during total knee arthroplasty for severe extra-articular deformity.

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    Moyad, Thomas F; Estok, Daniel

    2009-01-01

    Total knee arthroplasty (TKA) performed in knees with mild or moderate intraarticular deformity often can be resolved with careful ligament balancing and bone resection. However, extra-articular deformity may require an osteotomy to safely create rectangular flexion and extension gap balance. In these challenging situations, restoring the mechanical axis through intra-articular bone resection and soft tissue releases alone can lead to excessive bone loss and ligament instability. We report a case of TKA with combined femoral and tibial osteotomies in a post-polio patient with extra-articular deformities. Although a few small case studies have been previously published in the literature, specific details regarding this procedure are lacking. Our objective is to provide a detailed surgical technique and to review the indications for extra-articular osteotomies performed during TKA.

  20. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

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    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  1. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs

    NARCIS (Netherlands)

    van Tienen, TG; Heijkants, RGJC; de Groot, JH; Pennings, AJ; Poole, AR; Veth, RPH; Buma, P

    Objective: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce

  2. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs.

    NARCIS (Netherlands)

    Tienen, Tony van; Heijkants, R.G.J.C.; Groot, J.H. de; Pennings, A.J.; Poole, A.R.; Veth, R.P.H.; Buma, P.

    2003-01-01

    OBJECTIVE: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce

  3. Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee?

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Nasir; Shepel, Michael; Leswick, David A.; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Royal University Hospital, and College of Medicine, Saskatoon, Saskatchewan (Canada)

    2014-04-15

    The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings. (orig.)

  4. Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy.

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    Nakajima, Arata; Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi

    2013-01-01

    Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy.

  5. Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy

    Directory of Open Access Journals (Sweden)

    Arata Nakajima

    2013-01-01

    Full Text Available Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy.

  6. Intra-Articular Osteoid Osteoma as a Cause of Anteromedial Knee Pain

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    Ergin Sagtas

    2017-01-01

    Full Text Available A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method.

  7. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine.

    Science.gov (United States)

    Richards, Masters M; Maxwell, Joshua Shane; Weng, Lihui; Angelos, Mathew G; Golzarian, Jafar

    2016-01-01

    Knee osteoarthritis (OA) is a debilitating condition that may ultimately require total knee arthroplasty (TKA). Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI). The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. A literature search was executed using Medline, Cochrane, and Embase with keywords "knee osteoarthritis" and "injection." Specifically, 45 articles that discussed intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSC), were analyzed. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5 evidence. Papers included animal models. Local anesthetics have potential side effects and may only be effective for a few hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation . Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.

  8. Extra-articular soft tissue ganglion cyst around the knee: focus on the associated findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jee-Young; Jung, Sun-Ah; Park, Young-Ha [Department of Radiology, St. Vincent' s Hospital, Catholic University of Korea, 93-6 Ji-dong, Paldal-ku, Suwon, 442-723, Kyounggi-do (Korea); Sung, Mi-Sook [Department of Radiology, Holy Family Hospital, Catholic University of Korea, Sosa-dong, Puchun (Korea); Kang, Yong-Koo [Department of Orthopedic Surgery, St. Vincent' s Hospital, Catholic University of Korea, 93-6 Ji-dong, Paldal-ku, Suwon, 442-723, Kyounggi-do (Korea)

    2004-01-01

    The aim of this study was to evaluate MR imaging findings of the associated findings in surrounding tissues of the extra-articular soft tissue ganglion cysts around the knee. We retrospectively reviewed MR images of 30 patients who had surgically confirmed extra-articular soft tissue ganglion cysts around the knee with focus on the associated findings in surrounding tissues, such as muscle, subcutaneous fat, bone, and nerve. The most common associated finding was the visualization of channel between ganglion cyst and the joint, which was demonstrated in 20 cases (continuous type in 12 cases and discontinuous type in 8 cases). Other associated findings were seen in 15 cases; pericystic edema (n=9), bony remodelling (n=3), and nerve involvement (n=3). The bony remodelling involved the proximal metaphysis of tibia in all 3 cases. Two patients with nerve involvement had deep peroneal nerve in subacute phase and one involved common peroneal nerve in chronic phase. The MR imaging is a useful imaging modality to evaluate the associated findings in extra-articular soft tissue ganglion cysts around the knee. The evaluation of these associated findings is helpful for the differentiation of ganglion cysts from other cystic lesions around the knee. (orig.)

  9. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Directory of Open Access Journals (Sweden)

    Diego García-Germán

    2013-01-01

    Full Text Available We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

  10. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, L Ø; Husted, H; Kristensen, B B

    2010-01-01

    The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra......-articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief...

  11. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Nielsen, Christian Skovgaard; Jans, Øivind; Ørsnes, Thue

    2016-01-01

    BACKGROUND: In total knee arthroplasty, both intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) have been shown to reduce blood loss in several randomized controlled trials, although routine use of systemic TXA is considerably more common. However, to our knowledge......-only administration of TXA. METHODS: In this randomized, double-blind, placebo-controlled trial, 60 patients scheduled for total knee arthroplasty were randomized to one of two interventions. The TXA IV and IA group received combined administration of TXA consisting of 1 g administered intravenously preoperatively...... Instructions for Authors for a complete description of levels of evidence....

  12. Intra-Articular Hyaluronic Acid Injections Vs. Dextrose Prolotherapy in the Treatment of Osteoarthritic Knee Pain

    Directory of Open Access Journals (Sweden)

    S Nasiripour

    2012-05-01

    Full Text Available Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology (ACR for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid (Synocrom Forte® 1% weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score (KOOS self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis. Results: The mean age of the patients was 60.68.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups (P<0.001. Conclusion: It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA.

  13. Estabilidade articular do joelho no quadro do "joelho-flutuante" Knee joint stability in a "floating knee" condition

    Directory of Open Access Journals (Sweden)

    Felipe Antônio de Marco

    2008-01-01

    Full Text Available Neste trabalho, 22 pacientes com fraturas ipslaterais do fêmur e da tíbia ("joelho flutuante" tratados cirurgicamente foram convocados para reavaliação. Com seguimento mínimo de 4 meses, 17 pacientes compareceram e foram reavaliados através de exame físico, radiológico, escala de Lysholm e o escore de Kärlstron. As fraturas foram classificadas quanto ao grau de exposição (Gustillo e Andersen, cominuição (AO e o "joelho-flutuante" (Fraser. Doze pacientes (70,6% apresentaram alterações objetivas no exame físico do joelho. A instabilidade articular foi a alteração mais encontrada, presente em oito casos (47%, seguida da restrição de movimento em sete pacientes (41,2%. A instabilidade anterior foi diagnosticada em cinco casos (29,4%, sendo três associados à instabilidade em varo. A instabilidade posterior estava presente em dois pacientes (11,8%, ambos associados com instabilidade em varo. Um paciente apresentou instabilidade periférica em varo e valgo, associada à restrição importante da flexão do joelho. As presença de fraturas intra-articulares, fraturas expostas do fêmur cursaram com maior incidência de restrição do arco de movimento. Nesta casuística os resultados obtidos reforçam a necessidade da avaliação sistemática da estabilidade articular do joelho, visto que o quadro de "joelho flutuante" está freqüentemente associado à lesão cápsulo-ligamentar desta articulação.In this study, 22 patients who had undergone surgical treatment for ipsilateral fractures of the femur and tibia ("floating knee" were recalled for reassessment. Seventeen patients turned up after a follow-up period of four months and were reassessed by applying the physical and radiological exams, the Lysholm's knee scale and the Karlstron score. The fractures were classified according to degree of exposure, communication and "floating knee" condition. Twelve patients (70.6% presented with definite alterations during the physical

  14. Analgesic efficacy of intra-articular morphine after arthroscopic knee surgery in sport injury patients.

    Science.gov (United States)

    Yari, Mitra; Saeb, Morteza; Golfam, Parisa; Makhloogh, Zahra

    2013-07-01

    Anterior cruciate ligament (ACL) tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20 cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3).

  15. A comparative analysis of 7.0-Tesla magnetic resonance imaging and histology measurements of knee articular cartilage in a canine posterolateral knee injury model: a preliminary analysis.

    Science.gov (United States)

    Pepin, Scott R; Griffith, Chad J; Wijdicks, Coen A; Goerke, Ute; McNulty, Margaret A; Parker, Josh B; Carlson, Cathy S; Ellermann, Jutta; LaPrade, Robert F

    2009-11-01

    There has recently been increased interest in the use of 7.0-T magnetic resonance imaging for evaluating articular cartilage degeneration and quantifying the progression of osteoarthritis. The purpose of this study was to evaluate articular cartilage cross-sectional area and maximum thickness in the medial compartment of intact and destabilized canine knees using 7.0-T magnetic resonance images and compare these results with those obtained from the corresponding histologic sections. Controlled laboratory study. Five canines had a surgically created unilateral grade III posterolateral knee injury that was followed for 6 months before euthanasia. The opposite, noninjured knee was used as a control. At necropsy, 3-dimensional gradient echo images of the medial tibial plateau of both knees were obtained using a 7.0-T magnetic resonance imaging scanner. Articular cartilage area and maximum thickness in this site were digitally measured on the magnetic resonance images. The proximal tibias were processed for routine histologic analysis with hematoxylin and eosin staining. Articular cartilage area and maximum thickness were measured in histologic sections corresponding to the sites of the magnetic resonance slices. The magnetic resonance imaging results revealed an increase in articular cartilage area and maximum thickness in surgical knees compared with control knees in all specimens; these changes were significant for both parameters (P .1). These results demonstrate that 7.0-T magnetic resonance imaging provides an alternative method to histology to evaluate early osteoarthritic changes in articular cartilage in a canine model by detecting increases in articular cartilage area. The noninvasive nature of 7.0-T magnetic resonance imaging will allow for in vivo monitoring of osteoarthritis progression and intervention in animal models and humans for osteoarthritis.

  16. Development of an Electromechanical Grade to Assess Human Knee Articular Cartilage Quality.

    Science.gov (United States)

    Sim, Sotcheadt; Hadjab, Insaf; Garon, Martin; Quenneville, Eric; Lavigne, Patrick; Buschmann, Michael D

    2017-10-01

    Quantitative assessments of articular cartilage function are needed to aid clinical decision making. Our objectives were to develop a new electromechanical grade to assess quantitatively cartilage quality and test its reliability. Electromechanical properties were measured using a hand-held electromechanical probe on 200 human articular surfaces from cadaveric donors and osteoarthritic patients. These data were used to create a reference electromechanical property database and to compare with visual arthroscopic International Cartilage Repair Society (ICRS) grading of cartilage degradation. The effect of patient-specific and location-specific characteristics on electromechanical properties was investigated to construct a continuous and quantitative electromechanical grade analogous to ICRS grade. The reliability of this novel grade was assessed by comparing it with ICRS grades on 37 human articular surfaces. Electromechanical properties were not affected by patient-specific characteristics for each ICRS grade, but were significantly different across the articular surface. Electromechanical properties varied linearly with ICRS grade, leading to a simple linear transformation from one scale to the other. The electromechanical grade correlated strongly with ICRS grade (r = 0.92, p < 0.0001). Additionally, the electromechanical grade detected lesions that were not found visually. This novel grade can assist the surgeon in assessing human knee cartilage by providing a quantitative and reliable grading system.

  17. Synovial fluid biomarker levels predict articular cartilage damage following complete medial meniscectomy in the canine knee.

    Science.gov (United States)

    Carlson, Cathy S; Guilak, Farshid; Vail, Thomas P; Gardin, Jean F; Kraus, Virginia B

    2002-01-01

    The purposes of this study were to document the histological changes present in the tibial plateaus 12 weeks after complete medial meniscectomy in dogs and to determine if synovial lavage fluid biomarker levels are predictive of the severity of joint damage. Twelve adult dogs underwent complete unilateral medial meniscectomy and synovial lavage fluid biomarker levels, including cartilage oligomeric matrix protein (COMP), keratan sulfate (5D4). 3B3(-), and 3B3(+), were measured serially at 4-week intervals. The dogs were euthanized 12 weeks after surgery and each medial and lateral tibial plateau from the meniscectomized and contralateral knees was graded histologically. Histological data were analyzed using principal components analysis, which resulted in 4 factors that explained 70% of the variation in the data. Factor 2 (weighted most heavily by subchondral bone thickness) and Factor 3 (representative of articular cartilage damage) were significantly affected by compartmental site (P knee, and Factor 3 was significantly higher in this site than in the medial tibial plateau of the contralateral knee (P canine meniscectomy as surrogate measures of articular cartilage damage.

  18. Deginerative changes of femoral articular cartilage in the knee : comparative study of specimen sonography and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ju Youn; Hong, Sung Hwan; Sohn, Jin Hee; Wee, Young Hoon; Chang, Jun Dong; Park, Hong Seok; Lee, Eil Seoung; Kang Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To determine the sonographic findings of degenerative change in femoral articular cartilage of the knee by comparative study of specimen sonography and pathology. We obtained 40 specimens of cartilage of the femur (20 medial and 20 lateral condylar) from 20 patients with osteoarthritis of the knee who had undergone total knee replacement. The specimens were placed in a saline-filled container and sonography was performed using a 10-MHz linear transducer. Sonographic abnormalities were evaluated at the cartilage surface, within the cartilage, and at the bone-cartilage interface, and were compared with the corresponding pathologic findings. In addition, cartilage thickness was measured at a representative portion of each femoral cartilage specimen and was compared with the thickness determined by sonography. 'Dot' lesions, irregularity or loss of the hyperechoic line, were demonstrated by sonography at the saline-cartilage interface of 14 cartilages. Pathologic examination showed that these findings corresponded to cleft, detachment, erosion, and degeneration. Irregularities in the hyperechoic line at the bone-cartilage interface were revealed by sonography in eight cartilages and were related to irregularity or loss of tidemark, downward displacement of the cartilage, and subchondral callus formation. Dot lesions, corresponding to cleft and degeneration, were noted within one cartilage. Cartilage thickness measured on specimen and by sonography showed no significant difference (p=0.446). Specimen sonography suggested that articular cartilage underwent degenerative histopathological change. Cartilage thickness measured by sonography exactly reflected real thickness.

  19. Repair of articular osteochondral defects of the knee joint using a composite lamellar scaffold.

    Science.gov (United States)

    Lv, Y M; Yu, Q S

    2015-04-01

    The major problem with repair of an articular cartilage injury is the extensive difference in the structure and function of regenerated, compared with normal cartilage. Our work investigates the feasibility of repairing articular osteochondral defects in the canine knee joint using a composite lamellar scaffold of nano-ß-tricalcium phosphate (ß-TCP)/collagen (col) I and II with bone marrow stromal stem cells (BMSCs) and assesses its biological compatibility. The bone-cartilage scaffold was prepared as a laminated composite, using hydroxyapatite nanoparticles (nano-HAP)/collagen I/copolymer of polylactic acid-hydroxyacetic acid as the bony scaffold, and sodium hyaluronate/poly(lactic-co-glycolic acid) as the cartilaginous scaffold. Ten-to 12-month-old hybrid canines were randomly divided into an experimental group and a control group. BMSCs were obtained from the iliac crest of each animal, and only those of the third generation were used in experiments. An articular osteochondral defect was created in the right knee of dogs in both groups. Those in the experimental group were treated by implanting the composites consisting of the lamellar scaffold of ß-TCP/col I/col II/BMSCs. Those in the control group were left untreated. After 12 weeks of implantation, defects in the experimental group were filled with white semi-translucent tissue, protruding slightly over the peripheral cartilage surface. After 24 weeks, the defect space in the experimental group was filled with new cartilage tissues, finely integrated into surrounding normal cartilage. The lamellar scaffold of ß-TCP/col I/col II was gradually degraded and absorbed, while new cartilage tissue formed. In the control group, the defects were not repaired. This method can be used as a suitable scaffold material for the tissue-engineered repair of articular cartilage defects. Cite this article: Bone Joint Res 2015;4:56-64. ©2015 The British Editorial Society of Bone & Joint Surgery.

  20. Cartilage turnover and intra-articular corticosteroid injections in knee osteoarthritis.

    Science.gov (United States)

    Klocke, Rainer; Levasseur, Kirsty; Kitas, George D; Smith, Jacqueline P; Hirsch, George

    2018-02-02

    Intra-articular corticosteroid injections (IACI) are commonly used interventions for pain relief in patients with knee osteoarthritis (OA). Biomarkers may be helpful in further elucidating how IACI exert their effect. The aim of this study is to look at the response of biomarkers of cartilage and bone metabolism after IACI in knee OA. Eighty subjects with symptomatic knee OA [45% male, mean age (SD) 64 (11) years] underwent routine knee joint injection with 40 mg triamcinolone acetonide and 4 ml 1% lignocaine. Knee pain (as pain subscale of WOMAC VAS) and biomarkers [C-telopeptides of type-II collagen (uCTX-II), and N-telopeptides of type-I collagen in urine; cartilage oligomeric matrix protein (COMP), hyaluronic acid, N-terminal propeptide of type-IIA collagen, and human cartilage glycoprotein-39 (YKL-40) in serum] were measured at baseline and 3 weeks after IACI. Radiographic severity of disease was evaluated using knee radiographs. Median uCTX-II, a cartilage degradation marker, was lower at 3 weeks post IACI compared with baseline: 306.3 and 349.9 ng/mmol, respectively (p < 0.01), which remained significant after Bonferroni correction. Apart from a weak trend of lower sCOMP post IACI (p = 0.089), other biomarkers showed no change after IACI. Both baseline uCTX-II values and the change in uCTX-II from baseline to 3 weeks post injection correlated with radiographic severity of joint space narrowing, but not osteophyte grade. No association between uCTX-II and pain was observed. This observational study suggests that IACI in knee OA may reduce cartilage degradation in the short term.

  1. [Intra-articular knee stabilization with synthetic material. A practice-oriented stabilization technic].

    Science.gov (United States)

    Lieben, N H

    1986-12-01

    An intra-articular method designed to stabilise the knee joint using synthetic material after rupture of the anterior cruciate ligament is described. The results obtained in forty dogs and two cats treated by this method during the period from 1980 to 1985, are reported. The morbid-anatomical findings within fourteen months after surgery are referred to in one case. Rejection of the ligament was not observed in a single case. When habitual or stationary medial dislocation of the patella was present in addition to a lesion of the anterior cruciate ligament, the patella was no longer found to be subject to dislocation following stabilisation of the knee joint. Clinical results ranged from moderate to satisfactory, varying with the degree of arthrosis and the lesions of the meniscus which were present. This technique does not take up much time and consequently saves expenses.

  2. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

    2016-01-01

    OBJECTIVE: To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). DESIGN: Randomized, masked, parallel, placebo-controlled trial involving 100...... the injections all participants undertook a 12-week supervised exercise program. Main outcomes were changes from baseline in pressure-pain sensitivity (pressure-pain threshold [PPT] and temporal summation [TS]) assessed using cuff pressure algometry on the calf. These were exploratory outcomes from a randomized...... not provide additional benefits compared to placebo in reducing pain sensitivity in patients with knee OA. TRIAL REGISTRATION: EU clinical trials (EudraCT): 2012-002607-18....

  3. Modulation of Physical Activity to Optimize Pain Sensation following an Intra-Articular Corticosteroid Injection in Patients with Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Yoann Dessery

    2014-01-01

    Full Text Available Background. Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. Methods. Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. Results. From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients’ daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. Conclusions. The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients’ daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879.

  4. Articular cartilage thickness and glycosaminoglycan distribution in the young canine knee joint after remobilization of the immobilized limb.

    Science.gov (United States)

    Kiviranta, I; Tammi, M; Jurvelin, J; Arokoski, J; Säämänen, A M; Helminen, H J

    1994-03-01

    The recovery of articular cartilage from atrophy induced by joint immobilization was investigated in immature dogs. In a previous study, we showed that 11 weeks of immobilization of the knee (stifle) joint of young dogs reduced the concentration of articular cartilage glycosaminoglycans (GAGs) by 13-47%. In the present study, right hindlimbs from six female beagles were immobilized for 11 weeks, as in the previous study, and then were remobilized for 15 weeks. Cartilage from the knee joint was compared with cartilage from nonimmobilized knees of eight age-matched control beagles. Histological samples taken from 11 different locations of the knee joint were stained with safranin O, and microspectrophotometry was used to demonstrate distribution of GAGs in the tissue. After remobilization, GAG concentration was restored in the patellofemoral region and tibial condyles. On the summits of the femoral condyles, and especially at the periphery of the femoral condyles, GAG concentration remained 8-26% less than the control values. On the summits, the thickness of the uncalcified cartilage was as much as 15% less than in the age-matched controls. Consequently, the changes induced by unloading were reversible to a great extent, but a full restoration of articular cartilage was not obtained at all sites of the knee joint within the 15 weeks of remobilization. Immobilization of the skeletally immature joint therefore may affect the development of articular cartilage in such a way that very slow recovery or permanent alterations are induced.

  5. [Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee].

    Science.gov (United States)

    Cellár, R; Sokol, D; Lacko, M; Štolfa, Š; Gharaibeh, A; Vaško, G

    2012-01-01

    Magnetic resonance imaging (MRI) has the highest sensitivity of all methods for the diagnosis of intra-articular knee injuries. In spite of this, its benefit for the decision-making algorithm is questionable. The aim of this study was to evaluate the real situation in our regional conditions. The medical records of the patients who underwent knee arthroscopy in 2008 and 2009, and had pre-operative MRI examination, were retrospectively reviewed. The group included 92 patients (46 women and 46 men; average age, 41.7 years) of whom 49 had knee injury in their medical history. In medial meniscus (MM) injuries, the MRI examination had a sensitivity of 0.92 and a specificity of 0.44, and the congruence of MRI and arthroscopic findings was 0.73. In lateral meniscus (LM) tears, the values were 0.70 for sensitivity, 0.81 for specificity and 0.87 for congruence. In injury to the anterior cruciate ligament (ACL), MRI sensitivity was 0.66, specificity was 0.85 and congruence was 0.79. In evaluation of articular chondral lesions, the values were 0.45 for sensitivity, 0.87 for specificity and 0.60 for congruence. In our examination of knee structures for MM, LM, ACL and cartilage injuries, the diagnostic value of MRI was lowest for cartilage damage, with sensitivity being only 0.45. This was in agreement with the findings of other authors. Although this fact is known, our arthroscopic findings in patients with no MRI evidence of injury were very high: 22 knees with grade III or grade IV chondral lesions. Therefore, MRI examination is not considered to be sensitive enough to replace arthroscopy in the diagnosis of cartilage injuries. MRI examination is most frequently indicated in suspected meniscal damage. Its sensitivity reported in the literature varies; generally, it is about 0.90 in MM injuries, and about 0.75 in LM lesions, and this is in agreement with our results. However, in view of our previous experience, the high sensitivity of MRI in the diagnosis of MM lesions was

  6. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

    Science.gov (United States)

    McAlindon, Timothy E; LaValley, Michael P; Harvey, William F; Price, Lori Lyn; Driban, Jeffrey B; Zhang, Ming; Ward, Robert J

    2017-05-16

    Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis but might have adverse effects on cartilage and periarticular bone. To determine the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on progression of cartilage loss and knee pain. Two-year, randomized, placebo-controlled, double-blind trial of intra-articular triamcinolone vs saline for symptomatic knee osteoarthritis with ultrasonic features of synovitis in 140 patients. Mixed-effects regression models with a random intercept were used to analyze the longitudinal repeated outcome measures. Patients fulfilling the American College of Rheumatology criteria for symptomatic knee osteoarthritis, Kellgren-Lawrence grades 2 or 3, were enrolled at Tufts Medical Center beginning February 11, 2013; all patients completed the study by January 1, 2015. Intra-articular triamcinolone (n = 70) or saline (n = 70) every 12 weeks for 2 years. Annual knee magnetic resonance imaging for quantitative evaluation of cartilage volume (minimal clinically important difference not yet defined), and Western Ontario and McMaster Universities Osteoarthritis index collected every 3 months (Likert pain subscale range, 0 [no pain] to 20 [extreme pain]; minimal clinically important improvement, 3.94). Among 140 randomized patients (mean age, 58 [SD, 8] years, 75 women [54%]), 119 (85%) completed the study. Intra-articular triamcinolone resulted in significantly greater cartilage volume loss than did saline for a mean change in index compartment cartilage thickness of -0.21 mm vs -0.10 mm (between-group difference, -0.11 mm; 95% CI, -0.20 to -0.03 mm); and no significant difference in pain (-1.2 vs -1.9; between-group difference, -0.6; 95% CI, -1.6 to 0.3). The saline group had 3 treatment-related adverse events compared with 5 in the triamcinolone group

  7. The results of knee manipulation for stiffness after total knee arthroplasty with or without an intra-articular steroid injection.

    Science.gov (United States)

    Sharma, Vineet; Maheshwari, Aditya V; Tsailas, Panagiotis G; Ranawat, Amar S; Ranawat, Chitranjan S

    2008-07-01

    Stiffness after total knee arthroplasty (TKA) requiring manipulation has a reported incidence of 1.3-54%. The purpose of this study was to compare the incidence of stiffness warranting manipulation using two different pain management protocols. We also studied the effect of an intra-articular injection of local anesthetic and steroid given at the time of manipulation on the range-of-motion (ROM) at last follow-up. A total of 286 TKAs (248 patients between January 2002 and December 2003) were compared to a second group of 292 TKAs (251 patients between January 2004 and March 2006). The first group received patient-controlled analgesia (PCA) for postoperative pain management. The second group had a peri-articular injection of a steroid-containing local anesthetic at the time of surgery, but no postoperative PCA. All patients undergoing manipulation in the second group also received a similar intra-articular injection at the time of manipulation as well. Only patients with minimum 12 months follow-up after manipulation were included in the study. The overall incidence of stiffness requiring manipulation in both groups was similar at 2.4% and 2.1%, respectively (P = 0.1). The end results of manipulation with and without injection showed a significantly higher final ROM in patients who had had an injection at the time of manipulation (P = 0.001). The difference was due to the fact that patients who had an injection lost no motion from that achieved at the time of manipulation. We were unable to demonstrate a significant reduction in the incidence of stiffness after TKA using a modern pain management protocol. However, injection of a local anesthetic and steroid at the time of manipulation did have a significant influence on preserving the ROM that was obtained at the time of manipulation.

  8. Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics.

    NARCIS (Netherlands)

    Baar, M.E. van; Dekkers, J.; Lemmens, J.A.M.; Oostendorp, R.A.B.; Bijlsma, J.W.J.

    1998-01-01

    Objective: To determine to what extent articular, kinesiological, and psychological factors each contribute to pain and disability in patients with osteoarthritis (OA), after controlling for other factors. Methods: Cross sectional study among 200 patients with OA of the hip or knee. Dependent

  9. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments

    DEFF Research Database (Denmark)

    Altman, Roy D; Devji, Tahira; Bhandari, Mohit

    2016-01-01

    OBJECTIVES: Hyaluronic acid and corticosteroids are common intra-articular (IA) therapies widely used for the management of mild to moderate knee osteoarthritis (OA). Many trials evaluating the efficacy of IA administered therapies commonly use IA saline injections as a placebo comparator arm...

  10. A protocol for developing a clinical practice guideline for intra-articular injection for treating knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Dan Xing

    2018-01-01

    Ethics and dissemination: The protocol will provide us a roadmap to systematically develop evidence-based CPG for intra-articular injection for knee OA. The work will be disseminated electronically and in print. The guideline would be the first CPG that is developed primarily by orthopedic specialists in China and strictly based on systematic methodology.

  11. Kinematic Analysis of Gait Following Intra-articular Corticosteroid Injection into the Knee Joint with an Acute Exacerbation of Arthritis.

    Science.gov (United States)

    Mehta, Saurabh; Shay, Barbara L; Szturm, Tony; El-Gabalawy, Hani S

    2011-01-01

    The objective of this study was to examine the effects of intra-articular corticosteroid injection (ICI) on ipsilateral knee flexion/extension, ankle dorsiflexion/plantarflexion (DF/PF), and hip abduction/adduction (abd/add) during stance phase in people with an acute exacerbation of rheumatoid arthritis (RA) of the knee joint. The study also assessed the effects of ICI on spatiotemporal parameters of gait and functional status in this group. Nine people with an exacerbation of RA of the knee were recruited. Kinematic and spatiotemporal gait parameters were obtained for each participant. Knee-related functional status was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Spatiotemporal gait parameters and joint angles (knee flexion, ankle DF/PF, hip abd/add) of the affected side were compared pre- and post-ICI. Data for eight people were available for analysis. Median values for knee flexion and ankle PF increased significantly following ICI. Gait parameters of cadence, velocity, bilateral stride length, bilateral step length, step width, double-support percentage, and step time on the affected side also showed improvement. Pain and knee-related functional status as measured by the KOOS showed improvement. This study demonstrated a beneficial short-term effect of ICI on knee-joint movements, gait parameters, and knee-related functional status in people with acute exacerbation of RA of the knee.

  12. Kinematic Analysis of Gait Following Intra-articular Corticosteroid Injection into the Knee Joint with an Acute Exacerbation of Arthritis

    Science.gov (United States)

    Mehta, Saurabh; Szturm, Tony; El-Gabalawy, Hani S.

    2011-01-01

    ABSTRACT Purpose: The objective of this study was to examine the effects of intra-articular corticosteroid injection (ICI) on ipsilateral knee flexion/extension, ankle dorsiflexion/plantarflexion (DF/PF), and hip abduction/adduction (abd/add) during stance phase in people with an acute exacerbation of rheumatoid arthritis (RA) of the knee joint. The study also assessed the effects of ICI on spatiotemporal parameters of gait and functional status in this group. Methods: Nine people with an exacerbation of RA of the knee were recruited. Kinematic and spatiotemporal gait parameters were obtained for each participant. Knee-related functional status was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Spatiotemporal gait parameters and joint angles (knee flexion, ankle DF/PF, hip abd/add) of the affected side were compared pre- and post-ICI. Results: Data for eight people were available for analysis. Median values for knee flexion and ankle PF increased significantly following ICI. Gait parameters of cadence, velocity, bilateral stride length, bilateral step length, step width, double-support percentage, and step time on the affected side also showed improvement. Pain and knee-related functional status as measured by the KOOS showed improvement. Conclusions: This study demonstrated a beneficial short-term effect of ICI on knee-joint movements, gait parameters, and knee-related functional status in people with acute exacerbation of RA of the knee. PMID:22942516

  13. A double blind randomized active-controlled clinical trial on the intra-articular use of Md-Knee versus sodium hyaluronate in patients with knee osteoarthritis ("Joint").

    Science.gov (United States)

    Martin Martin, Luis Severino; Massafra, Umberto; Bizzi, Emanuele; Migliore, Alberto

    2016-02-22

    To evaluate the clinical outcomes of a group of patients affected by knee osteoarthritis (OA) treated with MD-Knee (Guna S.p.a., Milan, Italy) versus a group of patients treated with sodium hyaluronate. This non-inferiority prospective randomized controlled trial involved 60 patients affected by knee OA, grade 2-3 of Kellgren-Lawrence scale. The MD-Knee Group, Group A (n = 29) was administered five intra-articular injections at 1 week interval; the sodium hyaluronate Group, Group B (n = 31), was administered five doses of intra-articular injection of sodium hyaluronate at 1 week interval. All patients were prospectively evaluated before and at 3 and 6 months after the treatment by the Lequesne Knee Index (LKI) as primary endpoint and the Visual Analogue Scale (VAS), Pain Killer consumption and SF-36 questionnaires as secondary endpoints. At the 3- and 6 month follow-up, LKI and VAS improved significantly in both groups compared to baseline and no statistically significant differences were observed between Group A and Group B. There was no statistically significant difference in the SF36 questionnaire score and pain killer consumption between two groups at any time point. This study shows that both preparations exert similar clinical effects as assessed through multiple outcome measures. MD-Knee is effective on knee OA symptoms over 6 months after a 5-weekly injection course, and it is equally effective as the reference sodium hyaluronate. ISRCTN93862496 . Registration date: January 18th, 2016.

  14. Analgesic effects of intra-articular botulinum toxin Type B in a murine model of chronic degenerative knee arthritis pain

    Directory of Open Access Journals (Sweden)

    Stephanie Anderson

    2010-09-01

    Full Text Available Stephanie Anderson1,2, Hollis Krug1,2, Christopher Dorman1, Pari McGarraugh1, Sandra Frizelle1, Maren Mahowald1,21Rheumatology Section, Veteran’s Affairs Medical Center, Minneapolis, Minnesota; 2Division of Rheumatology and Autoimmune Diseases, University of Minnesota Medical School, Minneapolis, Minnesota, USAObjective: To evaluate the analgesic effectiveness of intra-articular botulinum toxin Type B (BoNT/B in a murine model of chronic degenerative arthritis pain.Methods and materials: Chronic arthritis was produced in adult C57Bl6 mice by intra-articular injection of Type IV collagenase into the left knee. Following induction of arthritis, the treatment group received intra-articular BoNT/B. Arthritic control groups were treated with intra-articular normal saline or sham injections. Pain behavior testing was performed prior to arthritis, after induction of arthritis, and following treatments. Pain behavior measures included analysis of gait impairment (spontaneous pain behavior and joint tenderness evaluation (evoked pain response. Strength was measured as ability to grasp and cling.Results: Visual gait analysis showed significant impairment of gait in arthritic mice that improved 43% after intra-articular BoNT/B, demonstrating a substantial articular analgesic effect. Joint tenderness, measured with evoked pain response scores, increased with arthritis induction and decreased 49.5% after intra-articular BoNT/B treatment. No improvement in visual gait scores or decrease in evoked pain response scores were found in the control groups receiving intra-articular normal saline or sham injections. Intra-articular BoNT/B was safe, and no systemic effects or limb weakness was noted.Conclusions: This study is the first report of intra-articular BoNT/B for analgesia in a murine model of arthritis pain. The results of this study validate prior work using intra-articular neurotoxins in murine models. Our findings show chronic degenerative arthritis

  15. Topographical variation of the elastic properties of articular cartilage in the canine knee.

    Science.gov (United States)

    Jurvelin, J S; Arokoski, J P; Hunziker, E B; Helminen, H J

    2000-06-01

    Equilibrium response of articular cartilage to indentation loading is controlled by the thickness (h) and elastic properties (shear modulus, mu, and Poisson's ratio, nu) of the tissue. In this study, we characterized topographical variation of Poisson's ratio of the articular cartilage in the canine knee joint (N=6). Poisson's ratio was measured using a microscopic technique. In this technique, the shape change of the cartilage disk was visualized while the cartilage was immersed in physiological solution and compressed in unconfined geometry. After a constant 5% axial strain, the lateral strain was measured during stress relaxation. At equilibrium, the lateral-to-axial strain ratio indicates the Poisson's ratio of the tissue. Indentation (equilibrium) data from our prior study (Arokoski et al., 1994. International Journal of Sports Medicine 15, 254-260) was re-analyzed using the Poisson's ratio results at the test site to derive values for shear and aggregate moduli. The lowest Poisson's ratio (0.070+/-0.016) located at the patellar surface of femur (FPI) and the highest (0.236+/-0.026) at the medial tibial plateau (TMI). The stiffest cartilage was found at the patellar groove of femur (micro=0.964+/-0.189MPa, H(a)=2.084+/-0. 409MPa) and the softest at the tibial plateaus (micro=0.385+/-0. 062MPa, H(a)=1.113+/-0.141MPa). Comparison of the mechanical results and the biochemical composition of the tissue (Jurvelin et al., 1988. Engineering in Medicine 17, 157-162) at the matched sites of the canine knee joint indicated a negative correlation between the Poisson's ratio and collagen-to-PG content ratio. This is in harmony with our previous findings which suggested that, in unconfined compression, the degree of lateral expansion in different tissue zones is related to collagen-to-PG ratio of the zone.

  16. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair

    Science.gov (United States)

    Mithoefer, Kai; Saris, Daniel B.F.; Farr, Jack; Kon, Elizaveta; Zaslav, Kenneth; Cole, Brian J.; Ranstam, Jonas; Yao, Jian; Shive, Matthew; Levine, David; Dalemans, Wilfried; Brittberg, Mats

    2011-01-01

    Objective: To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products. Design: A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field. Results: Current literature reflects the methodological limitations of the scientific evidence available for articular cartilage repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment, control group considerations, study endpoint definition, documentation of results, use of validated patient-reported outcome instruments, and inclusion and exclusion criteria for the design and conduct of scientifically sound cartilage repair study protocols. A consensus statement among the International Cartilage Repair Society (ICRS) and contributing authors experienced in clinical trial design and implementation was achieved. Conclusions: High-quality clinical research methodology is critical for the optimal evaluation of current and new cartilage repair technologies. In addition to generally applicable principles for orthopedic study design, specific criteria and considerations apply to cartilage repair studies. Systematic application of these criteria and considerations can facilitate study designs that are scientifically rigorous, ethical, practical, and appropriate for the question(s) being addressed in any given cartilage repair research project

  17. Chronic changes in the articular cartilage and meniscus following traumatic impact to the lapine knee.

    Science.gov (United States)

    Fischenich, Kristine M; Button, Keith D; Coatney, Garrett A; Fajardo, Ryan S; Leikert, Kevin M; Haut, Roger C; Haut Donahue, Tammy L

    2015-01-21

    The objective of this study was to induce anterior cruciate ligament (ACL) and meniscal damage, via a single tibiofemoral compressive impact, in order to document articular cartilage and meniscal changes post-impact. Tibiofemoral joints of Flemish Giant rabbits were subjected to a single blunt impact that ruptured the ACL and produced acute meniscal damage. Animals were allowed unrestricted cage activity for 12 weeks before euthanasia. India ink analysis of the articular cartilage revealed higher degrees of surface damage on the impacted tibias (p=0.018) and femurs (ppermeability (p=0.054), 40.8% increase in femoral condyle permeability (p=0.029), and 20.1% decrease in femoral condyle matrix modulus (p=0.012) in impacted joints compared to controls. Both instantaneous and equilibrium moduli of the lateral and medial menisci were decreased compared to control (p<0.02). Histological analyses revealed significantly increased presence of fissures in the medial femur (p=0.036). In both meniscus and cartilage there was a significant decrease in GAG coverage for the impacted limbs. Based on these results it is clear that an unattended combined meniscal and ACL injury results in significant changes to the soft tissues in this experimental joint 12 weeks post-injury. Such changes are consistent with a clinical description of mid to late stage PTOA of the knee. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis

    Directory of Open Access Journals (Sweden)

    Victor M Goldberg

    2010-05-01

    Full Text Available Victor M Goldberg1, Laura Goldberg21Department of Orthopaedics, Case Medical Center, Cleveland, Ohio, USA; 2Cleveland Clinic, Cleveland, Ohio, USAAbstract: The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. Intra-articular injections of hyaluronans (HAs are indicated when non-pharmacological and simple analgesics have failed to relieve symptoms. The HAs appear to reduce pain by restoring both mechanical and biomechanical homeostasis in the joint. There are five FDA-approved injectable preparations of HAs: Hyalgan®, Synvisc®, Supartz®, Orthovisc® and Euflexxa®. They all appear to relieve pain from 4 to 14 weeks after injection and may have disease-modification properties. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra-articular HA injections in the treatment of osteoarthritis.Keywords: hyaluronans, knee, pain, osteoarthritis

  19. Spatial and temporal changes of subchondral bone proceed to articular cartilage degeneration in rats subjected to knee immobilization.

    Science.gov (United States)

    Xu, Lei; Li, Zhe; Lei, Lei; Zhou, Yue-Zhu; Deng, Song-Yun; He, Yong-Bin; Ni, Guo-Xin

    2016-03-01

    This study was aimed to investigate the spatial and temporal changes of subchondral bone and its overlying articular cartilage in rats following knee immobilization. A total of 36 male Wistar rats (11-13 months old) were assigned randomly and evenly into 3 groups. For each group, knee joints in 6 rats were immobilized unilaterally for 1, 4, or 8 weeks, respectively, while the remaining rats were allowed free activity and served as external control groups. For each animal, femurs at both sides were dissected after sacrificed. The distal part of femur was examined by micro-CT. Subsequently, femoral condyles were collected for further histological observation and analysis. For articular cartilage, significant changes were observed only at 4 and 8 weeks of immobilization. The thickness of articular cartilage and chondrocytes numbers decreased with time. However, significant changes in subchondral bone were defined by micro-CT following immobilization in a time-dependent manner. Immobilization led to a thinner and more porous subchondral bone plate, as well as a reduction in trabecular thickness and separation with a more rod-like architecture. Changes in subchondral bone occurred earlier than in articular cartilage. More importantly, immobilization-induced changes in subchondral bone may contribute, at least partially, to changes in its overlying articular cartilage. © 2016 Wiley Periodicals, Inc.

  20. Genetic architecture of knee radiographic joint space in healthy young adults.

    Science.gov (United States)

    Duren, Dana L; Sherwood, Richard J; Czerwinski, Stefan A; Chumlea, William Cameron; Lee, Miryoung; Demerath, Ellen W; Sun, Shumei S; Siervogel, Roger M; Towne, Bradford

    2008-02-01

    Evidence of a significant genetic component to the age-related degenerative joint disease osteoarthritis has been established, but the nature of genetic influences on normal joint morphology in healthy individuals remains unclear. Following up on our previous findings on the influence of body habitus on phenotypic variation in knee joint space [Duren et al., Human Biology 78:353-364 (2006)], the objective of the current study was to estimate the heritability of radiographic joint space in the knees of healthy young adults from a community-based sample of families. A sample of 253 subjects (mean age = 18.02 years) from 87 randomly ascertained nuclear and extended families was examined. Joint width (JW) and minimum joint space in the medial (MJS) and lateral (LJS) knee compartments were measured. A maximum-likelihood variance components method was used to estimate the heritability of MJS, LJS, and JW. Covariate effects of age, sex, age-by-sex interactions, stature, weight, and BMI were simultaneously estimated. Genetic correlation analyses were then conducted to examine relationships between trait pairs. MJS, LJS, and JW were each significantly heritable (p healthy subjects. This suggests that there are specific but as yet unidentified genes that influence the morphology of healthy articular cartilage, the target tissue of osteoarthritis. Genetic correlation analyses indicate complete pleiotropy between MJS and LJS but genetic independence of joint space and JW.

  1. Computational biomechanics of articular cartilage of human knee joint: effect of osteochondral defects.

    Science.gov (United States)

    Shirazi, R; Shirazi-Adl, A

    2009-11-13

    Articular cartilage and its supporting bone functional conditions are tightly coupled as injuries of either adversely affects joint mechanical environment. The objective of this study was set to quantitatively investigate the extent of alterations in the mechanical environment of cartilage and knee joint in presence of commonly observed osteochondral defects. An existing validated finite element model of a knee joint was used to construct a refined model of the tibial lateral compartment including proximal tibial bony structures. The response was computed under compression forces up to 2000 N while simulating localized bone damage, cartilage-bone horizontal split, bone overgrowth and absence of deep vertical collagen fibrils. Localized tibial bone damage increased overall joint compliance and substantially altered pattern and magnitude of contact pressures and cartilage strains in both tibia and femur. These alterations were further exacerbated when bone damage was combined with base cartilage split and absence of deep vertical collagen fibrils. Local bone boss markedly changed contact pressures and strain patterns in neighbouring cartilage. Bone bruise/fracture and overgrowth adversely perturbed the homeostatic balance in the mechanical environment of articulate cartilage surrounding and opposing the lesion as well as the joint compliance. As such, they potentially contribute to the initiation and development of post-traumatic osteoarthritis.

  2. Effectiveness of intra-articular injections of sodium hyaluronate-chondroitin sulfate in knee osteoarthritis: a multicenter prospective study.

    Science.gov (United States)

    Rivera, Fabrizio; Bertignone, Luca; Grandi, Giancarlo; Camisassa, Roberto; Comaschi, Guido; Trentini, Diego; Zanone, Marco; Teppex, Giuseppe; Vasario, Gabriele; Fortina, Giorgio

    2016-03-01

    Intra-articular injection of hyaluronic acid is a well-established therapy for the treatment of knee osteoarthritis. The aim of the study was to assess the effectiveness and safety of the use of Arthrum HCS(®) (40 mg hyaluronic acid and 40 mg chondroitin sulfate in 2 mL). This was an open, multicenter, prospective study. Men or women over 40 years of age with documented knee osteoarthritis and WOMAC subscore A (severity of pain) ≥25 were enrolled. They received three weekly intra-articular injections of sodium hyaluronate 2 % and chondroitin sulfate 2 % in combination. WOMAC subscore A was assessed at 1, 3 and 6 months after the last injection. One hundred and twelve patients were included (women, 66 %). The mean (SD) WOMAC subscore A decreased from 52.1 (15.2) at inclusion to 20.5 (19.7) at month 6 (P hyaluronate-chondroitin sulfate in reducing pain (77 %), improving mobility (78 %) and reducing the consumption of analgesics (74 %). Only one adverse effect was reported by one patient (knee tumefaction). These results suggest that intra-articular injections of Arthrum HCS(®) (sodium hyaluronate plus chondroitin sulfate) in patients with knee osteoarthritis are efficient and safe. These results should be confirmed in a randomized controlled study. IV.

  3. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis

    DEFF Research Database (Denmark)

    Lundsgaard, C; Dufour, N; Fallentin, E

    2008-01-01

    Methodological constraints weaken previous evidence on intra-articular viscosupplementation and physiological saline distention for osteoarthritis. We conducted a randomized, patient- and observer-blind trial to evaluate these interventions in patients with painful knee osteoarthritis....

  4. Three-Point Dixon Chemical-Shift Imaging for Evaluating Articular Cartilage Defects in the Knee Joint on a Low-Field-Strength Open Magnet

    National Research Council Canada - National Science Library

    Bredella, M. A; Losasso, C; Moelleken, S. C; Huegli, R. W; Genant, H. K; Tirman, P. F. J

    2001-01-01

    .... OBJECTIVE. The purpose of our study was to assess the value of a modified three-point Dixon MR technique for evaluating articular cartilage defects in the knee joint on a low-field-strength open magnet...

  5. HISTOMORPHOMETRIC ANALYSIS OF THE KNEE ARTICULAR CARTILAGE AND SYNOVIUM FOR METADIAPHYSEAL LEG LENGTHENING (EXPERIMENTAL-AND-MORPHOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    T. A. Stupina

    2013-01-01

    Full Text Available The knee articular cartilage and synovial membrane have been studied for metadiaphyseal leg lengthening using the methods of light miscroscopy, computer morpho- and stereometry. The manner of bone integrity breaking, the rate and rhythm of distraction conformed to the lengthening technique most often used in the clinic. The results of the histomorphometric analysis have demonstrated that when osteotomy at the level of metadiaphysis and manual distraction by 1 mm a day for 4 times is performed, synovitis of mild and moderate degree develops through subsynovial layer hypervascularization, as well as reactive-destructive changes in nerve fibers with the tendency to regeneration. The structural-functional changes of reactive and/or destructive-reparative character have been revealed in the articular cartilage, and the manifestation degree of these changes correlates with synovial membrane changes. The intensity of the destructive-reparative processes in the articular cartilage and synovial membrane depends on fixation stability.

  6. Pain perception in knees with circumscribed cartilage lesions is associated with intra-articular IGF-1 expression

    DEFF Research Database (Denmark)

    Schmal, Hagen; Niemeyer, Philipp; Südkamp, Norbert P

    2011-01-01

    BACKGROUND: Circumscribed cartilage defects are considered as prearthritic lesions and lead to differential intra-articular cytokine expression. Mechanisms of associated pain development and influence of smoking behavior are not yet fully understood in humans. PURPOSE: This study aimed to reveal...... relations between synovial cytokine levels in knees with circumscribed cartilage defects and pain sensation. STUDY DESIGN: Descriptive laboratory study. METHODS: In a clinical trial, knee lavage fluids of 42 patients with circumscribed cartilage lesions treated by either microfracturing (n = 19......, IGF-1, and bFGF was significantly diminished compared to nonsmokers (P smoking negatively influenced...

  7. Isolation and characterization of human articular chondrocytes from surgical waste after total knee arthroplasty (TKA

    Directory of Open Access Journals (Sweden)

    Jakob Naranda

    2017-03-01

    Full Text Available Background Cartilage tissue engineering is a fast-evolving field of biomedical engineering, in which the chondrocytes represent the most commonly used cell type. Since research in tissue engineering always consumes a lot of cells, simple and cheap isolation methods could form a powerful basis to boost such studies and enable their faster progress to the clinics. Isolated chondrocytes can be used for autologous chondrocyte implantation in cartilage repair, and are the base for valuable models to investigate cartilage phenotype preservation, as well as enable studies of molecular features, nature and scales of cellular responses to alterations in the cartilage tissue. Methods Isolation and consequent cultivation of primary human adult articular chondrocytes from the surgical waste obtained during total knee arthroplasty (TKA was performed. To evaluate the chondrogenic potential of the isolated cells, gene expression of collagen type 2 (COL2, collagen 1 (COL1 and aggrecan (ACAN was evaluated. Immunocytochemical staining of all mentioned proteins was performed to evaluate chondrocyte specific production. Results Cartilage specific gene expression of COL2 and ACAN has been shown that the proposed protocol leads to isolation of cells with a high chondrogenic potential, possibly even specific phenotype preservation up to the second passage. COL1 expression has confirmed the tendency of the isolated cells dedifferentiation into a fibroblast-like phenotype already in the second passage, which confirms previous findings that higher passages should be used with care in cartilage tissue engineering. To evaluate the effectiveness of our approach, immunocytochemical staining of the evaluated chondrocyte specific products was performed as well. Discussion In this study, we developed a protocol for isolation and consequent cultivation of primary human adult articular chondrocytes with the desired phenotype from the surgical waste obtained during TKA. TKA is a

  8. Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement.

    Science.gov (United States)

    Lacko, Marek; Cellar, Robert; Schreierova, Daniela; Vasko, Gabriel

    2017-08-01

    This study aims to compare the efficacy and safety of intra-articular tranexamic acid (TA) versus intravenous (IV) TA in the reduction of perioperative blood loss and the degree of early postoperative complications associated with primary unilateral cemented total knee replacement. This prospective randomized study included 90 patients (36 males, 54 females; mean age 68.7 years; range 47 to 82 years) with knee osteoarthritis undergoing a unilateral cemented total knee replacement. Patients were randomized into three groups: group 1 received TA intravenously (dose 10 mg/kg) 20 minutes preoperatively and three hours after first dose, group 2 received TA (dose 3 g) locally (intra-articular) into surgical site, and group 3 did not receive TA. We measured perioperative blood loss, volume of drained blood in 24 hours postoperatively, overall blood loss, decrease in hemoglobin and hematocrit levels, and amount of blood transfusion. There were no differences between the groups in terms of patient preoperative demographics. Local or IV administration of TA significantly reduced the number of blood transfusions and blood losses in drainage. Intravenous application of TA was associated with statistically significantly higher hemoglobin and hematocrit levels and lower overall postoperative blood losses. No serious complications were observed in any of the groups. Intra-articular TA was equally effective as IV regimen in reducing the number of blood transfusions. However, IV administration of TA was associated with overall lower blood loss. Our results showed that IV administration of TA during total knee replacement is superior compared to intra-articular administration of TA.

  9. Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Mikel Sánchez

    2016-01-01

    Full Text Available The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55±14.11 to week 24 (74.60±19.19, after treatment (p=0.008, in the secondary outcomes (symptoms, p=0.004; ADL, p=0.022; sport/rec., p=0.017; QOL, p=0.012, as well as VAS score (p<0.001 and Lequesne Index (p=0.008. The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98±8.21 MSC/μL to 4.04±5.36 MSC/μL (p=0.019 and from 601.75±312.30 to 139.19±123.61  (p=0.012, respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.

  10. Electromechanical Assessment of Human Knee Articular Cartilage with Compression-Induced Streaming Potentials.

    Science.gov (United States)

    Becher, Christoph; Ricklefs, Marcel; Willbold, Elmar; Hurschler, Christof; Abedian, Reza

    2016-01-01

    To assess the electromechanical properties of human knee articular cartilage with compression-induced streaming potentials for reliability among users and correlation with macroscopic and histological evaluation tools and sulfated glycosaminoglycan (sGAG) content. Streaming potentials are induced in cartilage in response to loading when mobile positive ions in the interstitial fluid temporarily move away from negatively charged proteoglycans. Streaming potential integrals (SPIs) were measured with an indentation probe on femoral condyles of 10 human knee specimens according to a standardized location scheme. Interobserver reliability was measured using an interclass correlation coefficient (ICC). The learning curves of 3 observers were evaluated by regression analysis. At each SPI measurement location the degradation level of the tissue was determined by means of the International Cartilage Repair Society (ICRS) score, Mankin score, and sGAG content. The computed ICC was 0.77 (0.70-0.83) indicating good to excellent linear agreement of SPI values among the 3 users. A significant positive linear correlation of the learning index values was observed for 2 of the 3 users. Statistically significant negative correlations between SPI and both ICRS and Mankin scores were observed (r = 0.502, P < 0.001, and r = 0.255, P = 0.02, respectively). No correlation was observed between SPI and sGAG content (r = 0.004, P = 0.973). SPI values may be used as a quantitative means of cartilage evaluation with sufficient reliability among users. Due to the significant learning curve, adequate training should be absolved before routine use of the technique.

  11. Articular Cartilage Lesion Characteristic Reporting Is Highly Variable in Clinical Outcomes Studies of the Knee.

    Science.gov (United States)

    Jones, Kristofer J; Sheppard, William L; Arshi, Armin; Hinckel, Betina B; Sherman, Seth L

    2018-02-01

    Objective The purpose of this study was to investigate the degree of standardized evaluation and reporting of cartilage lesion characteristics in high-impact clinical studies for symptomatic lesions of the knee. We hypothesized that there are significant inconsistencies in reporting these metrics across orthopedic literature. Design A total of 113 clinical studies on articular cartilage restoration of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2016. Full-text review was used to evaluate sources for details on study methodology and reporting on the following variables: primary procedure, location, size, grade, and morphology of cartilage lesions. Results All studies reported on the type of primary cartilage procedure and precise lesion location(s). Approximately 99.1% reported lesion morphology (chondral, osteochondral, mixed). For lesion size, 32.7% of articles did not report how size was measured and 11.5% did not report units. The lesion sizing method was variable, as 27.4% used preoperative magnetic resonance imaging to measure/report lesion size, 31.0% used arthroscopy, and 8.8% used both. The majority of studies (83.2%) used area to report size, and 5.3% used diameter. Formal grading was not reported in 17.7% of studies. Only 54.8% of studies reported depth when sizing osteochondral defects. Conclusions Recent literature on cartilage restoration provides adequate information on surgical technique, lesion location, and morphology. However, there is wide variation and incomplete reporting on lesion size, depth, and grading. Future clinical studies should include these important data in a consistent manner to facilitate comparison among surgical techniques.

  12. Comparative study on identification of healthy and osteoarthritic articular cartilages by fourier transform infrared imaging and chemometrics methods

    Directory of Open Access Journals (Sweden)

    Zhi-Hua Mao

    2017-05-01

    Full Text Available Two discriminant methods, partial least squares-discriminant analysis (PLS-DA and Fisher’s discriminant analysis (FDA, were combined with Fourier transform infrared imaging (FTIRI to differentiate healthy and osteoarthritic articular cartilage in a canine model. Osteoarthritic cartilage had been developed for up to two years after the anterior cruciate ligament (ACL transection in one knee. Cartilage specimens were sectioned into 10 μm thickness for FTIRI. A PLS-DA model was developed after spectral pre-processing. All IR spectra extracted from FTIR images were calculated by PLS-DA with the discriminant accuracy of 90%. Prior to FDA, principal component analysis (PCA was performed to decompose the IR spectral matrix into informative principal component matrices. Based on the different discriminant mechanism, the discriminant accuracy (96% of PCA-FDA with high convenience was higher than that of PLS-DA. No healthy cartilage sample was mis-assigned by these two methods. The above mentioned suggested that both integrated technologies of FTIRI-PLS-DA and, especially, FTIRI-PCA-FDA could become a promising tool for the discrimination of healthy and osteoarthritic cartilage specimen as well as the diagnosis of cartilage lesion at microscopic level. The results of the study would be helpful for better understanding the pathology of osteoarthritics.

  13. The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Damir Hudetz

    2017-10-01

    Full Text Available Osteoarthritis (OA is one of the leading musculoskeletal disorders in the adult population. It is associated with cartilage damage triggered by the deterioration of the extracellular matrix tissue. The present study explores the effect of intra-articular injection of autologous microfragmented adipose tissue to host chondrocytes and cartilage proteoglycans in patients with knee OA. A prospective, non-randomized, interventional, single-center, open-label clinical trial was conducted from January 2016 to April 2017. A total of 17 patients were enrolled in the study, and 32 knees with osteoarthritis were assessed. Surgical intervention (lipoaspiration followed by tissue processing and intra-articular injection of the final microfragmented adipose tissue product into the affected knee(s was performed in all patients. Patients were assessed for visual analogue scale (VAS, delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC and immunoglobulin G (IgG glycans at the baseline, three, six and 12 months after the treatment. Magnetic resonance sequence in dGEMRIC due to infiltration of the anionic, negatively charged contrast gadopentetate dimeglumine (Gd-DTPA2− into the cartilage indicated that the contents of cartilage glycosaminoglycans significantly increased in specific areas of the treated knee joint. In addition, dGEMRIC consequently reflected subsequent changes in the mechanical axis of the lower extremities. The results of our study indicate that the use of autologous and microfragmented adipose tissue in patients with knee OA (measured by dGEMRIC MRI increased glycosaminoglycan (GAG content in hyaline cartilage, which is in line with observed VAS and clinical results.

  14. Comparative Effectiveness of Intra-Articular Hyaluronic Acid and Corticosteroid Injections on the Time to Surgical Knee Procedures.

    Science.gov (United States)

    Shewale, Anand R; Barnes, C Lowry; Fischbach, Lori A; Ounpraseuth, Songthip T; Painter, Jacob T; Martin, Bradley C

    2017-12-01

    Use of intra-articular hyaluronic acid (HA) injections to manage knee osteoarthritis (OA) remains controversial because of weak and conflicting evidence. The objective was to evaluate the effectiveness of intra-articular HA injections for knee OA management. A nested cohort of persons with knee OA seeing a specialist was created using a 10% random sample of LifeLink Plus claims (2010-2015) to compare the risk of composite (any) knee surgical interventions, total (TKA)/unicompartmental knee arthroplasty (UKA) and TKA only among HA users and 2 comparison groups: corticosteroid (CS) users and HA/CS nonusers. A high-dimensional propensity score (hdPS) was used to match HA users with CS users and with HA/CS nonusers on background covariates. The risk of surgical interventions among HA users relative to the comparison groups was assessed using Cox proportional hazard models. Among 13,849 patients, 797 were HA users, 5327 were CS users, and 7725 were HA/CS nonusers. After hdPS matching, the risk of composite surgical interventions did not differ between HA users and HA/CS nonusers (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.67-1.16) and CS users (HR, 0.89; 95% CI, 0.65-1.12). Seven of the 8 sensitivity analyses demonstrated no significant benefit among HA users compared to CS users and HA/CS nonusers. A sensitivity analysis that restricted the study cohort to those who ultimately have knee surgery showed a lower risk of surgery of HA (HR, 0.87; 95% CI, 0.79-0.95). There were no significant differences in the risk of surgical interventions among HA users compared to HA/CS nonusers and CS users after accounting for residual confounding using an hdPS. Copyright © 2017. Published by Elsevier Inc.

  15. Magnetic resonance imaging of the femoral trochlea: evaluation of anatomical landmarks and grading articular cartilage in cadaveric knees

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, Claus [Marienhospital Vechta, Department of Radiology, Vechta (Germany); Veterans Affairs Medical Center, Department of Radiology, San Diego, CA (United States); Mo Ahn, Joong [University of Iowa, Department of Radiology, Iowa, IA (United States); Trudell, Debra; Resnick, Donald [Veterans Affairs Medical Center, Department of Radiology, San Diego, CA (United States)

    2008-06-15

    The purpose of the study was to define magnetic resonance imaging (MRI) findings before and after contrast medium opacification of the knee joint in cadaveric specimens to demonstrate anatomical landmarks of the trochlear surface in relation to the neighboring structures, and to evaluate different MRI sequences in the detection of cartilage defects of the trochlear and patellar surface of the knee. The morphology and relationship of the proximal trochlear surface to the prefemoral fat of the distal femur were investigated by use of different MR sequences before and after intra-articular gadolinium administration into the knee joint in ten cadaveric knees. Anatomic sections were subsequently obtained. In addition, evaluation of the articular surface of the trochlea was performed by two independent observers. The cartilage surfaces were graded using a 2-point system, and results were compared with macroscopic findings. Of 40 cartilage surfaces evaluated, histopathologic findings showed 9 normal surfaces, 20 containing partial-thickness defects, and 11 containing full-thickness defects. Compared with macroscopic data, sensitivity of MR sequences for the two reviewers was between 17 and 90%; specificity, 75 and 100%; positive predictive value, 75 and 100%; negative predictive value, 20 and 100%, depending on patellar or trochlea lesions. Interobserver variability for the presence of disease, which was measured using the kappa statistic, was dependent on the MR sequence used between 0.243 and 0.851. Magnetic resonance imaging sequences can be used to evaluate the cartilage of the trochlear surface with less accuracy when compared with the results of grading the articular cartilage of the patella. (orig.)

  16. Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis.

    Science.gov (United States)

    Erbas, Mesut; Simsek, Tuncer; Kiraz, Hasan Ali; Sahin, Hasan; Toman, Huseyin

    2015-01-01

    Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. Twenty two of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  17. [Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis].

    Science.gov (United States)

    Erbas, Mesut; Simsek, Tuncer; Kiraz, Hasan Ali; Sahin, Hasan; Toman, Huseyin

    2015-01-01

    Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. 22 of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. Reproducibility of the measurements of knee joint proprioception in patients with osteoarthritis of the knee and healthy subject

    NARCIS (Netherlands)

    Hurkmans, E.; van der Esch, M.; Ostelo, R.W.J.G.; Knol, D.L.; Dekker, J; Steultjens, M

    2007-01-01

    Objective. To estimate the inter- and intrarater reliability and agreement of instrumented knee joint proprioception measurement in subjects with knee osteoarthritis (OA) and healthy subjects; to assess the effect of variations in the measurement procedure on agreement parameters. Methods.

  19. The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial.

    Science.gov (United States)

    Wallace, D F; Emmett, S R; Kang, K K; Chahal, G S; Hiskens, R; Balasubramanian, S; McGuinness, K; Parsons, H; Achten, J; Costa, M L

    2012-12-01

    Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

  20. Proteomic analysis of human articular cartilage: identification of differentially expressed proteins in knee osteoarthritis.

    Science.gov (United States)

    Guo, Dunming; Tan, Wenfeng; Wang, Fang; Lv, Zheng; Hu, Jun; Lv, Tianrun; Chen, Qun; Gu, Xiaoyuan; Wan, Bing; Zhang, Zhongnan

    2008-07-01

    The mechanisms underlying the development of age related osteoarthritis (OA) remain unclear. To better understand the pathogenesis of OA and the molecular basis of progressive destruction of articular cartilage in OA, we compared the proteome of OA cartilage with that of normal cartilage. After removal of proteoglycans and collagens, proteins extracted from either normal or OA knee joint cartilage were separated by two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins in OA cartilage were chosen to be further identified by linear ion trap-Fourier transform ion cyclotron resonance mass spectrometry (LTQ-FT/MS). A total of 1436+/-49 or 1472+/-7 protein spots were resolved by 2-DE of normal or OA cartilage extractions, respectively. Sixteen spots from OA cartilage samples were found to have statistically significant changes in the amount of protein compared with normal samples. Of 16 spots, the identities of 14 proteins were unambiguously determined by LTQ-FT/MS. These OA associated proteins fell into five groups, including glycolysis and energy production (ADH, ADK, ENOA, KPYM and FR), signaling (ANNX-I, PEBP and TUB), Redox (PRDX3 and SODM), and cartilage matrix (COLL-I and COLL-VI). Interestingly, two novel RING (Really Interesting New Gene) domain-containing proteins, RF, Zn-RF, were identified, suggesting novel pathways of cartilage protein regulation. This study shows that 2-DE followed by LTQ-FT/MS can be successfully used to characterize the proteome of cartilage without in vitro culturing which could obfuscate physiological differences. The definition of unique OA-associated proteins described here provides significant mechanistic insights into OA by corroborating previously suggested mechanisms and by defining unique players with roles yet to be defined in disease pathogenesis.

  1. Rapid multicomponent T2 analysis of the articular cartilage of the human knee joint at 3.0T.

    Science.gov (United States)

    Liu, Fang; Chaudhary, Rajeev; Hurley, Samuel A; Munoz Del Rio, Alejandro; Alexander, Andrew L; Samsonov, Alexey; Block, Walter F; Kijowski, Richard

    2014-05-01

    To determine the feasibility of using multicomponent-driven equilibrium single-shot observation of T1 and T2 (mcDESPOT) for evaluating the human knee joint at 3.0T and to investigate depth-dependent and regional-dependent variations in multicomponent T2 parameters within articular cartilage. mcDESPOT was performed on the knee joint of 10 asymptomatic volunteers at 3.0T. Single-component T2 relaxation time (T2single ), multicomponent T2 relaxation time for water tightly bound to proteoglycan (T2PG ) and bulk water loosely bound to the macromolecular matrix (T2BW ), and fraction of water tightly bound to proteoglycan (FPG ) were measured in eight cartilage subsections and within the superficial and deep layers of patellar cartilage. Statistical analysis was used to investigate depth-dependent and regional-dependent variations in parameters. There was lower (P = 0.001) T2single and T2PG and higher (P Multicomponent T2 parameters of the articular cartilage of the human knee joint can be measured at 3.0T using mcDESPOT and show depth-dependent and regional-dependent variations. Copyright © 2013 Wiley Periodicals, Inc.

  2. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.

    Science.gov (United States)

    Duymus, Tahir Mutlu; Mutlu, Serhat; Dernek, Bahar; Komur, Baran; Aydogmus, Suavi; Kesiktas, Fatma Nur

    2017-02-01

    This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas. A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months. At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001). In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities. Therapeutic study, Level I.

  3. Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Mesut Erbas

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30 included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30 included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

  4. Analgesic Effect of Intra-articular Morphine or Dexmedetomidine Added with Levobupivacaine in Arthroscopic Knee Surgeries - A Comparative Evaluation

    Science.gov (United States)

    Agarwal, Rajat Kumar; Chopra, Gaurav; Agrawal, Atul

    2017-01-01

    Introduction Knee arthroscopy is associated with variable amount of postoperative pain. In an attempt to improve postoperative analgesia, intra-articular injection of local anaesthetic in combination with other agent have been studied. However, the best combination is not known. Aim To compare the analgesic efficacy of intra-articular injection of morphine and dexmedetomidine when added with levobupivacaine in arthroscopic knee surgeries. Materials and Methods Seventy eight patients, scheduled to undergo elective arthroscopic procedure under spinal anaesthesia were recruited for the study. All the patients received 18 ml of 0.25% levobupivacaine however in addition to this Group M patients received 8 mg (2 ml) morphine, Group D patients received 100μg (2 ml) of dexmedetomidine while Group C patients received 2 ml of isotonic saline intra-articularly. Postoperatively the intensity of pain was assessed using Numerical Rating Scale (NRS). Rescue analgesia was given at NRS ≥ 4. The duration of analgesia and total diclofenac consumption was noted. Results The mean duration of analgesia was longest in Group M (576.20±67.09 minutes) followed by Group D (460.93±38.95 minutes) and Group C (370.27±58.80 minutes) statistically this difference was found to be highly significant (p-value < 0.001). Total consumption of diclofenac in 24 hours was found lowest in group M (86.25±27.48 mg) followed by group D (110.87±44.48 mg) and group C (141.35±44.13 mg) this difference was found to be highly significant (p-value < 0.001). Conclusion Morphine when added with levobupivacaine in patients undergoing arthroscopic knee surgery improves the quality and prolongs the duration of postoperative analgesia. PMID:28571238

  5. Mechanical Analysis of Extra-Articular Knee Ligaments. Part two: Tendon grafts used for knee ligament reconstruction.

    Science.gov (United States)

    Smeets, Kristof; Bellemans, Johan; Scheys, Lennart; Eijnde, Bert O; Slane, Joshua; Claes, Steven

    2017-10-01

    The aim of this study was to provide information about the mechanical properties of grafts used for knee ligament reconstructions and to compare those results with the mechanical properties of native knee ligaments. Eleven cadaveric knees were dissected for the semitendinosus, gracilis, iliotibial band (ITB), quadriceps and patellar tendon. Uniaxial testing to failure was performed using a standardized method and mechanical properties (elastic modulus, ultimate stress, ultimate strain, strain energy density) were determined. The elastic modulus of the gracilis tendon (1458±476MPa) (Pligament reconstructions often differ significantly from the original knee ligament which the graft is supposed to emulate. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Comparison of T2* relaxation times of articular cartilage of the knee in elite professional football players and age-and BMI-matched amateur athletes.

    Science.gov (United States)

    Behzadi, C; Welsch, G H; Laqmani, A; Henes, F O; Kaul, M G; Schoen, G; Adam, G; Regier, M

    2017-01-01

    Recent investigation has underlined the potential of quantitative MR imaging to be used as a complementary tool for the diagnosis of cartilage degeneration at an early state. The presented study analyses T2* relaxation times of articular cartilage of the knee in professional athletes and compares the results to age- and BMI (Body Mass Index)-matched healthy amateur athletes. 22 professional football players and 22 age- and BMI-matched individuals were underwent knee Magnetic Resonance Imaging (MRI) at 3T including qualitative and quantitative analysis. Qualitative analysis included e.g. meniscal tears, joint effusion and bone edema. For quantitative analysis T2* (22 ET: 4.6-53.6ms) measurements in 3D data acquisition were performed. Deep and superficial layers of 22 predefined cartilage segments were analysed. All data sets were postprocessed using a dedicated software tool. Statistical analysis included Student t-test, confidence intervals and a random effects model. In both groups, T2* relaxation times were significantly higher in the superficial compared to the deep layers (pweight-bearing segments of the lateral superficial femoral condyle (p<0.001). Elevated T2* values in cartilage layers of professional football players compared to amateur athletes were noted. The effects seem to predominate in superficial cartilage layers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. 3T MRI of the knee with optimised isotropic 3D sequences. Accurate delineation of intra-articular pathology without prolonged acquisition times

    Energy Technology Data Exchange (ETDEWEB)

    Abdulaal, Osamah M.; Rainford, Louise; Galligan, Marie; McGee, Allison [University College Dublin, Radiography and Diagnostic Imaging, School of Medicine, Belfield, Dublin (Ireland); MacMahon, Peter; Kavanagh, Eoin [Mater Misericordiae University Hospital, Department of Radiology, Dublin (Ireland); University College Dublin, School of Medicine, Dublin (Ireland); Cashman, James [Mater Misericordiae University Hospital, Department of Orthopaedics, Dublin (Ireland); University College Dublin, School of Medicine, Dublin (Ireland)

    2017-11-15

    To investigate optimised isotropic 3D turbo spin echo (TSE) and gradient echo (GRE)-based pulse sequences for visualisation of articular cartilage lesions within the knee joint. Optimisation of experimental imaging sequences was completed using healthy volunteers (n=16) with a 3-Tesla (3T) MRI scanner. Imaging of patients with knee cartilage abnormalities (n=57) was then performed. Acquired sequences included 3D proton density-weighted (PDW) TSE (SPACE) with and without fat-suppression (FS), and T2*W GRE (TrueFISP) sequences, with acquisition times of 6:51, 6:32 and 5:35 min, respectively. One hundred sixty-one confirmed cartilage lesions were detected and categorised (Grade II n=90, Grade III n=71). The highest sensitivity and specificity for detecting cartilage lesions were obtained with TrueFISP with values of 84.7% and 92%, respectively. Cartilage SNR mean for PDW SPACE-FS was the highest at 72.2. TrueFISP attained the highest CNR means for joint fluid/cartilage (101.5) and joint fluid/ligament (156.5), and the lowest CNR for cartilage/meniscus (48.5). Significant differences were identified across the three sequences for all anatomical structures with respect to SNR and CNR findings (p-value <0.05). Isotropic TrueFISP at 3T, optimised for acquisition time, accurately detects cartilage defects, although it demonstrated the lowest contrast between cartilage and meniscus. (orig.)

  8. [Changes in the knee joint synovial membrane and articular cartilage during shin lengthening by autodistractor at increased daily rate].

    Science.gov (United States)

    Stupina, T A; Shchudlo, M M; Shchudlo, N A

    2013-01-01

    Light microscopy and computerized morpho- and stereometry were used to examine the changes in the knee joint articular cartilage and synovial membrane studied during experimental canine shin lengthening by 15% of initial length by autodistraction at increased rate - 3 mm per day with switching on the automatic device 120 times. By the end of distraction period (10 days) the destructive changes in articular cartilage were more marked in the superficial and deep zones, synovitis of moderate and mild degree was observed accompanied by the destructive changes in the blood vessels and nerves of the subsynovial layer. Regeneration of articular cartilage was incomplete, and regressive neurovascular changes persisted in synovial membrane 30 days after the device removal. Comparison of these results with the previous data obtained using the distraction rate of 3 mm applied 180 times, leads to the conclusion, significant for functional prognosis, of the worsening the parameters of structural cartilage recovery in case of distraction pitch increase from 0.017 mm to 0.025 mm.

  9. Characterization and Correction of Errors in Computing Contact Location Between Curved Articular Surfaces: Application to Total Knee Arthroplasty.

    Science.gov (United States)

    Roth, Joshua D; Howell, Stephen M; Hull, Maury L

    2017-06-01

    In total knee arthroplasty (TKA), one common metric used to evaluate innovations in component designs, methods of component alignment, and surgical techniques aimed at decreasing the high rate of patient-reported dissatisfaction is tibiofemoral contact kinematics. Tibiofemoral contact kinematics are determined based on the movement of the contact locations in the medial and lateral compartments of the tibia during knee flexion. A tibial force sensor is a useful instrument to determine the contact locations, because it can simultaneously determine contact forces and contact locations. Previous reports of tibial force sensors have neither characterized nor corrected errors in the computed contact location (i.e., center of pressure) between the femoral and tibial components in TKA that, based on a static analysis, are caused by the curved articular surface of the tibial component. The objectives were to experimentally characterize these errors and to develop and validate an error correction algorithm. The errors were characterized by calculating the difference between the errors in the computed contact locations when forces were applied normal to the tibial articular surface and those when forces were applied normal to the tibial baseplate. The algorithm generated error correction functions to minimize these errors and was validated by determining how much the error correction functions reduced the errors in the computed contact location caused by the curved articular surface. The curved articular surface primarily caused bias (i.e., average or systematic error) which ranged from 1.0 to 2.7 mm in regions of high curvature. The error correction functions reduced the bias in these regions to negligible levels ranging from 0.0 to 0.6 mm (p contact locations caused by the curved articular surface of the tibial component as small as 1 mm needs to be accounted for, because it might inflate the computed internal-external rotation and anterior-posterior translation of

  10. Empirical evaluation of the inter-relationship of articular elements involved in the pathoanatomy of knee osteoarthritis using Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Yoshioka Hiroshi

    2009-10-01

    Full Text Available Abstract Background In this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee MRI. We assessed the association of pathological change in multiple articular structures involved in the pathoanatomy of osteoarthritis. Methods Knee MRI scans from patients over 45 years old were assessed using a semi-quantitative knee MRI assessment form. The form included six distinct elements: cartilage, bone marrow lesions, osteophytes, subchondral sclerosis, joint effusion and synovitis. Each type of pathology was graded using an ordinal scale with a value of zero indicating no pathology and higher values indicating increasingly severe levels of pathology. The principal dependent variable for comparison was the mean cartilage disease score (CDS, which captured the aggregate extent of involvement of articular cartilage. The distribution of CDS was compared to the individual and cumulative distributions of each articular element using the Chi-squared test. The correlations between pathological change in the various articular structures were assessed in a Spearman correlation table. Results Data from 140 patients were available for review. The cohort had a median age of 61 years (range 45-89 and was 61% female. The cohort included a wide spectrum of OA severity. Our analysis showed a statistically significant trend towards pathological change involving more articular elements as CDS worsened (p-value for trend Conclusion Our results support an inter-relationship of multiple articular elements in the pathoanatomy of knee OA. Prospective studies of OA pathogenesis in humans are needed to correlate these findings to clinically relevant outcomes such as pain and function.

  11. Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps.

    Science.gov (United States)

    Carneiro, Márcio de Oliveira; Barbieri, Cláudio Henrique; Barbieri Neto, José

    2013-03-01

    To assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (PRP). Osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous PRP and the left knees were left unfilled. Macroscopic and microscopic evaluation was carried out 12 week later. The results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the Wilcoxon paired test. Macroscopic appearance was not uniform among animals, nor was it different between the right and left knees (p=0.3125), and in no case the regenerated tissue was equal to the normal surrounding cartilage. At histological examination, apparently normal cartilage was not detected in any knee, but a poorly differentiated cartilage was present in 7 right knees, compared to 3 left knees. Fibrocartilaginous tissue was present in most of the remaining knees, with a significant difference in the overall score between right and left knees (p=0.0313). The PRP as used in this study has reparative properties of the joint cartilage of sheep knees, mostly by stimulating the formation of a fibrocartilaginous tissue. Laboratory investigation.

  12. Current concepts in the rehabilitation following articular cartilage repair procedures in the knee

    National Research Council Canada - National Science Library

    Reinold, Michael M; Wilk, Kevin E; Macrina, Leonard C; Dugas, Jeffrey R; Cain, E Lyle

    2006-01-01

    ... characteristics of the patient, and the type and detail of each surgical procedure. These programs are based on knowledge of the basic science, anatomy, and biomechanics of articular cartilage as well as the biological course of healing following surgery...

  13. Proteoglycan concentrations in healthy and diseased articular cartilage by Fourier transform infrared imaging and principal component regression

    Science.gov (United States)

    Yin, Jianhua; Xia, Yang

    2014-12-01

    Fourier transform infrared imaging (FTIRI) combining with principal component regression (PCR) analysis were used to determine the reduction of proteoglycan (PG) in articular cartilage after the transection of the anterior cruciate ligament (ACL). A number of canine knee cartilage sections were harvested from the meniscus-covered and meniscus-uncovered medial tibial locations from the control joints, the ACL joints at three time points after the surgery, and their contralateral joints. The PG loss in the ACL cartilage was related positively to the durations after the surgery. The PG loss in the contralateral knees was less than that of the ACL knees. The PG loss in the meniscus-covered cartilage was less than that of the meniscus-uncovered tissue in both ACL and contralateral knees. The quantitative mapping of PG loss could monitor the disease progression and repair processes in arthritis.

  14. In vivo articular cartilage deformation: noninvasive quantification of intratissue strain during joint contact in the human knee

    Science.gov (United States)

    Chan, Deva D.; Cai, Luyao; Butz, Kent D.; Trippel, Stephen B.; Nauman, Eric A.; Neu, Corey P.

    2016-01-01

    The in vivo measurement of articular cartilage deformation is essential to understand how mechanical forces distribute throughout the healthy tissue and change over time in the pathologic joint. Displacements or strain may serve as a functional imaging biomarker for healthy, diseased, and repaired tissues, but unfortunately intratissue cartilage deformation in vivo is largely unknown. Here, we directly quantified for the first time deformation patterns through the thickness of tibiofemoral articular cartilage in healthy human volunteers. Magnetic resonance imaging acquisitions were synchronized with physiologically relevant compressive loading and used to visualize and measure regional displacement and strain of tibiofemoral articular cartilage in a sagittal plane. We found that compression (of 1/2 body weight) applied at the foot produced a sliding, rigid-body displacement at the tibiofemoral cartilage interface, that loading generated subject- and gender-specific and regionally complex patterns of intratissue strains, and that dominant cartilage strains (approaching 12%) were in shear. Maximum principle and shear strain measures in the tibia were correlated with body mass index. Our MRI-based approach may accelerate the development of regenerative therapies for diseased or damaged cartilage, which is currently limited by the lack of reliable in vivo methods for noninvasive assessment of functional changes following treatment.

  15. Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: A canine model.

    Science.gov (United States)

    Pashuck, Troy D; Kuroki, Keiichi; Cook, Cristi R; Stoker, Aaron M; Cook, James L

    2016-10-01

    The objective of this study was to assess the safety and efficacy of intra-articular injections of hyaluronic acid (HA) versus saline for symptomatic treatment of osteoarthritis (OA). Twenty-five adult purpose-bred dogs underwent meniscal release of one knee. Clinical, arthroscopic, and radiographic signs of OA were confirmed in all dogs prior to treatment. Dogs were randomized into five groups: HA-1 (n = 5), HA-3 (n = 5), HA-5 (n = 5), Saline-1 (n = 5), and Saline-3 (n = 5). Each dog received intra-articular injections of the respective substance into the affected knee at the pre-determined time points. Dogs were assessed for heat, swelling, and erythema after each injection and for lameness, pain, effusion, range of motion, kinetics, radiographic OA scoring, and arthroscopic scoring prior to treatment and for 6 months after injection. Dogs were then humanely euthanatized and the knees assessed grossly and histologically. Only mild heat, swelling, and/or erythema were noted in some dogs following injection and resolved within 1 week. Dogs treated with HA-1, HA-3, and HA-5 were significantly (p < 0.05) better than dogs treated with Saline-1 and Saline-3 at the 4, 8, and 12 week time points based on at least one outcome measure. OA severity was not significantly different among groups at any time point, but increased in severity over time in all groups. Gross and histologic OA scores were not significantly different among groups. These data suggest the three HA injection protocols were safe, superior to saline for short-term amelioration of symptoms associated with chronic OA, and can be translated to human OA treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1772-1779, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  16. Intra-articular morphine versus bupivacaine for knee motion among patients with osteoarthritis: randomized double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Miriam Bellini Gazi

    Full Text Available CONTEXT AND OBJECTIVE: Osteoarthritis causes pain and disability in a high percentage of elderly people. The aim of the present study was to assess the efficacy of intra-articular morphine and bupivacaine on the joint flexion and extension angles of patients with knee osteoarthritis. DESIGN AND SETTING: A randomized double-blind study was performed at a pain clinic of Universidade Federal de São Paulo. METHODS: Thirty-nine patients with pain for more than three months, of intensity greater than three on a numerical scale (zero to 10, were included. G1 patients received 1 mg (1 ml of morphine diluted in 9 ml of saline, intra-articularly, and G2 patients received 25 mg (10 ml of 0.25% bupivacaine without epinephrine. Pain was assessed on a numerical scale and knee flexion and extension angles were measured after administration of the drugs at rest and during movement. The total amount of analgesic supplementation using 500 mg doses of paracetamol was also determined. RESULTS: No significant difference in pain intensity was observed between G1 and G2. Significant decreases in pain at rest and during movement and significant increases in mean flexion and extension angles were observed in both groups, with no significant difference between the two groups. The mean total amount of paracetamol used over a seven-day period was 3578 mg in G1 and 5333 mg in G2 (P = 0.2355; Mann-Whitney test. CONCLUSION: The analgesic effects of 1 mg of morphine and 25 mg of 0.25% bupivacaine were similar among patients with osteoarthritis of the knee.

  17. Effects of harvest and selected cartilage repair procedures on the physical and biochemical properties of articular cartilage in the canine knee.

    Science.gov (United States)

    Lee, C R; Grodzinsky, A J; Hsu, H P; Martin, S D; Spector, M

    2000-09-01

    This study utilizes a canine model to quantify changes in articular cartilage 15-18 weeks after a knee joint is subjected to surgical treatment of isolated chondral defects. Clinical and experimental treatment of articular cartilage defects may include implantation of matrix materials or cells, or both. Three cartilage repair methods were evaluated: microfracture, microfracture and implantation of a type-II collagen matrix, and implantation of an autologous chondrocyte-seeded collagen matrix. The properties of articular cartilage in other knee joints subjected to harvest of articular cartilage from the trochlear ridge (to obtain cells for the cell-seeded procedure) were also evaluated. Physical properties (thickness, equilibrium compressive modulus, dynamic compressive stiffness, and streaming potential) and biochemical composition (hydration, glycosaminoglycan content, and DNA content) of the cartilage from sites distant to the surgical treatment were compared with values measured for site-matched controls in untreated knee joints. No significant differences were seen in joints subjected to any of the three cartilage repair procedures. However, a number of changes were induced by the harvest operation. The largest changes (displaying up to 3-fold increases) were seen in dynamic stiffness and streaming potential of patellar groove cartilage from joints subjected to the harvest procedure. Whether the changes reported will lead to osteoarthritic degeneration is unknown, but this study provides evidence that the harvest procedure associated with autologous cell transplantation for treatment of chondral defects may result in changes in the articular cartilage in the joint.

  18. Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint.

    Science.gov (United States)

    Fatimah, Nibah; Salim, Babur; Raja, Ejaz-Ul-Haq; Nasim, Amjad

    2016-10-01

    This study aimed to determine the factors associated with response to intra-articular steroid injection (IASI) in patients with knee joint osteoarthritis. One hundred seventy-four female patients, age ranging from 30 to 80 years, diagnosed to have osteoarthritis of the knee joint, were given IASI. Response to IASI was assessed by using WOMAC and VAS at 2 weeks, 4 weeks and 3 months. At 3 months, the subjects were categorized as responders, partial responders and non-responders to treatment by IASI. Various factors were narrowed down to see their effect on response, namely age, BMI, smoking habits, comorbidities, presence of clinical effusion, radiographic score, local knee tenderness, range of movement and socioeconomic status. One hundred twenty-four patients completed the study. 16.1 % showed 50 % or more improvement in WOMAC score at 3 months post IASI therapy, whereas 38.7 % of OA patients had more than 50 % improvement in VAS score. Out of all factors, range of movement, local knee tenderness and radiographic score of the affected joint are the three parameters which can predict the improvement in WOMAC score after 3 months of IASI therapy (P = 0.013, P = 0.045 and P = 0.000, respectively). Age of the patient can predict improvement in VAS at 3 months post IASI (P = 0.027). We conclude that age, range of movement, local knee tenderness and radiographic score of the affected joint can predict response to IASI after 3 months of IASI therapy.

  19. Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20

    Directory of Open Access Journals (Sweden)

    Alberto Migliore

    2010-11-01

    Full Text Available Alberto Migliore1, Francesca Giovannangeli1, Emanuele Bizzi1, Bruno Laganà2, Mauro Granata31Department of Rheumatology, S Pietro FBF Hospital, 2Department of Rheumatology, Second Medical School, Sapienza University, 3Rheumatology and Osteoporosis Center, San Filippo Neri Hospital, Rome, ItalyBackground: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease.Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc® in the management of joint pain in knee osteoarthritis.Methods: Three databases were searched, ie, Medline (1970–2010, the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references.Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English, which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy.Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.Keywords: viscosupplementation, knee osteoarthritis, hyaluronic acid, hyaluronan, sodium

  20. T2 mapping of articular cartilage of the glenohumeral joint at 3.0 T in healthy volunteers: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yusuhn [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of); Choi, Jung-Ah [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of); Hallym University Dongtan Sacred Heart Hospital, Department of Radiology, Hwaseong, Gyeonggi-do (Korea, Republic of)

    2016-07-15

    The purpose of this study was to assess the T2 values of the glenohumeral joint cartilage in healthy asymptomatic individuals at 3.0 T and to analyze the T2 profile of the humeral cartilage. This prospective study was approved by our institutional review board and written informed consent was obtained. Thirteen subjects (mean age, 28.6 years; age range, 24-33 years) were included and underwent multiecho spin-echo T2-weighted MR imaging and T2 mapping was acquired. Regions of interest were placed on the humeral cartilage and glenoid cartilage on oblique coronal images. T2 profiles of humeral cartilage were measured from the bone-cartilage interface to the articular surface. Intra-observer agreement was analyzed using intraclass correlation coefficient (ICC). All 13 joints showed normal appearance on conventional T2-weighted images. The mean T2 values of humeral and glenoid cartilage were 50.5 ± 12.1 and 49.0 ± 9.9 ms, respectively. Intra-observer agreement was good, as determined by ICC (0.736). Longer T2 values were observed at the articular surface with a tendency to decrease toward the bone-cartilage interface. The mean cartilage T2 value was 69.03 ± 21.2 ms at the articular surface and 46.99 ± 19.6 ms at the bone-cartilage interface. T2 values of the glenohumeral joint cartilage were similar to reported values of cartilage in the knee. The T2 profile of normal humeral cartilage showed a spatial variation with an increase in T2 values from the subchondral bone to the articular surface. (orig.)

  1. A study on MR images of the articular cartilage in medial-type osteoarthritis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Hiroyuki; Ishii, Yoshiaki; Hayashi, Mitsutoshi; Kotani, Akihiro [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    2001-06-01

    Changes in the articular cartilage of 88 knees of 73 cases (age range 40-78) diagnosed clinically and radiologically as OA (osteoarthritis) were studied by obtaining fat-suppressed MR images of the knee. On 27 knees out of the 88, moreover, macroscopic observation was performed to make a comparative study between the directly-observed findings and MR findings. Fat-suppressed MR images were obtained sagittally by 3D-FLASH (fast low angle shot) sequence. The examined regions consisted of the following 4 sites; the medial condyle of the femur, its lateral condyle, the medial condyle of the tibia, and its lateral condyle. The revealed conditions of the cartilage were morphologically classified into 4 Stages. The evidence of cartilage defect on MR images was most frequently found at the medial condyle of the femur, with the medial condyle of the tibia, the lateral condyle of the femur, and the lateral condyle of the tibia following in a less frequent order. Fat-suppressed MRI's sensitivity to cartilage defect against macroscopy was 94.5%, specificity 95.4%, and accuracy 95.2%. MR imaging using fat-suppression can reveal cartilaginous degeneration and defect so well that this technique provides an important indication for selecting a proper method of treatment. (author)

  2. The effect of local heat and cold therapy on the intra-articular and skin surface temperature of the knee

    NARCIS (Netherlands)

    Oosterveld, F.G.J.; Rasker, Hans J.; Jacobs, J.W.G.; Overmars, H.J.A.

    1992-01-01

    Objective. To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. Methods. Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint

  3. Experimental knee joint pain during strength training and muscle strength gain in healthy subjects

    DEFF Research Database (Denmark)

    Sørensen, T J; Langberg, Henning; Hodges, P W

    2012-01-01

    Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and t...... and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals.......Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function...

  4. Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis.

    Science.gov (United States)

    Spasovski, Duško; Spasovski, Vesna; Baščarević, Zoran; Stojiljković, Maja; Vreća, Miša; Anđelković, Marina; Pavlović, Sonja

    2018-01-01

    Osteoarthritis (OA) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men. Recently, adipose-derived mesenchymal stem cells (AD-MSCs) came into focus for regenerative medicine as a promising tool for the treatment of OA. The administration of stem cells into impaired joints results in pain relief and improves quality of life, accompanied by restoration of hyaline articular cartilage. In the present study, nine patients (including two patients with bilateral symptoms) diagnosed with osteoarthritis (International Knee Documentation grade B in 5 and grade D in six knees) were treated using a single injection of AD-MSCs at a concentration of 0.5-1.0 × 10 7 cells and were followed up for 18 months. During follow-up, all the cases were evaluated clinically by Knee Society score (KSS), Hospital for Special Surgery knee score (HSS-KS), Tegner-Lysholm (T-L) score and visual analogue scale (VAS) of pain, as well as by plain radiography and by magnetic resonance imaging visualization with 2D Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score assessment. Significant improvement of all four clinical scores was observed within the first 6 months (KSS for 41.4 points, HSS-KS for 33.9 points, T-L score for 44.8 points, VAS of pain from 54.5 to 9.3) and improvement persisted throughout the rest of the follow-up. MOCART score showed significant cartilage restoration (from 43 ± 7.2 to 63 ± 17.1), whereas radiography showed neither improvement, nor further joint degeneration. The results obtained in the present study provide good basis for prospective randomized controlled clinical trials with respect to the use of AD-MSCs in the treatment of osteoarthritis. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective

    Science.gov (United States)

    Bhandari, Mohit; Bannuru, Raveendhara R.; Babins, Eric M.; Martel-Pelletier, Johanne; Khan, Moin; Raynauld, Jean-Pierre; Frankovich, Renata; Mcleod, Deanna; Devji, Tahira; Phillips, Mark; Schemitsch, Emil H.; Pelletier, Jean-Pierre

    2017-01-01

    Osteoarthritis (OA) is a chronic condition characterized by a loss of joint cartilage and is a major cause of disability in Canada, with an estimated CN$195 billion annual cost. Knee OA leads to persistent pain and loss of function, and treatment goals primarily focus on symptom relief and retention of function. Intra-articular hyaluronic acid (IAHA) has therapeutic benefits, and numerous recently published meta-analyses (MAs) and commentaries have highlighted new evidence on the role of IAHA therapy for knee OA. A diverse, multidisciplinary group of specialists met independently in closed sessions to review findings from eight MAs with literature search end dates no earlier than 2012 to address controversies surrounding IAHA therapy for mild-to-moderate knee OA within the Canadian treatment context. Outcomes from a total of eight MAs were reviewed, and consistent and statistically significant improvements in pain, function and stiffness up to 26 weeks were found with IAHA therapy compared with IA placebo or controls, regardless of MA size or trial quality. These findings are in line with those of a Cochrane review, another recent systematic review and patient satisfaction survey. Overall, three MAs reported outcomes based on molecular weight (MW), with the two reporting effect sizes showing significantly improved pain outcomes for higher compared with lower MW HAs. Recent evidence suggests that HA therapy is well tolerated with no increased risk of serious adverse events compared with placebo and the full therapeutic effect of IAHA therapy appears to have considerable clinical importance, consisting of the combined IA placebo and HA therapeutic effects. IAHA therapy is a well-tolerated and effective option for patients with mild-to-moderate knee OA failing first-line pharmacological therapy. PMID:28932293

  6. Surgical Treatment of Articular Cartilage Defects in the Knee: Are We Winning?

    Directory of Open Access Journals (Sweden)

    A. R. Memon

    2012-01-01

    Full Text Available Articular cartilage (AC injury is a common disorder. Numerous techniques have been employed to repair or regenerate the cartilage defects with varying degrees of success. Three commonly performed techniques include bone marrow stimulation, cartilage repair, and cartilage regeneration. This paper focuses on current level of evidence paying particular attention to cartilage regeneration techniques.

  7. Intra-articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee: A 2-Year Follow-up Study.

    Science.gov (United States)

    Jo, Chris Hyunchul; Chai, Jee Won; Jeong, Eui Cheol; Oh, Sohee; Shin, Ji Sun; Shim, Hackjoon; Yoon, Kang Sup

    2017-10-01

    The intra-articular injection of mesenchymal stem cells (MSCs) into the knee has shown a potential for the treatment of generalized cartilage loss in osteoarthritis (OA). However, there have been few midterm reports with clinical and structural outcomes. To assess the midterm safety and efficacy of an intra-articular injection of autologous adipose tissue-derived (AD) MSCs for knee OA at 2-year follow-up. Cohort study; Level of evidence, 3. Eighteen patients with OA of the knee were enrolled (3 male, 15 female; mean age, 61.8 ± 6.6 years [range, 52-72 years]). Patients in the low-, medium-, and high-dose groups received an intra-articular injection of 1.0 × 10 7 , 5.0 × 10 7 , and 1.0 × 10 8 AD MSCs into the knee, respectively. Clinical and structural evaluations were performed with widely used methodologies including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and measurements of the size and depth of the cartilage defect, signal intensity of regenerated cartilage, and cartilage volume using magnetic resonance imaging (MRI). There were no treatment-related adverse events during the 2-year period. An intra-articular injection of autologous AD MSCs improved knee function, as measured with the WOMAC, Knee Society clinical rating system (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS), and reduced knee pain, as measured with the visual analog scale (VAS), for up to 2 years regardless of the cell dosage. However, statistical significance was found mainly in the high-dose group. Clinical outcomes tended to deteriorate after 1 year in the low- and medium-dose groups, whereas those in the high-dose group plateaued until 2 years. The structural outcomes evaluated with MRI also showed similar trends. This study identified the safety and efficacy of an intra-articular injection of AD MSCs into the OA knee over 2 years, encouraging a larger randomized clinical trial. However, this study also showed potential concerns about the

  8. Routine clinical knee MR reports: comparison of diagnostic performance at 1.5 T and 3.0 T for assessment of the articular cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Mandell, Jacob C.; Rhodes, Jeffrey A.; Shah, Nehal; Gaviola, Glenn C.; Smith, Stacy E. [Brigham and Women' s Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Gomoll, Andreas H. [Brigham and Women' s Hospital, Cartilage Repair Center, Department of Orthopedic Surgery, Boston, MA (United States)

    2017-11-15

    Accurate assessment of knee articular cartilage is clinically important. Although 3.0 Tesla (T) MRI is reported to offer improved diagnostic performance, literature regarding the clinical impact of MRI field strength is lacking. The purpose of this study is to compare the diagnostic performance of clinical MRI reports for assessment of cartilage at 1.5 and 3.0 T in comparison to arthroscopy. This IRB-approved retrospective study consisted of 300 consecutive knees in 297 patients who had routine clinical MRI and arthroscopy. Descriptions of cartilage from MRI reports of 165 knees at 1.5 T and 135 at 3.0 T were compared with arthroscopy. The sensitivity, specificity, percent of articular surfaces graded concordantly, and percent of articular surfaces graded within one grade of the arthroscopic grading were calculated for each articular surface at 1.5 and 3.0 T. Agreement between MRI and arthroscopy was calculated with the weighted-kappa statistic. Significance testing was performed utilizing the z-test after bootstrapping to obtain the standard error. The sensitivity, specificity, percent of articular surfaces graded concordantly, and percent of articular surfaces graded within one grade were 61.4%, 82.7%, 62.2%, and 77.5% at 1.5 T and 61.8%, 80.6%, 59.5%, and 75.6% at 3.0 T, respectively. The weighted kappa statistic was 0.56 at 1.5 T and 0.55 at 3.0 T. There was no statistically significant difference in any of these parameters between 1.5 and 3.0 T. Factors potentially contributing to the lack of diagnostic advantage of 3.0 T MRI are discussed. (orig.)

  9. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial.

    Science.gov (United States)

    Jo, Chris Hyunchul; Lee, Young Gil; Shin, Won Hyoung; Kim, Hyang; Chai, Jee Won; Jeong, Eui Cheol; Kim, Ji Eun; Shim, Hackjoon; Shin, Ji Sun; Shin, Il Seob; Ra, Jeong Chan; Oh, Sohee; Yoon, Kang Sup

    2014-05-01

    Mesenchymal stem cells (MSCs) are known to have a potential for articular cartilage regeneration. However, most studies focused on focal cartilage defect through surgical implantation. For the treatment of generalized cartilage loss in osteoarthritis, an alternative delivery strategy would be more appropriate. The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee. The phase I study consists of three dose-escalation cohorts; the low-dose (1.0 × 10(7) cells), mid-dose (5.0 × 10(7)), and high-dose (1.0 × 10(8)) group with three patients each. The phase II included nine patients receiving the high-dose. The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 6 months. Secondary outcomes included clinical, radiological, arthroscopic, and histological evaluations. There was no treatment-related adverse event. The WOMAC score improved at 6 months after injection in the high-dose group. The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage. © 2014 AlphaMed Press.

  10. Articular Cartilage of the Human Knee Joint: In Vivo Multicomponent T2 Analysis at 3.0 T

    Science.gov (United States)

    Choi, Kwang Won; Samsonov, Alexey; Spencer, Richard G.; Wilson, John J.; Block, Walter F.; Kijowski, Richard

    2015-01-01

    Purpose To compare multicomponent T2 parameters of the articular cartilage of the knee joint measured by using multicomponent driven equilibrium single-shot observation of T1 and T2 (mcDESPOT) in asymptomatic volunteers and patients with osteoarthritis. Materials and Methods This prospective study was performed with institutional review board approval and with written informed consent from all subjects. The mcDESPOT sequence was performed in the knee joint of 13 asymptomatic volunteers and 14 patients with osteoarthritis of the knee. Single-component T2 (T2Single), T2 of the fast-relaxing water component (T2F) and of the slow-relaxing water component (T2S), and the fraction of the fast-relaxing water component (FF) of cartilage were measured. Wilcoxon rank-sum tests and multivariate linear regression models were used to compare mcDESPOT parameters between volunteers and patients with osteoarthritis. Receiver operating characteristic analysis was used to assess diagnostic performance with mcDESPOT parameters for distinguishing morphologically normal cartilage from morphologically degenerative cartilage identified at magnetic resonance imaging in eight cartilage subsections of the knee joint. Results Higher cartilage T2Single (P < .001), lower cartilage FF (P < .001), and similar cartilage T2F (P = .079) and T2S (P = .124) values were seen in patients with osteoarthritis compared with those in asymptomatic volunteers. Differences in T2Single and FF remained significant (P < .05) after consideration of age differences between groups of subjects. Diagnostic performance was higher with FF than with T2Single for distinguishing between normal and degenerative cartilage (P < .05), with greater areas under the curve at receiver operating characteristic analysis. Conclusion Patients with osteoarthritis of the knee had significantly higher cartilage T2Single and significantly lower cartilage FF than did asymptomatic volunteers, and receiver operating characteristic analysis

  11. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  12. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study.

    Science.gov (United States)

    Lopes de Jesus, Carlos César; Dos Santos, Fânia Cristina; de Jesus, Luciana Maria Oliveira Bueno; Monteiro, Iara; Sant'Ana, Maria Sonia Sousa Castro; Trevisani, Virginia Fernandes Moça

    2017-01-01

    The aim of the trial was to determine the effectiveness of oxygen-ozone injections on knee osteoarthritis concerning pain reduction, joint functional improvement, and quality of life. In this randomized, double-blinded, placebo controlled clinical trial, 98 patients with symptomatic knee osteoarthritis (OA) were randomized into two groups receiving intra-articular 20 μg/ml of ozone (OZ) or placebo (PBO) for 8 weeks. The efficacy outcomes for knee OA were the Visual Analogue Scale (VAS), Lequesne Index, Timed Up and Go Test (TUG Test), SF-36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Geriatric Pain Measure (GPM). After 8 weeks of treatment, ozone was more effective than the placebo: VAS [mean difference (MD) = 2.16, p ozone group) and included only puncture accidents. The study confirms the efficacy of ozone concerning pain relief, functional improvement, and quality of life in patients with knee osteoarthritis. International Standard Randomized Controlled Trial Number Register ISRCTNR55861167.

  13. Intra-articular lipoma with osteochondroid metaplasia in the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Lee, F.Y.I. [Dept. of Orthopaedic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY (United States); Orthopaedic Oncology Unit and Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Keel, S.B. [Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Gebhardt, M.C. [Orthopaedic Oncology Unit and Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Rosenthal, D.I. [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2001-04-01

    We describe a case of lipoma with osteochondroid metaplasia in the knee joint. Although the location of the lesion and radiographic findings were unusual, computed tomography and magnetic resonance imaging were useful in characterizing adipose, cartilaginous and osseous tissue components within the lesion. (orig.)

  14. Effects of local heat and cold treatment on surface and articular temperature of arthritic knees

    NARCIS (Netherlands)

    Oosterveld, Frederikus G.J.; Rasker, Hans J.

    1994-01-01

    Objective: To evaluate and compare the effects of locally applied heat and cold treatments on skin and intraarticular temperature in patients with arthritis. Methods. Thirty-nine patients with arthritis of the knee were divided at random into 4 treatment groups (ice chips, nitrogen cold air,

  15. Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

    Directory of Open Access Journals (Sweden)

    Seher Altinel

    2017-06-01

    Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000: 91-95

  16. Relationship between knee alignment and T1ρ values of articular cartilage and menisci in patients with knee osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ligong, E-mail: ligong.wang@hotmail.com [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); School of Radiation Medicine and Protection, Medical College of Soochow University, School for Radiological and interdisciplinary Sciences (RAD-X), Soochow University, Suzhou, Jiangsu 215123 (China); Vieira, Renata La Rocca, E-mail: relarocca@gmail.com [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Rybak, Leon D., E-mail: Leon.Rybak@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Babb, James S., E-mail: James.Babb@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Chang, Gregory, E-mail: gregory.chang@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Krasnokutsky, Svetlana, E-mail: Svetlana.Krasnokutsky@nyumc.org [Department of Rheumatology, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 (United States); Abramson, Steven, E-mail: StevenB.Abramson@nyumc.org [Department of Rheumatology, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 (United States); and others

    2013-11-01

    Objective: To assess the relationship between knee alignment and subregional T1ρ values of the femorotibial cartilage and menisci in patients with mild (Kellgren–Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3 T. Materials and methods: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3 T MR scanner. Mann–Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1ρ values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. Results: Medial femoral anterior cartilage subregion in varus group had significantly higher (p < 0.05) T1ρ values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1ρ values (p < 0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1ρ values (p < 0.0029) than all meniscus subregions in valgus group. Conclusion: There exists some degree of association between knee alignment and subregional T1ρ values of femorotibial cartilage and menisci in patients with clinical OA.

  17. The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen.

    Science.gov (United States)

    Bottoni, G; Herten, A; Kofler, P; Hasler, M; Nachbauer, W

    2013-12-01

    Proprioception has been defined as the capacity to feel the position of a joint in space as sensed by the central nervous system. Prophylactic knee braces are supposed to help in knee injury prevention not just with a mechanical support of the joint but also improving proprioception. The main aim of this study was to determine the effects of a knee brace and a knee sleeve on knee proprioception. The secondary aim was to determine if different starting angles of the knee and different movement directions influence knee proprioception. We tested a group of twenty healthy male sport students without knee injuries. They were tested with the brace, with the sleeve and without support. The threshold of detection of passive knee movement with a starting knee angle of 30° and 60°, both in flexion and extension was determined. We did not find any statistically significant change in the threshold of detection of passive knee movement wearing the brace or the sleeve compared to the unsupported condition (p=0.462, α=0.05). We found a significantly lower proprioceptive sensitivity starting at the more flexed knee angle (p=0.005, α=0.05) and moving in extension than in the other test situations (p=0.001, α=0.05). Movement direction and starting position appear to influence the threshold of detection of passive knee movement. The results of this study also suggest that knee supports do not influence either positively or negatively knee proprioception of uninjured active subjects. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Intra-articular injection of collagenase in the knee of rats as an alternative model to study nociception associated with osteoarthritis

    Science.gov (United States)

    2014-01-01

    Introduction Animal models currently used in osteoarthritis-associated pain research inadequately reproduce the initiating events and structural pathology of human osteoarthritis. Conversely, intra-articular injection of collagenase is a structurally relevant model, as it induces articular degeneration both by digesting collagen from cartilage and by causing articular instability, thereby reproducing some of the main events associated with osteoarthritis onset and development. Here, we evaluated if the intra-articular injection of collagenase can be an alternative model to study nociception associated with osteoarthritis. Methods Osteoarthritis was induced by two intra-articular injections of either 250 U or 500 U of collagenase into the left knee joint of adult male Wistar rats. A six weeks time-course assessment of movement- and loading-induced nociception was performed by the Knee-Bend and CatWalk tests. The effect of morphine, lidocaine and diclofenac on nociceptive behaviour was evaluated in animals injected with 500 U of collagenase. Joint histopathology was scored for both doses throughout time. The expression of transient receptor potential vanilloid 1 (TRPV1) in ipsilateral dorsal root ganglia (DRG) was evaluated. Results An increase in nociceptive behaviour associated with movement and loading of affected joints was observed after intra-articular collagenase injection. With the 500 U dose of collagenase, there was a significant correlation between the behavioural and the histopathological osteoarthritis-like structural changes developed after six weeks. One week after injection of 500 U collagenase, swelling of the injected knee and inflammation of the synovial membrane were also observed, indicating the occurrence of an early inflammatory reaction. Behavioural changes induced by the 500 U dose of collagenase were overall effectively reversed by morphine and lidocaine. Diclofenac was effective one week after injection. TRPV1 expression increased six weeks

  19. The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis

    DEFF Research Database (Denmark)

    Riis, R G C; Henriksen, M; Klokker, L

    2017-01-01

    before exercise therapy in KOA-patients. PROMs were assessed using the KOOS (knee injury and osteoarthritis outcome score). Synovitis was assessed on conventional non-contrast-enhanced, conventional contrast-enhanced (CE) and dynamic contrast-enhanced (DCE) MRI. PROMs and MRIs were obtained prior...... no statistically significant differences between the two interventions in regards of changes in MRI-measures of synovitis at any time-point. At week 14, we found no statistical significant MRI-explanatory variables of either of the PROMs. CONCLUSIONS: The present study does not justify the use of intra......-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other...

  20. Refractory knee giant cell tumor of the synovial membrane treated with intra-articular injection of Infliximab: a case series and review of the literature.

    Science.gov (United States)

    Praino, Emanuela; Lapadula, Giovanni; Scioscia, Crescenzio; Ingravallo, Giuseppe; Covelli, Michele; Lopalco, Giuseppe; Iannone, Florenzo

    2015-11-01

    Giant cell tumor (GCT) of the synovial membrane, also known as pigmented villonodular synovitis, causes a progressive, relapsing and destructive arthropathy affecting one or more synovial joints. Systemic therapy can be combined to intra-articular treatments, including surgical synoviectomy, especially when monoarticular. Despite that, the synovial membrane commonly grows again with clinical relapse. Here, we report three case of patients diagnosed with GCT of the knee who had an early relapse of the disease even after surgical synoviectomy. All of them underwent intra-articular therapy with infliximab and subsequent synoviectomy to eradicate residual tissue. A complete remission of CGT was achieved without relapse occurring during the follow-up. These preliminary data need to be confirmed by further clinical trials; however, intra-articular therapy with infliximab might be deemed a potential option to treat CGT of a single joint. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  1. Spaceflight-Relevant Challenges of Radiation and/or Reduced Weight Bearing Cause Arthritic Responses in Knee Articular Cartilage.

    Science.gov (United States)

    Willey, J S; Kwok, A T; Moore, J E; Payne, V; Lindburg, C A; Balk, S A; Olson, J; Black, P J; Walb, M C; Yammani, R R; Munley, M T

    2016-10-01

    acute degenerative and pre-arthritic changes in the knee articular cartilage of rats. A return to normal weight bearing resulted in some recovery from cartilage degradation. However, radiation delivered as both a single challenge and when combined with HLU resulted in chronic cartilage damage. These findings suggest that radiation exposure during spaceflight leads to and/or impairs recovery of cartilage upon return to reloading, generating long-term joint problems for astronauts.

  2. Fully Automatic Analysis of the Knee Articular Cartilage T1ρ relaxation time using Voxel Based Relaxometry

    Science.gov (United States)

    Pedoia, Valentina; Li, Xiaojuan; Su, Favian; Calixto, Nathaniel; Majumdar, Sharmila

    2016-01-01

    Purpose To develop and compare with classical ROI-based approach, a fully-automatic, local and unbiased way of studying the knee T1ρ relaxation time by creating an atlas and using Voxel Based Relaxometry (VBR) in OA and ACL subjects Materials and Methods In this study 110 subjects from 2 cohorts: (i) Mild OA 40 patients with mild-OA KL ≤ 2 and 15 controls KL ≤ 1; (ii) ACL cohort (a model for early OA): 40 ACL-injured patients imaged prior to ACL reconstruction and 1-year post-surgery and 15 controls are analyzed. All the subjects were acquired at 3T with a protocol that includes: 3D-FSE (CUBE) and 3D-T1ρ. A Non-rigid registration technique was applied to align all the images on a single template. This allows for performing VBR to assess local statistical differences of T1ρ values using z-score analysis. VBR results are compared with those obtained with classical ROI-based technique Results ROI-based results from atlas-based segmentation were consistent with classical ROI-based method (CV = 3.83%). Voxel-based group analysis revealed local patterns that were overlooked by ROI-based approach; e.g. VBR showed posterior lateral femur and posterior lateral tibia significant T1ρ elevations in ACL injured patients (sample mean z-score=9.7 and 10.3). Those elevations were overlooked by the classical ROI-based approach (sample mean z-score =1.87, and −1.73) Conclusion VBR is a feasible and accurate tool for the local evaluation of the biochemical composition of knee articular cartilage. VBR is capable of detecting specific local patterns on T1ρ maps in OA and ACL subjects PMID:26443990

  3. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions; Acuracia da ressonancia magnetica para identificar lesoes traumaticas intra-articulares do joelho

    Energy Technology Data Exchange (ETDEWEB)

    Vaz, Carlos Eduardo Sanches; Camargo, Olavo Pires de; Santana, Paulo Jose de; Valezi, Antonio Carlos [Universidade Estadual de Londrina, PR (Brazil). Hospital Regional do Parana. Dept. de Ortopedia e Traumatologia]. Email: carvaz@uol.com.br

    2005-12-15

    Purpose: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. Method: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). Results: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. Conclusion: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly

  4. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

    2017-07-01

    The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA). A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3. There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P  0.05) when compared with IA TXA. Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.

  5. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan® injections

    Directory of Open Access Journals (Sweden)

    Miller LE

    2017-05-01

    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  6. Effect of prophylactic and functional knee brace and knee sleeve on plantar pressure distribution during stance phase of gait in healthy individuals

    OpenAIRE

    Pánková, Barbora

    2009-01-01

    Title: Effect of prophylactic and functional knee brace and knee sleeve on plantar pressure distribution during stance phase of gait in healthy individuals Summary: Knee bracing is a very commonly used method by both doctors and patients. Brace producers and also most of the studies focus the effect of the brace directly on the knee joint, but do not study, how it influences other regions of human body. This work studied the influence of knee bracing on plantar pressure distribution changes a...

  7. Efficacy of intra-articular hyaluronic acid injections and exercise-based rehabilitation programme, administered as isolated or integrated therapeutic regimens for the treatment of knee osteoarthritis.

    Science.gov (United States)

    Saccomanno, Maristella F; Donati, Fabrizio; Careri, Silvia; Bartoli, Matteo; Severini, Gabriele; Milano, Giuseppe

    2016-05-01

    To assess the efficacy of intra-articular hyaluronic acid (HA) injections and exercise-based rehabilitation (EBR) programme, administered as isolated or integrated for the treatment of knee osteoarthritis. One hundred sixty-five patients affected by moderate degrees of knee OA were randomly divided into three groups. Group 1 (HA) underwent three HA injections (one every 2 weeks); group 2 (EBR) underwent 20 treatment sessions in a month of an individualized programme; and group 3 (HA + EBR) received both treatments simultaneously. Primary outcome was the Italian version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; secondary outcome was the evaluation of active range of movement (AROM). All patients were evaluated before and 1, 3 and 6 months after treatment. Significance was set at p treatment (p = 0.004, p = 0.026 and p = 0.025, respectively). AROM revealed no significant differences between and within groups over time. Intra-articular HA injections and individualized rehabilitation programmes administered in isolation or in combination are effective in improving knee function and pain relief. The combined treatment showed the greatest pain relief at 1-month follow-up compared to either in isolation. Compared to the previous studies, this is the first study, which proposed an EBR programme tailored to the compartment of the knee joint most involved in the degenerative process. I.

  8. Three-point Dixon chemical-shift imaging for evaluating articular cartilage defects in the knee joint on a low-field-strength open magnet.

    Science.gov (United States)

    Bredella, M A; Losasso, C; Moelleken, S C; Huegli, R W; Genant, H K; Tirman, P F

    2001-12-01

    The purpose of our study was to assess the value of a modified three-point Dixon MR technique for evaluating articular cartilage defects in the knee joint on a low-field-strength open magnet, correlated with arthroscopy. Twenty consecutive patients who underwent both MR imaging and arthroscopy of the knee joint for suspected internal derangement were examined. A modified three-point Dixon MR sequence with a single radiofrequency echo single-scan method for water and fat separation with correction of the static field inhomogeneities was performed on a 0.35-T open magnet to obtain fat suppression. The MR images were prospectively evaluated for the presence and grade of articular cartilage defects. Uniform fat suppression was obtained in all patients using the modified three-point Dixon technique. Fifty-nine cartilage abnormalities were identified in 19 patients on the basis of arthroscopy. Forty-seven of 59 arthroscopically proven abnormalities were prospectively detected on MR imaging. Compared with arthroscopy, the overall sensitivity of the modified three-point Dixon technique in detecting cartilage lesions was 80% and the specificity was 73%. Sixty-five percent of the cartilage abnormalities were graded identically on MR imaging and arthroscopy. The modified three-point Dixon sequence is a useful technique for achieving fat suppression in the knee joint on a 0.35-T open magnet. It is a sensitive and specific technique for the assessment of cartilage abnormalities in the knee.

  9. The effect of local heat and cold therapy on the intra-articular and skin surface temperature of the knee

    OpenAIRE

    Oosterveld, F. G. J.; Rasker, Hans J.; Jacobs, J.W.G.; Overmars, H.J.A.

    1992-01-01

    Objective. To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. Methods. Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours, by treatment group, were recorded. Results. The mean skin surface temperature dropped from 27.9°C to 11.5°C af...

  10. Multidrug-resistant Acinetobacter baumannii infection following para-articular steroid injection in the knee--a case report.

    Science.gov (United States)

    Artiaco, Stefano; Cicero, Giuseppe; Bellomo, Franco; Bianchi, Pasquale

    2012-01-01

    Acinetobacter baumannii is an emerging gram-negative nosocomial pathogen that rarely causes infections in orthopaedic patients. We report a case of imipenem-resistant Acinetobacter baumannii paraarticular infection of the knee occurring in a healthy patient following one ambulatory steroid injection for the treatment of quadriceps tendinopathy. The infection was reduced by early surgical debridement of infected tissues, abscess drainage, and prolonged antibiotic therapy with colistin. To our knowledge, this is the first case in the literature reporting such an infection following single steroid injection in orthopaedic patients.

  11. The Effects of a Prophylactic Knee Brace and Two Neoprene Knee Sleeves on the Performance of Healthy Athletes: A Crossover Randomized Controlled Trial

    OpenAIRE

    Niyousha Mortaza; Ismail Ebrahimi; Ali Ashraf Jamshidi; Vahid Abdollah; Mohammad Kamali; Wan Abu Bakar Wan Abas; Noor Azuan Abu Osman

    2012-01-01

    Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s) without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5) volunteered as participants to examine th...

  12. Intensity-Dependent Effect of Treadmill Running on Knee Articular Cartilage in a Rat Model

    Directory of Open Access Journals (Sweden)

    Guo-Xin Ni

    2013-01-01

    Full Text Available Objective. To understand the changes of femoral cartilage in response to treadmill running with different intensities in the hope of differentiating “moderate” and “strenuous” running in a rat model. Method. A total of 24 male Wistar rats were randomly assigned into groups of sedentary (SED, low-intensity running (LIR, medium-intensity running (MIR, and high-intensity running (HIR. Rats in LIR, MIR, and HIR groups underwent 8 weeks’ treadmill running programs. After sacrificed, femoral condyles were collected to take histomorphometric analysis and immunohistochemistry for collagen II. Results. Gross and histological observation showed osteoarthritic changes in group HIR. In comparison to SED group, there was significant increase in cartilage thickness, number of chondrocytes, and GAG content in groups LIR and MIR. Conversely, decrease in cartilage thickness, chondrocyte number, and GAG content was found in rats of HIR group, without significant difference though. In addition, in comparison to SED group, HIR group exhibited disorganization of collagen fibril and significantly lower content of collagen type II. Conclusion. An intensity-dependent effect was suggested on the articular cartilage. Our results also demonstrated that running with low-to-medium intensity applied in the present study should be regarded as “moderate” running, whereas high-intensity running as “strenuous” running.

  13. Comparison of the efficacy of static versus articular spacers in two-stage revision surgery for the treatment of infection following total knee arthroplasty: a meta-analysis.

    Science.gov (United States)

    Ding, Hai; Yao, Jian; Chang, Wenju; Liu, Fendou

    2017-10-17

    The aim of this study was to compare the outcomes of static versus articular spacers in two-stage reimplantation for the treatment of infected total knee arthroplasty (TKA). The literature regarding the articulating and static spacers for treating infected TKA were searched in PubMed, Embase, Cochrane Library, Chinese Periodical Full-Text Database of CNKI, and Wanfang database. Data were extracted according to the inclusion and exclusion criteria and analyzed by Review Manager 5.3. Ten studies were included to this meta-analysis (nine retrospective studies, one prospective study) according to the principle of PICOS. There was no significant difference regarding the eradication rate (P = 0.28) and the American Knee Society knee score (KSS) pain score (P = 0.11) between the articulating and static spacers in the two-stage revision surgery. There was no significant difference regarding quadriceps femoroplasty and tibial tubercle osteotomy between the two groups (P = 0.50). The knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and KSS function score in the articulating group were significantly higher than those in the static group (P < 0.00001). Articulating spacers can provide better ROM and knee function scores after revision surgery when compared to static spacer while not compromising the infection eradication rate, soft tissue contracture during exclusion period, and knee pain scores.

  14. The effect of intra-articular injection of autologous bone marrow stem cells on pain and knee function in patients with osteoarthritis.

    Science.gov (United States)

    Garay-Mendoza, Domingo; Villarreal-Martínez, Laura; Garza-Bedolla, Alejandra; Pérez-Garza, Daniela M; Acosta-Olivo, Carlos; Vilchez-Cavazos, Felix; Diaz-Hutchinson, Cesar; Gómez-Almaguer, David; Jaime-Pérez, José C; Mancías-Guerra, Consuelo

    2018-01-01

    Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA. This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198. A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  15. Effects of unloading on knee articular cartilage T1rho and T2 magnetic resonance imaging relaxation times: a case series.

    Science.gov (United States)

    Souza, Richard B; Baum, Thomas; Wu, Samuel; Feeley, Brian T; Kadel, Nancy; Li, Xiaojuan; Link, Thomas M; Majumdar, Sharmila

    2012-06-01

    Case series. It has been shown in rodent and canine models that cartilage composition is significantly altered in response to long-term unloading. To date, however, no in vivo human studies have investigated this topic. The objective of this case series was to determine the influence of unloading and reloading on T1rho and T2 relaxation times of articular cartilage in healthy young joints. Ten patients who required 6 to 8 weeks of non-weight bearing (NWB) for injuries affecting the distal lower extremity participated in the study. Quantitative T1rho and T2 imaging of the ipsilateral knee joint was performed at 3 time points: (1) prior to surgery (baseline), (2) immediately after a period of NWB (post-NWB), and (3) after 4 weeks of full weight bearing (post-FWB). Cartilage regions of interest were segmented and overlaid on T1rho and T2 relaxation time maps for quantification. Descriptive statistics are provided for all changes. Increases of 5% to 10% in T1rho times of all femoral and tibial compartments were noted post-NWB. All values returned to near-baseline levels post-FWB. Increases in medial tibia T2 times were noted post-NWB and remained elevated post-FWB. The load-bearing regions showed the most significant changes in response to unloading, with increases of up to 12%. The observation of a transient shift in relaxation times confirms that cartilage composition is subject to alterations based on loading conditions. These changes appear to be mostly related to proteoglycan content and more localized to the load-bearing regions. However, following 4 weeks of full weight bearing, relaxation times of nearly all regions had returned to baseline levels, demonstrating reversibility in compositional fluctuations. Therapy, level 4.

  16. Safety and tolerability of intra-articular hyaluronic acid (Sinovial®/GELSYN-3tm) injections in the treatment of knee osteoarthritis.

    Science.gov (United States)

    Abate, M; Salini, V

    2017-01-01

    Osteoarthritis (OA) is a progressively degenerative joint disease, with a very high prevalence rate that is expected to increase worldwide with the ageing of the population. Considering that OA requires long-term treatment, therapies with minimal side effects and which can be repeated as needed are warranted. Hyaluronic acid (HA), a natural glycosaminoglycan with viscoelastic properties, is a major component of synovial fluid and the extracellular matrix of the joint cartilage, and plays key roles in maintaining synovial fluid viscosity and the bio-mechanical integrity of healthy cartilage. Intra-articular administration of exogenous HA has therefore been used to successfully improve the viscoelastic properties of the joint to improve lubrication, modulate inflammation and modify the catabolic micro-environment. Sinovial®/GELSYN-3TM is a sterile, non-pyrogenic formulation of highly purified, chemically unmodified HA of bio-fermentative origin, which has been introduced in several different concentrations in clinical use within the European market. This expert opinion reports on the published data regarding the efficacy and tolerability of first and multiple injection series of Sinovial®-based product formulations. The data regarding the tolerability of Sinovial® in patients with knee osteoarthritis were analyzed, showing that this formulation, beside favourable therapeutic effects, has a very good tolerability profile, with only mild, transient, and easily managed, local injection-site reactions and absence of systemic reactions. In particular, repetitive cycles of HA have been shown to yield positive results in terms of both efficacy and safety and therefore should be offered to patients who had undergone a successful first course of therapy when their symptoms reoccur.

  17. O gel de plasma rico em plaquetas propicia a regeneração da cartilagem articular do joelho de ovelhas Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps

    Directory of Open Access Journals (Sweden)

    Márcio de Oliveira Carneiro

    2013-04-01

    Full Text Available OBJETIVO: Avaliar a regeneração da cartilagem articular em defeitos osteocondrais do joelho induzidos pelo plasma rico em plaquetas (PRP autógeno. MÉTODOS: Defeitos osteocondrais produzidos no sulco troclear de ambos os joelhos de dez ovelhas foram preenchidos com PRP autógeno à direita e deixados vazios à esquerda. Avaliação macroscópica e histológica foram efetuadas 12 semanas mais tarde. Os resultados foram avaliados por um escore geral de ambas as avaliações macroscópica e histológica comparativamente entre os lados por meio do teste pareado de Wilcoxon. RESULTADOS: o aspecto macroscópico não foi uniforme entre os animais, nem diferiu entre os joelhos direitos e esquerdos (p=0,03125; em nenhum caso o tecido regenerado se nivelou com a cartilagem normal circundante. Ao exame histológico, cartilagem aparentemente normal não foi detectada em nenhum joelho, mas uma cartilagem pouco diferenciada estava presente em sete joelhos direitos e em três joelhos esquerdos. Tecido fibrocartilaginoso estava presente nos joelhos restantes, com diferença significante no escore geral entre os joelhos direitos e esquerdos (p=0,0313. CONCLUSÃO: o PRP como usado neste estudo tem propriedades reparativas da cartilagem articular no joelho de ovelhas, principalmente por estimular a formação de tecido fibrocartilaginoso. Trabalho Experimental.OBJECTIVE: to assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (pRp. METHODS: osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous pRp and the left knees were left unfilled. macroscopic and microscopic evaluation was carried out 12 week later. the results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the wilcoxon paired test. RESULTS: macroscopic appearance was not uniform among

  18. Return to Sport After Articular Cartilage Repair in Athletes' Knees: A Systematic Review.

    Science.gov (United States)

    Campbell, Andrew B; Pineda, Miguel; Harris, Joshua D; Flanigan, David C

    2016-04-01

    To perform a systematic review of cartilage repair in athletes' knees to (1) determine which (if any) of the most commonly implemented surgical techniques help athletes return to competition, (2) identify which patient- or defect-specific characteristics significantly affect return to sport, and (3) evaluate the methodologic quality of available literature. A systematic review of multiple databases was performed. Return to preinjury level of sport was defined as the ability to play in the same or greater level (i.e., league or division) of competition after surgery. Study methodologic quality for all studies analyzed in this review was evaluated with the Coleman Methodology Score. Systematic review of 1,278 abstracts identified 20 level I-IV studies for inclusion but only 1 randomized controlled trial. Twenty studies (1,117 subjects) were included. Subjects (n = 970) underwent 1 of 4 surgeries (microfracture [n = 529], autologous chondrocyte implantation [ACI, n = 259], osteochondral autograft [n = 139], or osteochondral allograft [n = 43]), and 147 were control patients. The rate of return to sports was greatest after osteochondral autograft transplantation (89%) followed by osteochondral allograft, ACI, and microfracture (88%, 84%, and 75%, respectively). Osteochondral autograft transplantation and ACI had statistically significantly greater rates of return to sports compared with microfracture (P sports participation after microfracture, ACI, osteochondral autograft, or osteochondral allograft, but microfracture patients were least likely to return to sports. The athletes who had a better prognosis after surgery were younger, had a shorter preoperative duration of symptoms, underwent no previous surgical interventions, participated in a more rigorous rehabilitation protocol, and had smaller cartilage defects. Level IV, systematic review of Level I-IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights

  19. Influence of Knee Immobilization on Chondrocyte Apoptosis and Histological Features of the Anterior Cruciate Ligament Insertion and Articular Cartilage in Rabbits.

    Science.gov (United States)

    Mutsuzaki, Hirotaka; Nakajima, Hiromi; Wadano, Yasuyoshi; Furuhata, Syogo; Sakane, Masataka

    2017-01-26

    This study examined the influence of immobilization on chondrocyte apoptosis and histological features of the anterior cruciate ligament (ACL) insertion and knee articular cartilage in rabbits. Forty-eight male Japanese white rabbits were assigned to an immobilization (n = 24) or sham (n = 24) group. Rabbits in the immobilization group underwent complete unilateral surgical knee immobilization and rabbits in the sham group underwent a sham surgery. The average thickness of the glycosaminoglycan (GAG) stained red area by safranin O staining, the chondrocyte apoptosis rate and the chondrocyte proliferation rate in the cartilage layer in the ACL insertion and the articular cartilage of the medial tibial condyle were measured at one, two, four and eight weeks in six animals from each group. In the ACL insertion, the chondrocyte apoptosis rate was higher in the immobilization group than in the sham group at two and eight weeks after surgery (p immobilization group. The GAG layer was thinner in the immobilization group than in the sham group at two, four and eight weeks after surgery (p immobilization group was higher than in the sham group at four and eight weeks after surgery (p immobilization group than that in the sham group at four and eight weeks after surgery (p immobilization significantly increased chondrocyte apoptosis at two and eight weeks after surgery in the ACL insertion and at four and eight weeks after surgery in the articular cartilage of the medial tibial condyle, and decreased GAG layer thickness from two to eight weeks after surgery in the ACL insertion and from four to eight weeks after surgery in the articular cartilage.

  20. Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma in association with hyaluronic acid injection: three case reports

    Directory of Open Access Journals (Sweden)

    Chen SH

    2016-09-01

    Full Text Available Szu-Hsuan Chen,1,* Ta-Shen Kuan,2,3,* Mu-Jung Kao,4 Wei-Ting Wu,1 Li-Wei Chou1,5 1Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, 2Department of Physical Medicine and Rehabilitation, College of Medicine, 3Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 4Department of Rehabilitation, Taipei City Hospital, Zhong Xiao Branch, Taipei, 5Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Osteoarthritis (OA is a degenerative disorder resulting from loss of joint cartilage and underlying bone and causes pain and loss of function. The treatment of knee OA is still a challenge because of the poor self-regeneration capacity of cartilage. The nonsurgical interventions include control of the aggravating factor (such as weight control and the use of walking aids, symptomatic treatment (such as acetaminophen or nonsteroidal anti-inflammatory drugs, prolotherapy, and viscosupplementation. However, the combination of platelet-rich plasma (PRP and hyaluronic acid (HA has not been widely used because of lack of clinical evidence and several limitations in patients with severe knee OA. Three patients who suffered from knee pain and poor walking endurance were diagnosed with advanced knee OA. They underwent PRP treatment in association with intra-articular HA injection and showed pain relief and functional improvement. The follow-up standard weight-bearing X-ray images of knees also confirmed the improvement and indicated the possibility of regeneration of the articular cartilage. These cases provide clinical and radiographic evidence for a new therapy for advanced knee OA. This treatment strategy of PRP in association with HA injection can offer a chance to treat severe

  1. Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls.

    Science.gov (United States)

    Thorlund, Jonas B; Creaby, Mark W; Wrigley, Tim V; Metcalf, Ben R; Bennell, Kim L

    2014-10-01

    Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4 ± 5.5 years, 175.3 ± 7.9 cm, 83.6 ± 12.8 kg, mean ± SD) and 21 healthy controls (18 men, 42.0 ± 6.7 years, 176.8 ± 5.7 cm, 77.8 ± 13.4 kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3 years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. Greater knee joint varus (-10.1 vs. -7.3°, pknee joint angular laxity and reduced passive stiffness ~3 months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Movement detection impaired in patients with knee osteoarthritis compared to healthy controls

    DEFF Research Database (Denmark)

    Lund, H; Juul-Kristensen, Birgit; Hansen, Klaus

    2009-01-01

    The purpose of this study was to clarify whether osteoarthritis (OA) patients have a localized or a generalized reduction in proprioception. Twenty one women with knee OA (mean age [SD]: 57.1 [12.0] years) and 29 healthy women (mean age [SD]: 55.3 [10.1] years) had their joint position sense (JPS......) and threshold to detection of a passive movement (TDPM) measured in both knees and elbows. JPS was measured as the participant's ability to actively reproduce the position of the elbow and knee joints. TDPM was measured as the participant's ability to recognize a passive motion of the elbow and knee joints...... that there is an increase in threshold to detection of a passive motion in knees and elbows for patients with knee OA. This indicates that OA may be associated with a generalized defect in proprioception with possible implications for the pathogenesis of the joint degeneration....

  3. Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis.

    Science.gov (United States)

    Alvarado-Vazquez, P A; Morado-Urbina, C E; Castañeda-Corral, G; Acosta-Gonzalez, R I; Kitaura, H; Kimura, K; Takano-Yamamoto, T; Jiménez-Andrade, J M

    2015-01-01

    Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of complete Freund's adjuvant (CFA) into the right knee joint of adult male ICR mice. CFA-injected mice were then treated twice weekly from day 10 until day 25 with anti-CSF-1R antibody (3 and 10 μg/5 μL per joint), isotype control (rat IgG 10 μg/5 μL per joint) or PBS (5 μl/joint). Knee edema, spontaneous flinching, vertical rearing and horizontal exploratory activity were assessed at different days. Additionally, counts of peripheral leukocytes and body weight were measured to evaluate general health status. Intra-articular treatment with anti-CSF-1R antibody significantly increased horizontal exploratory activity and vertical rearing as well as reduced spontaneous flinching behavior and knee edema as compared to CFA-induced arthritis mice treated with PBS. Treatment with this antibody neither significantly affect mouse body weight nor the number of peripheral leukocytes. These results suggest that blockade of CSF-1R at the initial injury site (joint) could represent a therapeutic alternative for improving the functional disabilities and attenuating pain and inflammation in patients with RA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Effect of intra-articular injection of intermediate-weight hyaluronic acid on hip and knee cartilage: in-vivo evaluation using T2 mapping.

    Science.gov (United States)

    Ferrero, Giulio; Sconfienza, Luca Maria; Fiz, Francesco; Fabbro, Emanuele; Corazza, Angelo; Dettore, Daniele; Orlandi, Davide; Castellazzo, Carlo; Tornago, Stefano; Serafini, Giovanni

    2018-01-09

    We used T2 mapping to quantify the effect of intra-articular hyaluronic acid administration (IAHAA) on cartilage with correlation to clinical symptoms. One hundred two patients with clinical and MRI diagnosis of hip or knee grade I-III chondropathy were prospectively included. All patients received a standard MRI examination of the affected hip/knee (one joint/patient) and T2-mapping multiecho sequence for cartilage evaluation. T2 values of all slices were averaged and used for analysis. One month after MR evaluation 72 patients (38 males; mean age 51±10 years) underwent IAHAA. As a control group, 30 subjects (15 males; 51 ± 9 years) were not treated. MR and WOMAC evaluation was performed at baseline and after 3, 9, and 15 months in all patients. T2 mapping in hyaluronic acid (HA) patients showed a significant increase in T2 relaxation times from baseline to the first time point after therapy in knees (40.7 ± 9.8 ms vs. 45.8 ± 8.6 ms) and hips (40.9 ± 9.7 ms; 45.9 ± 9.5 ms) (p < 0.001). At the 9- and 15-month evaluations, T2 relaxation dropped to values similar to the baseline ones (p < 0.001 vs. 3 month). The correlation between T2 increase and pain reduction after IAHAA was statistically significant (r = 0.54, p < 0.01) in patients with grade III chondropathy. T2 mapping can be used to evaluate the effect over time of IAHAA in patients with hip and knee chondropathy. • T2 relaxation times change over time after hyaluronic acid intra-articular administration • T2 relaxation times of the medial femoral condyle correlate with WOMAC variation • T2 relaxation times are different between Outerbridge I and II-III.

  5. Reemplazo total de rodilla en gonartrosis asociada a deformidad extraarticular. [Total knee replacement inosteoarthritis associated with extra-articular deformity

    Directory of Open Access Journals (Sweden)

    Hernan del Sel

    2012-12-01

    Full Text Available Introducción El éxito a largo plazo de un reemplazo total de rodilla (RTR depende de la restitución del eje mecánico del miembro, de la correcta colocación del implante y del balance de partes blandas. Los pacientes con gonartrosis asociada a una deformidad extraarticular, femoral o tibial, requieren de una cuidadosa evaluación y planificación preoperatoria con el objeto de decidir si la corrección del eje podrá realizarse mediante la resección ósea intraarticular, o si deberá asociarse una osteotomía extraarticular. Material y Método Se evaluaron 22 RTR (en 20 pacientes por gonartrosis asociada a deformidad extraarticular. La etiología de la deformidad extraarticular fue postraumática en 8 casos y postosteotomía en 14 (8 femorales y 6 tibiales. Resultados En todos los casos se realizó la corrección del eje del miembro mediante un RTR con cortes óseos intra articulares “inusuales”, sin que fuera necesario realizar una osteotomía. La evaluación clínica y funcional se realizó mediante el sistema de puntaje de la Knee Society2. El promedio de la evaluación clínica fue de 24,3 puntos en el prequirúrgico y 86 al año postoperatorio. Con respecto al puntaje funcional, paso de un promedio de 34 puntos en el prequirúrgico a 85,3 puntos al año. Conclusión No hay un criterio único en relación al tratamiento del paciente con gonartrosis sintomática asociada a una deformidad extraarticular. La corrección de la deformidad extraarticular por medio de cortes óseos intraarticulares ¨inusuales¨ es posible si estos no afectan las inserciones ligamentarias femorales ni tibiales. Este método puede aplicarse en desejes femorales de hasta 20° y tibiales de hasta 30° en el plano coronal. Mediante esta técnica hemos obtenido buenos resultados, a más de 5 años de seguimiento, en 20 de los 22 casos operados.

  6. Naringenin regulates production of matrix metalloproteinases in the knee-joint and primary cultured articular chondrocytes and alleviates pain in rat osteoarthritis model

    Directory of Open Access Journals (Sweden)

    C.C. Wang

    Full Text Available Inflammation of cartilage is a primary symptom for knee-joint osteoarthritis. Matrix metalloproteinases (MMPs are known to play an important role in the articular cartilage destruction related to osteoarthritis. Naringenin is a plant-derived flavonoid known for its anti-inflammatory properties. We studied the effect of naringenin on the transcriptional expression, secretion and enzymatic activity of MMP-3 in vivo in the murine monosodium iodoacetate (MIA osteoarthritis model. The assessment of pain behavior was also performed in the MIA rats. The destruction of knee-joint tissues was analyzed microscopically. Moreover, the effect of naringenin was also studied in vitro in IL-1β activated articular chondrocytes. The transcriptional expression of MMP-3, MMP-1, MMP-13, thrombospondin motifs (ADAMTS-4 and ADAMTS-5 was also studied in primary cultured chondrocytes of rats. Naringenin caused significant reduction in pain behavior and showed marked improvement in the tissue morphology of MIA rats. Moreover, a significant inhibition of MMP-3 expression in MIA rats was observed upon treatment with naringenin. In the in vitro tests, naringenin caused a significant reduction in the transcriptional expression, secretion and enzymatic activity of the studied degradative enzymes. The NF-κB pathway was also found to be inhibited upon treatment with naringenin in vitro. Overall, the study suggests that naringenin alleviated pain and regulated the production of matrix-metalloproteinases via regulation of NF-κB pathway. Thus, naringenin could be a potent therapeutic option for the treatment of osteoarthritis.

  7. Naringenin regulates production of matrix metalloproteinases in the knee-joint and primary cultured articular chondrocytes and alleviates pain in rat osteoarthritis model.

    Science.gov (United States)

    Wang, C C; Guo, L; Tian, F D; An, N; Luo, L; Hao, R H; Wang, B; Zhou, Z H

    2017-03-23

    Inflammation of cartilage is a primary symptom for knee-joint osteoarthritis. Matrix metalloproteinases (MMPs) are known to play an important role in the articular cartilage destruction related to osteoarthritis. Naringenin is a plant-derived flavonoid known for its anti-inflammatory properties. We studied the effect of naringenin on the transcriptional expression, secretion and enzymatic activity of MMP-3 in vivo in the murine monosodium iodoacetate (MIA) osteoarthritis model. The assessment of pain behavior was also performed in the MIA rats. The destruction of knee-joint tissues was analyzed microscopically. Moreover, the effect of naringenin was also studied in vitro in IL-1β activated articular chondrocytes. The transcriptional expression of MMP-3, MMP-1, MMP-13, thrombospondin motifs (ADAMTS-4) and ADAMTS-5 was also studied in primary cultured chondrocytes of rats. Naringenin caused significant reduction in pain behavior and showed marked improvement in the tissue morphology of MIA rats. Moreover, a significant inhibition of MMP-3 expression in MIA rats was observed upon treatment with naringenin. In the in vitro tests, naringenin caused a significant reduction in the transcriptional expression, secretion and enzymatic activity of the studied degradative enzymes. The NF-κB pathway was also found to be inhibited upon treatment with naringenin in vitro. Overall, the study suggests that naringenin alleviated pain and regulated the production of matrix-metalloproteinases via regulation of NF-κB pathway. Thus, naringenin could be a potent therapeutic option for the treatment of osteoarthritis.

  8. Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Raeissadat SA

    2018-01-01

    Full Text Available Seyed Ahmad Raeissadat,1,2 Seyed Mansoor Rayegani,2 Bijan Forogh,3 Porya Hassan Abadi,4 Mahsa Moridnia,5 Shahram Rahimi Dehgolan6 1Clinical Development Research Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences,Tehran, Iran 2Shohada-e-Tajrish Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3College of Medical and Dental Sciences, Birmingham Medical School, Birmingham, UK; 4Physical Medicine and Rehabilitation Department, Iran University of Medical Sciences, 5Shahid Beheshti University of Medical Sciences, Deputy of Education, 6Physical Medicine and Rehabilitation Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Purpose: Knee osteoarthritis (OA is a common disease, imposing a great burden through pain and decreased function. There are many therapeutic modalities including non-pharmacologic choices and oral, topical, and intra-articular medications. New studies have shown promising results for ozone application in knee OA. Our aim was to compare the effects of ozone therapy versus hyaluronic acid (HA intra-articular injection in knee OA patients.Methods: In this randomized clinical trial, a total of 174 patients with more than 3 months of chronic pain or swelling in the knee joints along with consistent imaging findings were enrolled and randomly allocated into two groups of HA and ozone, which were planned to undergo 3 weekly injections of HA (Hyalgan® and 10 mL of a 30 µg/mL ozone solution, respectively. Patients were evaluated at baseline and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS and the Western Ontario and McMaster Universities Arthritis Index (WOMAC questionnaire. Results: No major adverse events were detected in this study. Total WOMAC score decreased from 40.8±9.8 to 20.4±4.9 (p<0.01 in the ozone group and from 38

  9. The efficacy of intra-articular lidocaine administration in chronic knee pain due to osteoarthritis: A randomized, double-blind, controlled study.

    Science.gov (United States)

    Eker, H Evren; Cok, Oya Yalcin; Aribogan, Anis; Arslan, Gulnaz

    2017-04-01

    Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Patients with osteoarthritis were randomly allocated to two groups. Group I (n=26) received 7mL 0.5% lidocaine and group II (n=26) received 7mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P=0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P=0.006, P=0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P=0.035, P=0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P=0.002, Plidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  10. Bilateral assessment of knee muscle relationships in healthy adults

    Directory of Open Access Journals (Sweden)

    Gislaine Regina Santos dos Santos

    2014-09-01

    Full Text Available Asymmetric performance of flexor and extensor muscles of the knee may be a risk factor for knee injuries, especially the anterior cruciate ligament. Additionally, asymmetries in power and work may have correlations with fatigue and performance during functional tasks. Among untrained individuals, such asymmetries may be of potential interest for training prescription. Here, we investigated the bilateral performance of knee flexors and extensors muscle groups of untrained individuals. We quantified the torque-angle and torque-velocity relationships, as well as work, power and asymmetry indexes in 20 untrained male (25 ± 4 years old; height 1.74 ± 0.05 m; body mass 76 ± 9 kg. No significant asymmetry was observed for torque-angle and torque-velocity relationships, work and power output for knee flexor and extensor muscle groups (p < .05. Our results suggest that untrained male present symmetry in the knee flexion and extension bilateral performance. Changes in this behavior due to physical training must be monitored.

  11. Relationships Between Tibiofemoral Contact Forces and Cartilage Morphology at 2 to 3 Years After Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction and in Healthy Knees.

    Science.gov (United States)

    Saxby, David John; Bryant, Adam L; Wang, Xinyang; Modenese, Luca; Gerus, Pauline; Konrath, Jason M; Bennell, Kim L; Fortin, Karine; Wrigley, Tim; Cicuttini, Flavia M; Vertullo, Christopher J; Feller, Julian A; Whitehead, Tim; Gallie, Price; Lloyd, David G

    2017-08-01

    Prevention of knee osteoarthritis (OA) following anterior cruciate ligament (ACL) rupture and reconstruction is vital. Risk of postreconstruction knee OA is markedly increased by concurrent meniscal injury. It is unclear whether reconstruction results in normal relationships between tibiofemoral contact forces and cartilage morphology and whether meniscal injury modulates these relationships. Since patients with isolated reconstructions (ie, without meniscal injury) are at lower risk for knee OA, we predicted that relationships between tibiofemoral contact forces and cartilage morphology would be similar to those of normal, healthy knees 2 to 3 years postreconstruction. In knees with meniscal injuries, these relationships would be similar to those reported in patients with knee OA, reflecting early degenerative changes. Cross-sectional study; Level of evidence, 3. Three groups were examined: (1) 62 patients who received single-bundle hamstring reconstruction with an intact, uninjured meniscus (mean age, 29.8 ± 6.4 years; mean weight, 74.9 ± 13.3 kg); (2) 38 patients with similar reconstruction with additional meniscal injury (ie, tear, repair) or partial resection (mean age, 30.6 ± 6.6 years; mean weight, 83.3 ± 14.3 kg); and (3) 30 ligament-normal, healthy individuals (mean age, 28.3 ± 5.2 years; mean weight, 74.9 ± 14.9 kg) serving as controls. All patients underwent magnetic resonance imaging to measure the medial and lateral tibial articular cartilage morphology (volumes and thicknesses). An electromyography-driven neuromusculoskeletal model determined medial and lateral tibiofemoral contact forces during walking. General linear models were used to assess relationships between tibiofemoral contact forces and cartilage morphology. In control knees, cartilage was thicker compared with that of isolated and meniscal-injured ACL-reconstructed knees, while greater contact forces were related to both greater tibial cartilage volumes (medial: R2 = 0.43, β = 0

  12. [Intra-articular use of sodium hyaluronate (2,2,-2,7 MDa) in the treatment of Moroccan patients with knee osteoarthritis: randomized controlled trial].

    Science.gov (United States)

    Watik, A; Rachidi, W; Janani, S; Nassar, K; Mkinsi, O; Serhier, Z; Bennani Othmani, M

    2014-01-01

    To assess the efficacy of intra-articular sodium hyaluronate, administred once weekly for 3 weeks (3 injections) in Moroccan patients with knee osteoarthritis over 6-month period. We prospectively studied the outcome of 75 patients with painful knee osteoarthritis in grade 1, 2 and 3 on ACR radiological criteria in our rheumatology clinic in Morocco. Group 1: 45 patients were treated with 3-weekly injections of intra-articular sodium hyaluronate (1%; 2,2-2,7 MDa). Group 2 : 30 patients treated with symptomatic slow-acting drugs for osteoarthritis (SYSADOA). The efficacy parameters were Visual Analogue Scale (VAS) and Lequesne index. In group 1: 35/45 were female, a mean age of patients was 57.2 (± 8.2) years, and a mean Body Mass Index (BMI) was 28 (± 1.4) kg/m2. In group 2: 23/30 were female, a mean age of patients was 58.6 (± 2.8) years, and a mean of BMI was 27.8 (± 1.4) kg/m2. Before treatment in group 1, the mean of VAS was 6.5 cm (± 1), and of Lequesne index 10.5 (± 2.1). At 3 and 6 months after the third injection of sodium hyaluronate, there was a significant improvement from baseline of Lequesne index and VAS (P = 0.001). In group 2 before treatment, the mean of VAS was 7 cm (± 0,7), and of Lequesne index 8 (+ 1.1), but the improvement from baseline at 3 and 6 months of treatment was lower than group 1. The results of this prospective study, showed the efficacy of 3-weekly injections of sodium hyaluronate in the treatment of knee osteoarthritis in Moroccan patients over a 6-month period.

  13. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Science.gov (United States)

    Mortaza, Niyousha; Ebrahimi, Ismail; Jamshidi, Ali Ashraf; Abdollah, Vahid; Kamali, Mohammad; Abas, Wan Abu Bakar Wan; Osman, Noor Azuan Abu

    2012-01-01

    Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s) without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5) volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control) 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec). Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05). The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  14. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Niyousha Mortaza

    Full Text Available Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5 volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec. Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05. The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  15. A pilot study of the effect of Kinesiology tape on knee proprioception after physical activity in healthy women.

    Science.gov (United States)

    Hosp, Simona; Bottoni, Giuliamarta; Heinrich, Dieter; Kofler, Philipp; Hasler, Michael; Nachbauer, Werner

    2015-11-01

    Kinesiology tape has gained significant popularity in recent years and is widely used as an adjunct for treatment and prevention of musculoskeletal injuries. However, evidence regarding its influence on knee proprioception is scarce. The purpose of this study was to evaluate the effect of Kinesiology tape on knee proprioception after physical activity in healthy women. It was hypothesized that Kinesiology tape enhances knee proprioception. Longitudinal analysis, pretest-posttest design. Twelve young women with healthy knees were tested for knee proprioception without the use of Kinesiology tape and wearing Kinesiology tape at the knee. The joint position sense was measured at the start and after a 30-min uphill walking protocol on a treadmill. Outcome was the knee angle deviation. No significant difference of proprioceptive performance between the application with Kinesiology tape and without Kinesiology tape was found after uphill walking (p > 0.05). However, when the participants' results for knee angle deviation were graded into good ( 6.1°), Kinesiology tape significantly enhanced those with poor proprioceptive ability after uphill walking, compared to the untaped knee (p = 0.002). This study has shown that the application of Kinesiology tape did not improve knee proprioception in a group of healthy young women. However, it also has demonstrated that Kinesiology tape provided significant proprioceptive enhancement at the knee joint after uphill walking in healthy women with poor proprioceptive ability. This may support its use in sports medicine for preventing knee injuries. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  16. Supramolecular Organization of Collagen Fibrils in Healthy and Osteoarthritic Human Knee and Hip Joint Cartilage.

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    Riccardo Gottardi

    Full Text Available Cartilage matrix is a composite of discrete, but interacting suprastructures, i.e. cartilage fibers with microfibrillar or network-like aggregates and penetrating extrafibrillar proteoglycan matrix. The biomechanical function of the proteoglycan matrix and the collagen fibers are to absorb compressive and tensional loads, respectively. Here, we are focusing on the suprastructural organization of collagen fibrils and the degradation process of their hierarchical organized fiber architecture studied at high resolution at the authentic location within cartilage. We present electron micrographs of the collagenous cores of such fibers obtained by an improved protocol for scanning electron microscopy (SEM. Articular cartilages are permeated by small prototypic fibrils with a homogeneous diameter of 18 ± 5 nm that can align in their D-periodic pattern and merge into larger fibers by lateral association. Interestingly, these fibers have tissue-specific organizations in cartilage. They are twisted ropes in superficial regions of knee joints or assemble into parallel aligned cable-like structures in deeper regions of knee joint- or throughout hip joints articular cartilage. These novel observations contribute to an improved understanding of collagen fiber biogenesis, function, and homeostasis in hyaline cartilage.

  17. Reproducibility of a knee and hip proprioception test in healthy older adults.

    Science.gov (United States)

    Arvin, Mina; Hoozemans, Marco J M; Burger, Bart J; Verschueren, Sabine M P; van Dieën, Jaap H; Pijnappels, Mirjam

    2015-04-01

    Proprioception can be assessed by measuring joint position sense (JPS). Most studies have focused on JPS of the knee joint while literature for other joints especially for hip JPS is scarce. Although some studies have evaluated proprioception of the knee joint, the reproducibility of methods has rarely been investigated. To estimate intrasession reliability and agreement of an active-active JPS test for hip flexion/abduction and knee flexion in healthy older adults. Nineteen healthy older adults participated in this study. The proprioception of the hip (flexion and abduction) and knee (flexion) were assessed in both legs using the "active-active" reproduction technique. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and limits of agreement (LOA) were estimated for relative angular error (RE), absolute angular error (AE), and variable angular error (VE). Reliability of our JPS test was substantial to almost perfect for the RE for both joints and legs (ICC values ranging from 0.75 to 0.93). We also found that the ICC values for AE were substantial for knee flexion and hip abduction of the left and right leg. The ICC results of VE showed poor reliability for hip and knee joints. SEM and LOA values for hip abduction were generally lower than for hip and knee flexion, indicating lower measurement error or more precise scores for the proprioception test of hip abduction. Proprioceptive acuity of the knee and hip joints in healthy older adults can be reliably assessed with an active-active procedure in a standing position with respect to relative and absolute error.

  18. Research On The Special Moving Pair. The Moire Contour Fringes On The Femoral Articular Facies Of Knee Of Pongidae

    Science.gov (United States)

    Qu, Wenzi; Lan, Zuyun; Zhang, Renxiang

    1987-02-01

    Articulation is the special moving pair in the body of animal. In this article, the different forms and the comparative targets of the moire contour fringes on two condyles of knee of Pongidae, and comparative study of the articulation of knee between the Gorilla, Orangutan and Chimpanzee are given.

  19. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho; Choi, Sun Seob; Kim, Soo Jin; Lih, Wang [Dong-A University Medical Center, Busan (Korea, Republic of)

    2015-02-15

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  20. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome.

    Science.gov (United States)

    Ha, Dong-Ho; Choi, Sunseob; Kim, Soo-Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  1. The Influence of Articular Cartilage Thickness Reduction on Meniscus Biomechanics.

    Science.gov (United States)

    Łuczkiewicz, Piotr; Daszkiewicz, Karol; Chróścielewski, Jacek; Witkowski, Wojciech; Winklewski, Pawel J

    2016-01-01

    Evaluation of the biomechanical interaction between meniscus and cartilage in medial compartment knee osteoarthritis. The finite element method was used to simulate knee joint contact mechanics. Three knee models were created on the basis of knee geometry from the Open Knee project. We reduced the thickness of medial cartilages in the intact knee model by approximately 50% to obtain a medial knee osteoarthritis (OA) model. Two variants of medial knee OA model with congruent and incongruent contact surfaces were analysed to investigate the influence of congruency. A nonlinear static analysis for one compressive load case was performed. The focus of the study was the influence of cartilage degeneration on meniscal extrusion and the values of the contact forces and contact areas. In the model with incongruent contact surfaces, we observed maximal compressive stress on the tibial plateau. In this model, the value of medial meniscus external shift was 95.3% greater, while the contact area between the tibial cartilage and medial meniscus was 50% lower than in the congruent contact surfaces model. After the non-uniform reduction of cartilage thickness, the medial meniscus carried only 48.4% of load in the medial compartment in comparison to 71.2% in the healthy knee model. We have shown that the change in articular cartilage geometry may significantly reduce the role of meniscus in load transmission and the contact area between the meniscus and cartilage. Additionally, medial knee OA may increase the risk of meniscal extrusion in the medial compartment of the knee joint.

  2. The safety and efficacy of intra-articular dual molecular weighted hyaluronic acid in the treatment of knee osteoarthritis: the I.D.E.H.A. study

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    Xuming Shen

    2013-12-01

    Full Text Available In clinical practice viscosupplementation with hyaluronic acid (HA is common for the treatment of degenerative osteoarthritis (OA. Both molecular weight and concentration of HA have significant impact on its rheological properties, which in turn affects its therapeutic effects. The objective of this study is to evaluate the effectiveness of a double HA preparation for the treatment of knee osteoarthritis with respect to pain reduction, joint function improvement and concomitant medication consumption reduction. One thousand and fourteen patients (521 males and 693 females with a mean age of 62.4 years old, suffering from OA of the knee, were enrolled into this study. All patients received two intra-articular injections one week apart and a third injection one month after the second one. Concomitant medication was recorded and evaluated at follow up visits. Evaluation was performed at baseline, day 30 and day 180, on several parameters: knee pain by visual analog scale (VAS 0-10 cm, Lequesne Index, and consumption of concomitant medications including non-steroidal anti-inflammatory drugs, analgesics and chondoprotective supplementations. A statistically significant reduction in pain VAS score was recorded at D30 (38.01±17.68; P<0.01 before the third injection, and D180 (25.91±15.33; P<0.01 check-points comparing to baseline (67.12±15.99. Similarly, remarkable reduction in Lequesne Index was shown at D30 (5.91±4.01; P<0.01 in 1214 patients before the third injection, and D180 (3.59±3.45; P<0.01 (with 938 patients when compared to the baseline (11.60±5.13. Patients also consumed less concomitant medications after the treatment course. The beneficial effects were maintained for up to six months. Intra-articular injection of a double HA preparation of low molecular weight and high molecular weight of different concentrations was well tolerated, and generated satisfactory results in terms of pain control, joint function improvement and

  3. Intra-articular injections of sodium hyaluronate (Hyalgan® in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the asian population

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    Chen Shih-Ching

    2011-10-01

    Full Text Available Abstract Background The efficacy and tolerability of 500-730 kDa sodium hyaluronate (Hyalgan® for treatment of osteoarthritis (OA pain has been established in clinical trials, but few data are available in the Asian population. We conducted a randomized, double-blind, multicenter, placebo-controlled study to evaluate the efficacy and tolerability of this preparation in a Taiwanese population. Methods Two hundred patients with mild to moderate OA of the knee were randomized to receive five weekly intra-articular injections of sodium hyaluronate or placebo. The primary efficacy outcome was the change from baseline to Week 25 in patients' evaluation of pain using a 100-mm visual analog scale (VAS during the 50-foot walking test. Additional outcomes included Western Ontario and McMaster Universities (WOMAC scores, time on the 50-foot walking test, patient's and investigator's subjective assessment of effectiveness, acetaminophen consumption, and the amounts of synovial fluid. Results The Hyalgan® treatment group showed a significantly greater improvement from baseline to Week 25 in VAS pain on the 50-foot walking test than the placebo group (p = 0.0020. The Hyalgan® group revealed significant improvements from baseline to week 25 in WOMAC pain and function score than the placebo group (p = 0.005 and 0.0038, respectively Other outcomes, such as time on the 50-foot walking test and subjective assessment of effectiveness, did not show any significant difference between groups. Both groups were safe and well tolerated. Conclusions The present study suggests that five weekly intra-articular injections of sodium hyaluronate are well tolerated, can provide sustained relief of pain, and can improve function in Asian patients with osteoarthritis of the knee. Level of Evidence Therapeutic study, Level I-1a (randomized controlled trial with a significant difference. Trial registration ClinicalTrials.gov Identifier: NCT01319461

  4. Intra-articular injections of sodium hyaluronate (Hyalgan®) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the asian population

    Science.gov (United States)

    2011-01-01

    Background The efficacy and tolerability of 500-730 kDa sodium hyaluronate (Hyalgan®) for treatment of osteoarthritis (OA) pain has been established in clinical trials, but few data are available in the Asian population. We conducted a randomized, double-blind, multicenter, placebo-controlled study to evaluate the efficacy and tolerability of this preparation in a Taiwanese population. Methods Two hundred patients with mild to moderate OA of the knee were randomized to receive five weekly intra-articular injections of sodium hyaluronate or placebo. The primary efficacy outcome was the change from baseline to Week 25 in patients' evaluation of pain using a 100-mm visual analog scale (VAS) during the 50-foot walking test. Additional outcomes included Western Ontario and McMaster Universities (WOMAC) scores, time on the 50-foot walking test, patient's and investigator's subjective assessment of effectiveness, acetaminophen consumption, and the amounts of synovial fluid. Results The Hyalgan® treatment group showed a significantly greater improvement from baseline to Week 25 in VAS pain on the 50-foot walking test than the placebo group (p = 0.0020). The Hyalgan® group revealed significant improvements from baseline to week 25 in WOMAC pain and function score than the placebo group (p = 0.005 and 0.0038, respectively) Other outcomes, such as time on the 50-foot walking test and subjective assessment of effectiveness, did not show any significant difference between groups. Both groups were safe and well tolerated. Conclusions The present study suggests that five weekly intra-articular injections of sodium hyaluronate are well tolerated, can provide sustained relief of pain, and can improve function in Asian patients with osteoarthritis of the knee. Level of Evidence Therapeutic study, Level I-1a (randomized controlled trial with a significant difference). Trial registration ClinicalTrials.gov Identifier: NCT01319461 PMID:21978211

  5. Comparison of MRI T2 relaxation changes of knee articular cartilage before and after running between young and old amateur athletes.

    Science.gov (United States)

    Cha, Jang Gyu; Lee, Jae Chul; Kim, Hyun Joo; Han, Jong Kyu; Lee, Eun Hye; Kim, Yong Dai; Jeon, Chan Hong

    2012-01-01

    To compare changes in T2 relaxation on magnetic resonance (MR) images of knee articular cartilage in younger and older amateur athletes before and after running. By using a 3.0-T MR imager, quantitative T2 maps of weight-bearing femoral and tibial articular cartilages in 10 younger and 10 older amateur athletes were acquired before, immediately after, and 2 hours after 30 minutes of running. Changes in global cartilage T2 signals of the medial and lateral condyles of the femur and tibia and regional cartilage T2 signals in the medial condyles of femoral and tibia in response to exercise were compared between the two age groups. Changes in global cartilage T2 values after running did not differ significantly between the age groups. In terms of the depth variation, relatively higher T2 values in the older group than in the younger group were observed mainly in the superficial layers of the femoral and tibial cartilage (p < 0.05). Age-related cartilage changes may occur mainly in the superficial layer of cartilage where collagen matrix degeneration is primarily initiated. However, no trend is observed regarding a global T2 changes between the younger and older age groups in response to exercise.

  6. Comparison of MRI T2 Relaxation Changes of Knee Articular Cartilage before and after Running between Young and Old Amateur Athletes

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    Cha, Jang Gyu; Jeon, Chan Hong; Lee, Eun Hye [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of); Lee, Jae Chul; Kim, Hyun Joo [Soonchunhyang University College of Medicine, Seoul Hospital, Seoul (Korea, Republic of); Han, Jong Kyu [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Yong Dai [Dept. of Statistics, College of Natural Sciences, Seoul National University, Seoul (Korea, Republic of)

    2012-09-15

    To compare changes in T2 relaxation on magnetic resonance (MR) images of knee articular cartilage in younger and older amateur athletes before and after running. By using a 3.0-T MR imager, quantitative T2 maps of weight-bearing femoral and tibial articular cartilages in 10 younger and 10 older amateur athletes were acquired before, immediately after, and 2 hours after 30 minutes of running. Changes in global cartilage T2 signals of the medial and lateral condyles of the femur and tibia and regional cartilage T2 signals in the medial condyles of femoral and tibia in response to exercise were compared between the two age groups. Changes in global cartilage T2 values after running did not differ significantly between the age groups. In terms of the depth variation, relatively higher T2 values in the older group than in the younger group were observed mainly in the superficial layers of the femoral and tibial cartilage (p < 0.05). Age-related cartilage changes may occur mainly in the superficial layer of cartilage where collagen matrix degeneration is primarily initiated. However, no trend is observed regarding a global T2 changes between the younger and older age groups in response to exercise.

  7. Test-retest reliability of knee kinesthesia in healthy adults

    Directory of Open Access Journals (Sweden)

    Flenhagen Johan

    2007-07-01

    Full Text Available Abstract Background Sensory information from mechanoreceptors in the skin, muscles, tendons, and joint structures plays an important role in joint stability. A joint injury can lead to disruption of the sensory system, which can be measured by proprioceptive acuity. When evaluating proprioception, assessment tools need to be reliable. The aim of this study was to assess the test-retest reliability of a device designed to measure knee proprioception. Methods Twenty-four uninjured individuals (14 women and 10 men were examined with regard to test-retest reliability of knee kinesthesia, measured by the threshold to detection of passive motion (TDPM. Measurements were performed towards extension and flexion from the two starting positions, 20 degrees and 40 degrees knee joint flexion, giving four variables. The mean difference between test and retest together with the 95% confidence interval (test 2 minus test 1, the intraclass correlation coefficient (ICC2,1, and Bland and Altman graphs with limits of agreement, were used as statistical methods for assessing test-retest reliability. Results The intraclass correlation coefficients ranged from 0.59 to 0.70 in all variables except one. No difference was found between test and retest in three of the four TDPM variables. TDPM would need to decrease between 10% and 38%, and increase between 17% and 24% in groups of uninjured subjects to be 95% confident of detecting a real change. The limits of agreement were rather wide in all variables. The variables associated with the 20-degree starting position tended to have higher intraclass correlation coefficients and narrower limits of agreement than those associated with 40 degrees. Conclusion Three TDPM variables were considered reliable for observing change in groups of subjects without pathology. However, the limits of agreement revealed that small changes in an individual's performance cannot be detected. The higher intraclass correlation coefficients and

  8. Automating measurement of subtle changes in articular cartilage from MRI of the knee by combining 3D image registration and segmentation

    Science.gov (United States)

    Lynch, John A.; Zaim, Souhil; Zhao, Jenny; Peterfy, Charles G.; Genant, Harry K.

    2001-07-01

    In osteoarthritis, articular cartilage loses integrity and becomes thinned. This usually occurs at sites which bear weight during normal use. Measurement of such loss from MRI scans, requires precise and reproducible techniques, which can overcome the difficulties of patient repositioning within the scanner. In this study, we combine a previously described technique for segmentation of cartilage from MRI of the knee, with a technique for 3D image registration that matches localized regions of interest at followup and baseline. Two patients, who had recently undergone meniscal surgery, and developed lesions during the 12 month followup period were examined. Image registration matched regions of interest (ROI) between baseline and followup, and changes within the cartilage lesions were estimate to be about a 16% reduction in cartilage volume within each ROI. This was more than 5 times the reproducibility of the measurement, but only represented a change of between 1 and 2% in total femoral cartilage volume. Changes in total cartilage volume may be insensitive for quantifying changes in cartilage morphology. A combined used of automated image segmentation, with 3D image registration could be a useful tool for the precise and sensitive measurement of localized changes in cartilage from MRI of the knee.

  9. Similar properties of chondrocytes from osteoarthritis joints and mesenchymal stem cells from healthy donors for tissue engineering of articular cartilage.

    Science.gov (United States)

    Fernandes, Amilton M; Herlofsen, Sarah R; Karlsen, Tommy A; Küchler, Axel M; Fløisand, Yngvar; Brinchmann, Jan E

    2013-01-01

    Lesions of hyaline cartilage do not heal spontaneously, and represent a therapeutic challenge. In vitro engineering of articular cartilage using cells and biomaterials may prove to be the best solution. Patients with osteoarthritis (OA) may require tissue engineered cartilage therapy. Chondrocytes obtained from OA joints are thought to be involved in the disease process, and thus to be of insufficient quality to be used for repair strategies. Bone marrow (BM) derived mesenchymal stem cells (MSCs) from healthy donors may represent an alternative cell source. We have isolated chondrocytes from OA joints, performed cell culture expansion and tissue engineering of cartilage using a disc-shaped alginate scaffold and chondrogenic differentiation medium. We performed real-time reverse transcriptase quantitative PCR and fluorescence immunohistochemistry to evaluate mRNA and protein expression for a range of molecules involved in chondrogenesis and OA pathogenesis. Results were compared with those obtained by using BM-MSCs in an identical tissue engineering strategy. Finally the two populations were compared using genome-wide mRNA arrays. At three weeks of chondrogenic differentiation we found high and similar levels of hyaline cartilage-specific type II collagen and fibrocartilage-specific type I collagen mRNA and protein in discs containing OA and BM-MSC derived chondrocytes. Aggrecan, the dominant proteoglycan in hyaline cartilage, was more abundantly distributed in the OA chondrocyte extracellular matrix. OA chondrocytes expressed higher mRNA levels also of other hyaline extracellular matrix components. Surprisingly BM-MSC derived chondrocytes expressed higher mRNA levels of OA markers such as COL10A1, SSP1 (osteopontin), ALPL, BMP2, VEGFA, PTGES, IHH, and WNT genes, but lower levels of MMP3 and S100A4. Based on the results presented here, OA chondrocytes may be suitable for tissue engineering of articular cartilage.

  10. Comparative Study of the Use of Intra-articular and Systemic Meloxicam to Control Experimentally Induced Osteoarthritis in Rabbit Knees

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    Valeria Trombini Vidotto

    2013-12-01

    Full Text Available Objective: This study aimed to evaluate morphologic changes, as well as chondroprotective and intra-articular effects of meloxicam on joint repair in rabbits induced by experimental trochleoplasty, minimizing possible adverse side effects. Methods: Thirty-five rabbits were divided into four groups: the control group, which did not undergo surgery, and operated groups, which used different ways of administering the anti-inflammatory agent: systemic, 0.2 mg/kg; intra-articular, 0.5 mg/kg; positive group control, without meloxicam. Each operated group was divided according to the periods of 7 or 30 days evaluation after surgery. Results: Regarding macroscopic and histological evaluation of cartilage, after 30 days, most animals showed almost complete joint repair, the presence of few or no inflammatory cells; whereas part of the animals treated with meloxicam presented necrosis in the trochlear ridge and absence of inflammatory cells after 7 days. In positive control group, it was observed moderate inflammation and connective tissue proliferation. None of the animals in the operated groups showed irregularities 30 days after surgery. Conclusion: Either intra-articular or systemic, meloxicam revealed to be favorable to be used for joint repair and control of inflammatory reaction.

  11. Comparison of different material models of articular cartilage in 3D computational modeling of the knee: Data from the Osteoarthritis Initiative (OAI).

    Science.gov (United States)

    Klets, Olesya; Mononen, Mika E; Tanska, Petri; Nieminen, Miika T; Korhonen, Rami K; Saarakkala, Simo

    2016-12-08

    The intricate properties of articular cartilage and the complexity of the loading environment are some of the key challenges in developing models for biomechanical analysis of the knee joint. Fibril-reinforced poroelastic (FRPE) material models have been reported to accurately capture characteristic responses of cartilage during dynamic and static loadings. However, high computational and time costs associated with such advanced models limit applicability of FRPE models when multiple subjects need to be analyzed. If choosing simpler material models, it is important to show that they can still produce truthful predictions. Therefore, the aim of this study was to compare depth-dependent maximum principal stresses and strains within articular cartilage in the 3D knee joint between FRPE material models and simpler isotropic elastic (IE), isotropic poroelastic (IPE) and transversely isotropic poroelastic (TIPE) material models during simulated gait cycle. When cartilage-cartilage contact pressures were matched between the models (15% allowed difference), maximum principal stresses in the IE, IPE and TIPE models were substantially lower than those in the FRPE model (by more than 50%, TIPE model being closest to the FRPE model), and stresses occurred only in compression in the IE model. Additional simulations were performed to find material parameters for the TIPE model (due to its anisotropic nature) that would yield maximum principal stresses similar to the FRPE model. The modified homogeneous TIPE model was in a better agreement with the homogeneous FRPE model, and the average and maximum differences in maximum principal stresses throughout the depth of cartilage were 7% and 9%, respectively, in the lateral compartment and 9% and 11% in the medial compartment. This study revealed that it is possible to match simultaneously maximum principal stresses and strains of cartilage between non-fibril-reinforced and fibril-reinforced knee joint models during gait. Depending on

  12. Clinicians' Perspectives on the Use of Intra-Articular Hyaluronic Acid as a Treatment for Knee Osteoarthritis: A North American, Multidisciplinary Survey.

    Science.gov (United States)

    Rosen, Jeffrey; Avram, Victoria; Fierlinger, Anke; Niazi, Faizan; Sancheti, Parag; Bedi, Asheesh

    2016-01-01

    This study aims to describe the perceptions of orthopedic surgeons on the efficacy of intra-articular hyaluronic acid (IA-HA), the influence of IA-HA product characteristics on its efficacy, and to identify patterns and factors related to the use of IA-HA. Additionally, this study examines factors that influence IA-HA brand selection, focusing on Euflexxa(®) (1% sodium hyaluronate). We developed survey questions by reviewing the current literature and consulting with experts on the use of IA-HA in the management of knee osteoarthritis (OA). The survey included questions on demographics, previous experience with knee OA treatment, opinions on different treatment methods, and where information regarding treatments is obtained. Additionally, questions specific to opinions regarding IA-HA and the reasoning behind these opinions were asked. A total of 117 orthopedic surgeons and physicians completed the survey. IA-HA is most frequently prescribed to patients with early-stage (82%) or mid-stage (82.8%) OA, while fewer orthopedic surgeons and physicians use IA-HA for patients with late-stage OA (57.4%). Respondents were generally uncertain of the effects that intrinsic characteristics, such as molecular weight, cross-linking, and production process, had on patient outcomes. Respondents typically use their own clinical experience and results as a deciding factor in utilizing IA-HA treatment, as well as in choosing an IA-HA brand. Uncertainty regarding the efficacy of IA-HA treatments is likely due to inconsistency within clinical guidelines and the current literature. Additional research investigating the efficacy of IA-HA treatment and how product characteristics affect outcome and safety is required to provide clarity to the controversy surrounding IA-HA treatment for knee OA.

  13. SAFETY AND EFFECTIVENESS OF INTRAARTICULAR ADMINISTRATION OF ADIPOSE-DERIVED STROMAL VASCULAR FRACTION FOR TREATMENT OF KNEE ARTICULAR CARTILAGE DEGENERATIVE DAMAGE: PRELIMINARY RESULTS OF A CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    I. A. Smyshlyaev

    2017-01-01

    Full Text Available The incidence of knee osteoarthritis tends to increase every year and constitutes more than 83% of overall OA morbidity. Moreover, the OA morbidity among younger patients is also increasing. However, currently available treatment methods do not provide quite satisfactory outcomes.Purpose of the study – to evaluate safety and efficacy of intraarticular introduction of autologous adipose-derived stromal vascular fraction for treatment of knee osteoarthritis.Material and methods. By the moment of writing the present report, 28 patients were included into the study. All patients underwent tumescent liposuction under local anesthesia. The stromal vascular fraction was isolated from lipoaspirate within 1,5 hours after harvesting and subsequently injected into the articular cavity. Follow-up period was 6 months after injections. The authors report on efficacy data of 10 patients who completed the study according to protocol and safety data of all 28 patients. Efficacy was evaluated basing on laboratory assessments and patient’s subjective assessment by validated questionnaires.Results. Neither adverse reactions no adverse events were observed. Significant decrease of pain severity by VAS was noted in one week after injection and pain score continued decreasing during the whole follow up period. The increase of KOOS score was noted starting on the fifth week after injection. KSS part 1 score increased in 8 weeks, KSS part 2 score — in 6 months after injection. Physical health, assessed with SF-36 questionnaire significantly improved in 2 and 6 months after the procedure. There was a clear trend towards improvement of mental health.Conclusion. Preliminary results of clinical study suggest intraarticular injection of autologous adipose-derived stromal vascular fraction to be a safe and efficient method of the treatment of knee osteoarthritis. 

  14. Intra-articular versus intravenous magnesium-sulfate as adjuvant to femoral nerve block in arthroscopic knee sur

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    Mohamed Abdulatif

    2015-07-01

    Conclusion: The combined use of femoral nerve block with IA or IV MgSO4 is associated with significant reduction of the intensity and duration of postoperative pain and postoperative analgesic requirements in patients undergoing arthroscopic knee surgery with the IA MgSO4 being superior to IV route of administration.

  15. Changes in ultrasound assessed markers of inflammation following intra-articular steroid injection combined with exercise in knee osteoarthritis

    DEFF Research Database (Denmark)

    Henricsdotter, C; Ellegaard, K.; Klokker, L

    2016-01-01

    in inflammation markers assessed by ultrasound imaging (US) in KOA secondary to intra-articular corticosteroid injection given prior to exercise therapy. DESIGN: This study is a sub-study to a larger clinical trial which compared the clinical effects of steroid injection in KOA to placebo injection, both given...... prior to exercise therapy. The US outcomes were changes from baseline in US-assessed synovial size, Doppler activity presence in the synovial membrane, and numbers of US-detected Baker's cysts. US was performed at baseline, week 14 (exercise stop), and week 26 (follow-up). RESULTS: Fifty participants...

  16. Comparison of Two Methods for Calculating the Frictional Properties of Articular Cartilage Using a Simple Pendulum and Intact Mouse Knee Joints

    Science.gov (United States)

    Drewniak, Elizabeth I.; Jay, Gregory D.; Fleming, Braden C.; Crisco, Joseph J.

    2009-01-01

    In attempts to better understand the etiology of osteoarthritis, a debilitating joint disease that results in the degeneration of articular cartilage in synovial joints, researchers have focused on joint tribology, the study of joint friction, lubrication, and wear. Several different approaches have been used to investigate the frictional properties of articular cartilage. In this study, we examined two analysis methods for calculating the coefficient of friction (μ) using a simple pendulum system and BL6 murine knee joints (n=10) as the fulcrum. A Stanton linear decay model (Lin μ) and an exponential model that accounts for viscous damping (Exp μ) were fit to the decaying pendulum oscillations. Root mean square error (RMSE), asymptotic standard error (ASE), and coefficient of variation (CV) were calculated to evaluate the fit and measurement precision of each model. This investigation demonstrated that while Lin μ was more repeatable, based on CV (5.0% for Lin μ; 18% for Exp μ), Exp μ provided a better fitting model, based on RMSE (0.165° for Exp μ; 0.391° for Lin μ) and ASE (0.033 for Exp μ; 0.185 for Lin μ), and had a significantly lower coefficient of friction value (0.022±0.007 for Exp μ; 0.042±0.016 for Lin μ) (p=0.001). This study details the use of a simple pendulum for examining cartilage properties in situ that will have applications investigating cartilage mechanics in a variety of species. The Exp μ model provided a more accurate fit to the experimental data for predicting the frictional properties of intact joints in pendulum systems. PMID:19632680

  17. COMPARATIVE EFFICACY AND TOLERABILITY OF AVOCADO / SOYBEAN UNSAPONIFIABLES AND THEIR COMBINATION WITH INTRA-ARTICULAR HYALURONIC ACID IN PATIENTS WITH KNEE AND HIP OSTEOARTHROSIS

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    Ye. I. Shmidt

    2014-11-01

    Full Text Available Objective: to evaluate the comparative efficacy and tolerability of avocado / soybean unsaponifiables (ASU and their combination with intra-articular hyaluronic acid in patients with knee and hip osteoarthrosis (OA.Subjects and methods. A randomized observational non-interventional non-placebo controlled trial was conducted. It included 18 patients who were randomized to 2 groups with 9 in each. One patient group took only ASU along with nonsteroidal anti-nflammatory drugs (NSAIDs; the other received ASU in combination with intra-articular hyaluronic acid. Their treatment was performed for 6 months, followed by a 6-month follow-up. The results were assessed by the WOMAC index. Account was taken of the opinions of a patient and his / her physician on therapeutic effectiveness, as well as altered needs for NSAIDs during treatment and after the follow-up.Results. There was a gradual reduction in joint pain, stiffness, and dysfunction (as shown by the visual analog scale in both groups just one month posttherapy. This trend remained for 3 months. After 6 months of therapy, there were slight increases in the values of joint pain, stiffness, and dysfunction in the combined therapy group whereas the values continued to decrease in the monotherapy group. Six months after termination of treatment, the examined values doubled in the ASU monotherapy group and remained at posttreatment visit levels in the combined therapy group. Just the same, six months after termination of 6-month therapy, both groups displayed the significantly lower values of pain, stiffness, and dysfunction than those prior to treatment. ASU used both alone and in combination with hyaluronic acid was noted to be well tolerated. The considerable reduction in the needs for NSAIDs in both groups and, in a number of cases, the possibility of reducing their intake proved the efficiency of ASU used alone and in combination with hyaluronic acid. The important result of this trial

  18. Comparison of T1rho and T2 mapping of knee articular cartilage in an asymptomatic population

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Min A; Hong, Suk Joo; Im, A Lan [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kang, Chang Ho [Dept. of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Baek Hyun [Dept. of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of); Kim, In Seong [Siemens Healthcare, Seoul (Korea, Republic of)

    2016-11-15

    To analyze subregional differences in T1rho (T1ρ) and T2 values and their correlation in asymptomatic knee cartilage, and to evaluate angular dependence with magic angles. Six asymptomatic volunteers underwent knee MRI with T1ρ and T2 mapping. T1ρ and T2 values were measured by two radiologists independently, at nine subregions in the medial femoral condyle (MFC) cartilage, at angles of ± 0°, 15°, 35°, 55°, 75° respective to a vertical line (B0) bisecting the width of the distal femur, and at two locations in the patella. Subregional values of T1ρ and T2 were analyzed and significant differences in three divided portions of the MFC (anterior, central, and posterior) were statistically evaluated. Correlation between T1ρ and T2 and angular dependence with magic angles were also assessed for statistical significance. T1ρ values were lowest at +15° and highest at -55°. T2 values were lowest at +75° and highest at +35°. Both T1ρ and T2 were higher in superior patella than inferior patella. T1ρ showed significant differences in the three divided portions of the MFC, while T2 showed significant differences only between central and posterior portions. There was a weak correlation between T1ρ and T2 (r = 0.217, p = 0.127). T1ρ showed more angular dependence than T2. T1ρ and T2 showed different subregional values and angular dependence in asymptomatic knee cartilage with a weak correlation. Awareness of these differences will aid in assessment of cartilage in a specific subregion of the knee.

  19. Texture analysis of articular cartilage traumatic changes in the knee calculated from morphological 3.0 T MR imaging

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    Boutsikou, Konstantina [Department of Medical Radiologic Technology, Technological Educational Institute of Athens, Ag.Spyridonos, Egaleo, Athens 12210 (Greece); Kostopoulos, Spiros; Glotsos, Dimitris; Cavouras, Dionisis [Department of Medical Instruments Technology, Technological Educational Institute of Athens, Ag.Spyridonos, Egaleo, Athens 12210 (Greece); Lavdas, Eleftherios; Oikonomou, Georgia [Department of Medical Radiologic Technology, Technological Educational Institute of Athens, Ag.Spyridonos, Egaleo, Athens 12210 (Greece); Malizos, Konstantinos [Department of Orthopaedic Surgery, University of Thessaly, School of Health Sciences, University Hospital of Larissa, Biopolis, Larissa 41110 (Greece); Fezoulidis, Ioannis V. [Department of Radiology, University of Thessaly, School of Health Sciences, University Hospital of Larissa, Biopolis, Larissa 41110 (Greece); Vlychou, Marianna, E-mail: mvlychou@med.uth.gr [Department of Radiology, University of Thessaly, School of Health Sciences, University Hospital of Larissa, Biopolis, Larissa 41110 (Greece)

    2013-08-15

    Objectives: In the present work, we aim to identify changes in the cartilage texture of the injured knee in young, physically active, patients by computer analysis of MRI images based on 3.0 T morphological sequences. Methods: Fifty-three young patients with training injury or trauma in one knee underwent MRI and arthroscopy. Textural features were computed from the MRI images of the knee-cartilages and two classes were formed of 28 normal and 16 with pathology only in the medial femoral condyle (MFC) cartilage. Results: Textural features with statistically significant differences between the two classes were found only at the MFC and the medial tibial condyle (MTC) areas. Three features-combinations, at the MFC or the MTC, maximized the between classes separation, thus, rendering alterations in cartilage texture due to injury more evident. The MFC cartilage in the pathology class was found more inhomogeneous in the distribution of gray-levels and of lower texture anisotropy and the opposed MTC cartilage, though normal on MRI and arthroscopy, was found to have lower texture anisotropy than cartilage in the normal class. Conclusion: Texture analysis may be used as an adjunct to morphological MR imaging for improving the detection of subtle cartilage changes and contributes to early therapeutic approach.

  20. Therapeutic effect of intra-articular injection of ribbon-type decoy oligonucleotides for hypoxia inducible factor-1 on joint contracture in an immobilized knee animal model.

    Science.gov (United States)

    Sotobayashi, Daisuke; Kawahata, Hirohisa; Anada, Natsuki; Ogihara, Toshio; Morishita, Ryuichi; Aoki, Motokuni

    2016-08-01

    Limited range of motion (ROM) as a result of joint contracture in treatment associated with joint immobilization or motor paralysis is a critical issue. However, its molecular mechanism has not been fully clarified and a therapeutic approach is not yet established. In the present study, we investigated its molecular mechanism, focusing on the role of a transcription factor, hypoxia inducible factor-1 (HIF-1), which regulates the expression of connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF), and evaluated the possibility of molecular therapy to inhibit HIF-1 activation by ribbon-type decoy oligonucleotides (ODNs) for HIF-1 using immobilized knee animal models. In a mouse model, ROM of the immobilized knee significantly decreased in a time-dependent manner, accompanied by synovial hypertrophy. Immunohistochemical studies suggested that CTGF and VEGF are implicated in synovial hypertrophy with fibrosis. CTGF and VEGF were up-regulated at both the mRNA and protein levels at 1 and 2 weeks after immobilization, subsequent to up-regulation of HIF-1 mRNA and transcriptional activation of HIF-1. Of importance, intra-articular transfection of decoy ODNs for HIF-1 in a rat model successfully inhibited transcriptional activation of HIF-1, followed by suppression of expression of CTGF and VEGF, resulting in attenuation of restricted ROM, whereas transfection of scrambled decoy ODNs did not. The present study demonstrates the important role of HIF-1 in the initial progression of immobilization-induced joint contracture, and indicates the possibility of molecular treatment to prevent the progression of joint contracture prior to intervention with physical therapy. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  1. Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho Estudio comparativo de la analgesia entre bupivacaína y morfina intra-articular en osteoartritis de la rodilla Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

    Directory of Open Access Journals (Sweden)

    Miriam C B Gazi

    2005-10-01

    recibieron 1 mg (1 mL de morfina diluida en 9 mL de solución fisiológica a 0,9% y los del G2 (n = 21 25 mg (10 mL de bupivacaína a 0,25% sin vasoconstrictor, por vía intra-articular. La intensidad del dolor fue evaluada por la escala numérica y verbal en los tiempos 0, 30, 60 minutos y 7 días, en reposo y en movimiento. Fueron evaluados la necesidad de complementación analgésica con paracetamol (500 mg, la dosis total de analgésico utilizado, la duración de la analgesia y la calidad de la analgesia (por el paciente. RESULTADOS: De los 39 pacientes estudiados, 31 completaron el estudio. No hubo diferencia significativa de la intensidad del dolor en reposo y en movimiento entre los dos grupos en los tiempos estudiados. No hubo diferencia entre los dos grupos en el tiempo entre la administración de la solución y la necesidad de complementación analgésica. La dosis media del paracetamol utilizada en el primer día de la semana fue de 796 mg del G1 y de 950 mg en el G2; la complementación en la semana fue de 3578 mg G1 y 5333 mg en el G2. CONCLUSIONES: El efecto analgésico de 1 mg de morfina y de 25 mg de bupivacaína a 0,25% sin vasoconstrictor intra-articular fueron semejantes.BACKGROUND AND OBJECTIVES: Osteoarthritis is the most common joint disease among elderly people. This study aimed at comparing the analgesic effects of intra-articular bupivacaine and morphine in knee osteoarthritis patients. METHODS: Thirty-nine patients were included in this randomized double-blind study and divided in two groups: G1 (n = 18 patients were given intra-articular 1 mg (1 mL morphine diluted in 9 mL of 0.9% saline, while G2 (n = 21 received intra-articular 25 mg (10 mL of 0.25% plain bupivacaine. Pain intensity was evaluated by numerical and verbal scale at 0, 30, 60 minutes and 7 days at rest and in movement. Evaluated parameters were analgesic supplementation requirement with paracetamol (500 mg, total analgesic dose throughout the study, analgesia duration and quality

  2. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

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    Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-08-31

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre

  3. Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Paphon Sa-ngasoongsong

    2017-01-01

    Full Text Available Background. Recently, intra-articular tranexamic acid (IA-TXA application has become a popular method for perioperative blood loss (PBL reduction in total knee replacement (TKR. Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT after IA-TXA. Materials and Methods. A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014. Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL, estimated total blood loss (ETBL, and drainage volume per kg (DV/kg. Excessive PBL was defined as PBL that exceeded 90th percentile. Results. From multivariate analysis, low preoperative hemoglobin (Hb level and body mass index (BMI were the significant predictors of postoperative BT (p<0.0001 and 0.003, resp.. Excessive THL significant associated with preoperative Hb (p<0.0001. Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05 all. Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001 and 0.002, resp.. Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

  4. Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals.

    Science.gov (United States)

    Protopapadaki, Anastasia; Drechsler, Wendy I; Cramp, Mary C; Coutts, Fiona J; Scott, Oona M

    2007-02-01

    Few studies have reported the biomechanical aspects of stair climbing for this ergonomically demanding task. The purpose of this ethically approved study was to identify normal functional parameters of the lower limb during stair climbing and to compare the actions of stair ascent and descent in young healthy individuals. Thirty-three young healthy subjects, (16 M, 17 F, range 18-39 years) participated in the study. The laboratory staircase consisted of four steps (rise height 18 cm, tread length 28.5 cm). Kinematic data were recorded using 3D motion analysis system. Temporal gait cycle data and ground reaction forces were recorded using a force platform. Kinetic data were standardized to body mass and height. Paired-samples t tests showed significantly greater hip and knee angles (mean difference standard deviation (SD): hip 28.10 degrees (SD 4.08), knee 3.39 degrees (SD 7.20)) and hip and knee moments (hip 0.25 Nm/kg (SD 0.18), knee 0.17 Nm/kg (SD 0.15)) during stair ascent compared to descent. Significantly greater ankle dorsiflexion angles (9.90 degrees (SD 3.80)) and plantarflexion angles (8.78 degrees (SD 4.80)) were found during stair descent compared to ascent. Coefficient of variation (mean (SD)) in percentage between repeated tests varied for joint angles and moments, respectively (2.35% (SD 1.83)-17.53% (SD 13.62)) and (4.65% (SD 2.99)-40.73% (SD 24.77)). Stair ascent was shown to be the more demanding biomechanical task when compared to stair descent for healthy young subjects. The findings from the current study provide baseline measures for pathological studies, theoretical joint modelling, and for mechanical joint simulators.

  5. Increased joint loads during walking--a consequence of pain relief in knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Simonsen, Erik B; Alkjaer, T

    2006-01-01

    Joint pain is a primary symptom in knee osteoarthritis (OA), but the effect of pain and pain relief on the knee joint mechanics of walking is not clear. In this study, the effects of local knee joint analgesia on knee joint loads during walking were studied in a group of knee osteoarthritis...... patients. A group of healthy subjects was included as a reference group. The joint loads were calculated from standard gait analysis data obtained with standardised walking speed (4 km/h). The gait analyses were performed before and after pain relief by intra-articular injections of 10 mL lidocaine (1...

  6. Assessing the effect of football play on knee articular cartilage using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC).

    Science.gov (United States)

    Wei, Wenbo; Lambach, Becky; Jia, Guang; Flanigan, David; Chaudhari, Ajit M W; Wei, Lai; Rogers, Alan; Payne, Jason; Siston, Robert A; Knopp, Michael V

    2017-06-01

    The prevalence of cartilage lesions is much higher in football athletes than in the general population. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been shown to quantify regional variations of glycosaminoglycan (GAG) concentrations which is an indicator of early cartilage degeneration. The goal of this study is to determine whether dGEMRIC can be used to assess the influence in cartilage GAG concentration due to college level football play. Thirteen collegiate football players with one to four years of collegiate football play experience were recruited and both knee joints were scanned using a dedicated 8-channel phased array knee coil on a 3T MRI system. The contrast concentrations within cartilage were calculated based on the T 1 values from dGEMRIC scans. No substantial differences were found in the contrast concentrations between the pre- and post-season across all the cartilage compartments. One year collegiate football players presented an average contrast concentration at the pre-season of 0.116±0.011mM and post-season of 0.116±0.011mM. In players with multiple years of football play, contrast uptake was elevated to 0.141±0.012mM at the pre-season and 0.139±0.012mM at the post-season. The pre-season 0.023±0.016mM and post-season 0.025±0.016mM increase in contrast concentration within the group with multiple years of experience presented with a >20% increase in contrast uptake. This may indicate the gradual, cumulative damage of football play to the articular cartilage over years, even though the effect may not be noticeable after a season of play. Playing collegiate football for a longer period of time may lead to cartilage microstructural alterations, which may be linked to early knee cartilage degeneration. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Intra articular hyaluronic acid in the management of knee osteoarthritis: Pharmaco-economic study from the perspective of the national health insurance system

    Science.gov (United States)

    Thomas, Thierry; Amouroux, Françoise

    2017-01-01

    Introduction Pharmaco-economic data on the management of knee osteoarthritis (OA) with intra articular hyaluronic acid (IA HA) viscosupplementation is limited. We contrasted IA HA with non-steroidal anti-inflammatory drugs (NSAIDs). Methods Observational, prospective and multicenter study comparing treatments of knee OA costs and efficacy with either NSAIDs alone, or hyaluronic acid (Arthrum H 2%®), during a 6-month follow-up period. The investigators were pharmacists who recorded data on disease, drug consumption and healthcare circuit. Retrospectively, the 6-month period preceding inclusion was also studied, to ensure the comparability of groups. Results 199 patients were analyzed in a NSAIDs group and 202 in an IA HA group. Any of the WOMAC sub-scores and the EQ-5D Quality of Life index were significantly improved in the IA HA group (pexpenses per 6-month period were comparable before and after inclusion, €96 and €98 for NSAIDs group vs €94 and €101 for IA HA group, which indicates no evidence of additional cost from IA HA. For the active part of the population, the incidence of sick leave was lower in the IA HA group, indicating a better maintenance of patient activity. The overall expense on 12 months (6 months before and 6 months after inclusion) for the national health insurance system was comparable for NSAIDs and IA HA groups: €528 and €526, respectively. The number of patients taking NSAIDs significantly decreased in IA HA group (from 100% at inclusion to 66% at 1–3 months and 44% at 4–6 months), but remained unchanged (100%) during the follow-up period, in NSAIDs group. Conclusion Treatment with IA HA did not generate additional cost for the national health insurance and was associated with a functional improvement of knee osteoarthritis and Quality of Life. The cost-utility analysis was in favor of IA HA, with a gain of QALY equivalent to half a month, after the 6-month follow-up period comparing both treatments. The NSAIDs consumption

  8. Site-specific immunostaining for type X collagen in noncalcified articular cartilage of canine stifle knee joint.

    Science.gov (United States)

    Lammi, P E; Lammi, M J; Hyttinen, M M; Panula, H; Kiviranta, I; Helminen, H J

    2002-12-01

    Type X collagen is a short-chain collagen that is strongly expressed in hypertrophic chondrocytes. In this study, we used an immunohistochemical technique exploiting a prolonged hyaluronidase unmasking of type X collagen epitopes to show that type X collagen is not restricted to calcified cartilage, but is also present in normal canine noncalcified articular cartilage. A 30 degrees valgus angulation procedure of the right tibia was performed in 15 dogs at the age of 3 months, whereas their nonoperated sister dogs served as controls. Samples were collected 7 and 18 months after the surgery and immunostained for type X collagen. The deposition of type X collagen increased during maturation from age 43 weeks to 91 weeks. In the patella, most of the noncalcified cartilage stained for type X collagen, whereas, in the patellar surface of the femur, it was present mainly in the femoral groove close to cartilage surface. In femoral condyles, the staining localized mostly in the superficial cartilage on the lateral and medial sides, but not in the central weight-bearing area. In tibial condyles, type X collagen was often observed close to the cartilage surface in medial parts of the condyles, although staining could also be seen in the deep zone of the cartilage. Staining for type X collagen appeared strongest at sites where the birefringence of polarized light was lowest, suggesting a colocalization of type X collagen with the collagen fibril arcades in the intermediate zone. No significant difference in type X collagen immunostaining was observed in lesion-free articular cartilage between controls and dogs that underwent a 30 degrees valgus osteotomy. In osteoarthritic lesions, however, there was strong immunostaining for both type X collagen and collagenase-induced collagen cleavage products. The presence of type X collagen in the transitional zone of cartilage in the patella, femoropatellar groove, and in tibial cartilage uncovered by menisci suggests that it may

  9. Leukocyte and Platelet Rich Plasma (L-PRP) Versus Leukocyte and Platelet Rich Fibrin (L-PRF) For Articular Cartilage Repair of the Knee: A Comparative Evaluation in an Animal Model.

    Science.gov (United States)

    Kazemi, Davoud; Fakhrjou, Ashraf

    2015-10-01

    Articular cartilage injuries of the knee are among the most debilitating injuries leading to osteoarthritis due to limited regenerative capability of cartilaginous tissue. The use of platelet concentrates containing necessary growth factors for cartilage healing has recently emerged as a new treatment method. The efficacy of two types of different platelet concentrates were compared in the treatment of acute articular cartilage injuries of the knee in an animal model. Eighteen adult Iranian mixed breed male dogs were used to conduct this experimental study. Full thickness articular cartilage defects (diameter 6 mm, depth 5 mm) were created in the weight bearing area of femoral condyles of both hind limbs in all dogs (n = 72). Twelve dogs were randomly selected to receive treatment and their right and left hind limb defects were treated by L-PRP and L-PRF implantation respectively, while no treatment was undertaken in six other dogs as controls. The animals were euthanized at 4, 16 and 24 weeks following surgery and the resultant repair tissue was investigated macroscopically and microscopically. At each sampling time, 4 treated dogs and 2 control dogs were euthanized, therefore 8 defects per group were evaluated. Mean macroscopic scores of the treated defects were higher than the controls at all sampling times with significant differences (P L-PRF treated and control defects (10.13 vs. 8.37) and L-PRP treated and control defects (10 vs. 8.5) at 4 and 16 weeks, respectively. A similar trend in mean total microscopic scores was observed with a significant difference (P L-PRF could be used to effectively promote the healing of articular cartilage defects of the knee.

  10. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions.

    Science.gov (United States)

    Zaffagnini, S; Signorelli, C; Lopomo, N; Bonanzinga, T; Marcheggiani Muccioli, G M; Bignozzi, S; Visani, A; Marcacci, M

    2012-01-01

    Combinations of intra- and extra-articular procedures have been proposed for anterior cruciate ligament reconstruction with the aim of achieving an optimal control of translational and rotational knee laxities. Recently, the need for better reproducing the structural and functional behavior of the native anterior cruciate ligament led to the definition of anatomic double-bundle surgical approach. This study aimed to quantitatively verify whether the in vivo static and dynamic behavior obtained using over-the-top single-bundle with extra-articular tenodesis reconstruction was comparable to the results achieved by anatomic double-bundle approach. Thirty-five consecutive patients, with an isolated anterior cruciate ligament injury, were included in the study. Standard clinical laxities and pivot-shift test were quantified before and after anterior cruciate ligament reconstruction by means of a surgical navigation system dedicated to kinematic assessment; displacements of medial and lateral compartment during stress tests were also analyzed. Single-bundle with extra-articular tenodesis approach presented statistically better laxity reduction in varus/valgus stress test at full extension and in internal/external rotation at 90° of flexion; lateral plasty controlled better the lateral compartment during drawer test and varus/valgus stress test both at 0° and 30° of flexion and both the compartments during internal/external rotation at 90° of flexion. On the other hand, pivot-shift phenomenon was better controlled by anatomic double-bundle reconstruction. Both the reconstructions worked similarly for static knee laxity. The extra-articular procedure played an important role in better constraining the displacement of lateral tibial compartment, whereas the anatomic double-bundle reconstruction better restored the dynamic behavior of knee joint highlighted under pivot-shift stress test. Case series.

  11. Isokinetic knee function in healthy subjects with and without Kinesio taping.

    Science.gov (United States)

    Wong, Oscar M H; Cheung, Roy T H; Li, Raymond C T

    2012-11-01

    This study examined the difference in the isokinetic knee performance in healthy subjects with and without the Kinesio tape application onto the skin surface overlying the vastus medialis. A cross-sectional experimental study. Clinical setting. 30 healthy participants. Maximal concentric knee extension and flexion at three angular velocities (60, 120 and 180°/s) were measured with an isokinetic dynamometer. Normalized peak torque, normalized total work done and time to peak torque of knee extension and flexion were compared by repeated measures ANOVA. There was no significant main effect in ANOVA in normalized peak torque and normalized total work done between taping conditions and angular velocities. Conversely, participants demonstrated significant shorter time to peak extension torque with the tape condition (p = 0.03). Pair-wise comparisons indicated that such time reduction (36-101 ms) occurred at all three angular velocities (p Kinesio tape did not alter the muscle peak torque generation and total work done but shortened the time to generate peak torque. This finding may contribute to the rationale in injury prevention and rehabilitation in athletes with Kinesio taping. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Acute Effects of Kinesio Taping on Knee Extensor Peak Torque and Stretch Reflex in Healthy Adults

    Science.gov (United States)

    Yeung, Simon S.; Yeung, Ella W.

    2016-01-01

    Abstract Kinesio Tex tape (KT) is used to prevent and treat sports-related injuries and to enhance muscle performance. It has been proposed that the direction of taping may either facilitate or inhibit the muscle by having different effects on cutaneous receptors that modulate excitability of the motor neurons. This study had 2 goals. First, we wished to determine if KT application affects muscle performance and if the method of application facilitates or inhibits muscle performance. This was assessed by measuring isokinetic knee extension peak torque in the knee extensor. Second, we assessed neurological effects of taping on the excitability of the motor neurons by measuring the reflex latency and action potential by electromyography (EMG) in the patellar reflex. The study was a single-blind, placebo-controlled crossover trial with 28 healthy volunteers with no history of knee injuries. Participants received facilitative KT treatment, inhibitory KT treatment, or Hypafix taping of the knee extensor. There were significant differences in the peak torque between 3 treatments (F(2,54) = 4.873, P < 0.01). Post hoc analysis revealed that facilitative KT treatment resulted in higher knee extensor peak torque performance than inhibitory KT treatment (P = 0.036, effect size 0.26). There were, however, no significant differences in the reflex latency (F(2,54) = 2.84, P = 0.067) nor in the EMG values (F(2,54) = 0.18, P = 0.837) in the patellar reflex between the 3 taping applications. The findings suggest that the direction of KT application over the muscle has specific effects on muscle performance. Given the magnitude of effect is small, interpretation of clinical significance should be considered with caution. The underlying mechanism warrants further investigation. PMID:26825916

  13. The concentration, gene expression, and spatial distribution of aggrecan in canine articular cartilage, meniscus, and anterior and posterior cruciate ligaments: a new molecular distinction between hyaline cartilage and fibrocartilage in the knee joint.

    Science.gov (United States)

    Valiyaveettil, Manojkumar; Mort, John S; McDevitt, Cahir A

    2005-01-01

    The concentration, spatial distribution, and gene expression of aggrecan in meniscus, articular cartilage, and the anterior and posterior cruciate ligaments (ACL and PCL) was determined in the knee joints of five mature dogs. An anti-serum against peptide sequences specific to the G1 domain of aggrecan was employed in competitive-inhibition ELISA of guanidine HCl extracts and immunofluorescence microscopy. Gene expression was determined by Taqman real-time PCR. The concentration of aggrecan in articular cartilage (240.1 +/- 32 nMol/g dry weight) was higher than that in meniscus (medial meniscus: 33.4 +/- 4.3 nMol/g) and ligaments (ACL: 6.8 +/- 0.9 nMol/g). Aggrecan was more concentrated in the inner than the outer zone of the meniscus. Aggrecan in meniscus showed an organized, spatial network, in contrast to its diffuse distribution in articular cartilage. Thus, differences in the concentration, gene expression, and spatial distribution of aggrecan constitute another molecular distinction between hyaline cartilage and fibrocartilage of the knee.

  14. Assessment of T2 Relaxation Times for Normal Canine Knee Articular Cartilage by T2 Mapping Using 1.5-T Magnetic Resonance Imaging.

    Science.gov (United States)

    Matsui, Asami; Shimizu, Miki; Beale, Brian; Takahashi, Fumitaka; Yamaguchi, Sinya

    2017-11-01

    Objectives  This study aims to assess and compare the T2 relaxation times for articular cartilage of normal canine stifle joints in four regions by T2 mapping using a 1.5-T magnetic resonance imaging (MRI). Methods   In vivo prospective study: 20 hindlimbs (left and right) from 10 normal healthy beagle dogs ( n  = 20). The region of interest (ROI) was subdivided into medial and lateral condyles of femoral cartilage (MF and LF, respectively) and medial and lateral condyles of tibial cartilage (MT and LT, respectively). The T2 relaxation times were assessed in regions where the cartilage thickness was greater than 0.5 mm. Results  The median maximum cartilage thickness (mm) of the four ROI were 0.7 (range: 0.9-0.6), 0.6 (range: 0.7-0.5), 0.7 (range: 0.9-0.5) and 0.6 (range: 0.8-0.5) at MF, LF, MT and LT, respectively. The errors in the measurement (%) of the four ROI were 64.3 (range: 50.0-75.0), 75.0 (range: 64.3-90.0), 64.3 (range: 20.0-90.0) and 75.0 (range: 56.3-90.0) at MF, LF, MT and LT, respectively. The median T2 relaxation times (ms) for the articular cartilage of the four ROI were 70.2 (range: 57.9-87.9), 57.5 (range: 46.8-66.9), 65.0 (range: 52.0-92.0) and 57.0 (range: 49.0-66.2) at MF, LF, MT and LT, respectively. The inter-observer correlation coefficient (ICC, 2.1) for the T2 relaxation times of MF was 0.644. Clinical Significance  This study offers useful information on T2 relaxation times for articular cartilage of the stifle joint using a 1.5-T MRI in normal dogs. Schattauer GmbH Stuttgart.

  15. Avoidance of Total Knee Arthroplasty in Early Osteoarthritis of the Knee with Intra-Articular Implantation of Autologous Activated Peripheral Blood Stem Cells versus Hyaluronic Acid: A Randomized Controlled Trial with Differential Effects of Growth Factor Addition

    Directory of Open Access Journals (Sweden)

    Thana Turajane

    2017-01-01

    Full Text Available In this randomized controlled trial, in early osteoarthritis (OA that failed conservative intervention, the need for total knee arthroplasty (TKA and WOMAC scores were evaluated, following a combination of arthroscopic microdrilling mesenchymal cell stimulation (MCS and repeated intra-articular (IA autologous activated peripheral blood stem cells (AAPBSCs with growth factor addition (GFA and hyaluronic acid (HA versus IA-HA alone. Leukapheresis-harvested AAPBSCs were administered as three weekly IA injections combined with HA and GFA (platelet-rich plasma [PRP] and granulocyte colony-stimulating factor [hG-CSF] and MCS in group 1 and in group 2 but without hG-CSF while group 3 received IA-HA alone. Each group of 20 patients was evaluated at baseline and at 1, 6, and, 12 months. At 12 months, all patients in the AAPBSC groups were surgical intervention free compared to three patients needing TKA in group 3 (p<0.033. Total WOMAC scores showed statistically significant improvements at 6 and 12 months for the AAPBSC groups versus controls. There were no notable adverse events. We have shown avoidance of TKA in the AAPBSC groups at 12 months and potent, early, and sustained symptom alleviation through GFA versus HA alone. Differential effects of hG-CSF were noted with an earlier onset of symptom alleviation throughout.

  16. Imaging findings in 22 cases of Schnitzler syndrome: characteristic para-articular osteosclerosis, and the ''hot knees'' sign differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Niederhauser, Blake D. [Department of Radiology, Rochester, MN (United States); Dingli, David; Kyle, Robert A. [Mayo Clinic, Division of Hematology, Rochester, MN (United States); Ringler, Michael D. [Mayo Clinic, Department of Radiology, Rochester, MN (United States)

    2014-07-15

    Schnitzler syndrome is characterized by chronic urticaria, monoclonal gammopathy, and a risk of developing lymphoproliferative disorders. Patients frequently present with bone pain, fever, arthralgia, and lymphadenopathy. The purpose of this study is to retrospectively review and evaluate potentially attributable imaging abnormalities in a series of patients with clinically diagnosed Schnitzler syndrome. Clinical and pathological chart review identified 22 patients meeting Strasbourg criteria for Schnitzler syndrome. Imaging of these patients was retrospectively reviewed by a musculoskeletal radiologist and a radiology fellow to determine and characterize significant ''positive'' findings that could potentially be attributed to their primary disease process. Evidence of abnormal bone remodeling was present in 64 % (14/22) of patients with 40 bone abnormalities. Lesions were predominantly or entirely sclerotic and most commonly involved the distal femora (n = 11), proximal tibiae (nine), and innominate bones (six). Patterns of involvement were variable, but typically eccentrically intramedullary, cortical, and juxta-articular. Skeletal surveys and targeted radiographs identified only 37 % (10/27) of abnormal bones subsequently ''positive'' by additional modalities. PET and bone scans were all positive in patients with bone sclerosis (13/13 and 17/17 bone sites, respectively). Schnitzler syndrome often presents with characteristic osteosclerosis, most commonly around the knees and in the pelvis. In patients with a suggestive clinical history, the radiologist could direct an appropriate imaging strategy or might to be the first to suggest the diagnosis. Bone scan may be the most appropriate initial screening tool in suspected cases. (orig.)

  17. Acute effects of kinesio taping on knee extensor peak torque and electromyographic activity after exhaustive isometric knee extension in healthy young adults.

    Science.gov (United States)

    Yeung, Simon S; Yeung, Ella W; Sakunkaruna, Yosawin; Mingsoongnern, Sutida; Hung, Wing Y; Fan, Yun L; Iao, Heng C

    2015-05-01

    To evaluate the effect of Kinesio Tex tape and its method of application, Kinesio Taping (KT) on knee extensor performance before and after an exhaustive isometric knee extension exercise. Single-blinded, randomized control trial. Centre for Sports Training and Rehabilitation at The Hong Kong Polytechnic University. Twenty-six healthy volunteers with no history of knee injuries. Subjects were randomized to either the KT or sham taping group. The effects of KT on the neuromuscular performance of the knee extensors were measured before and after KT application, and immediately and 5 and 10 minutes after an exhaustive isometric knee extension exercise. Within-group analyses revealed a significant effect of time on the peak torque in isometric knee extension (F2.73,65.44 = 24.5, P Kinesio taping is commonly seen in the sports arena. The popularity is presumably due to the general belief in its injury prevention and enhancement of muscle performance. The results of the present findings suggested that KT shortens the time to reach peak torque generation. Aside from this, there is no other significant positive effect on muscle performance. Further investigation on the effects of KT on muscle performance is warranted.

  18. The influence of different non-articular proximal forearm orthoses (brace) widths in the wrist extensors muscle activity, range of motion and grip strength in healthy volunteers.

    Science.gov (United States)

    Marcolino, Alexandre Márcio; Fonseca, Marisa de Cássia Registro; Leonardi, Naiara Tais; Barbosa, Rafael Inácio; Neves, Lais Mara Siqueira das; de Jesus Guirro, Rinaldo Roberto

    2016-06-30

    The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects. Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM. The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model with mixed effects. According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01). A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.

  19. Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees.

    Science.gov (United States)

    Kaiser, Jarred M; Vignos, Michael F; Kijowski, Richard; Baer, Geoffrey; Thelen, Darryl G

    2017-12-01

    Although knees that have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit normal laxity on clinical examination, abnormal kinematic patterns have been observed when the joint is dynamically loaded during whole body activity. This study investigated whether abnormal knee kinematics arise with loading under isolated dynamic movements. Tibiofemoral and patellofemoral kinematics of ACLR knees will be similar to those of the contralateral uninjured control knee during passive flexion-extension, with bilateral differences emerging when an inertial load is applied. Controlled laboratory study. The bilateral knees of 18 subjects who had undergone unilateral ACLR within the past 4 years were imaged by use of magnetic resonance imaging (MRI). Their knees were cyclically (0.5 Hz) flexed passively. Subjects then actively flexed and extended their knees against an inertial load that induced stretch-shortening quadriceps contractions, as seen during the load acceptance phase of gait. A dynamic, volumetric, MRI sequence was used to track tibiofemoral and patellofemoral kinematics through 6 degrees of freedom. A repeated-measures analysis of variance was used to compare secondary tibiofemoral and patellofemoral kinematics between ACLR and healthy contralateral knees during the passive and active extension phases of the cyclic motion. Relative to the passive motion, inertial loading induced significant shifts in anterior and superior tibial translation, internal tibial rotation, and all patellofemoral degrees of freedom. As hypothesized, tibiofemoral and patellofemoral kinematics were bilaterally symmetric during the passive condition. However, inertial loading induced bilateral differences, with the ACLR knees exhibiting a significant shift toward external tibial rotation. A trend toward greater medial and anterior tibial translation was seen in the ACLR knees. This study demonstrates that abnormal knee kinematic patterns in ACLR knees emerge during a

  20. The Influence of Articular Cartilage Thickness Reduction on Meniscus Biomechanics.

    Directory of Open Access Journals (Sweden)

    Piotr Łuczkiewicz

    Full Text Available Evaluation of the biomechanical interaction between meniscus and cartilage in medial compartment knee osteoarthritis.The finite element method was used to simulate knee joint contact mechanics. Three knee models were created on the basis of knee geometry from the Open Knee project. We reduced the thickness of medial cartilages in the intact knee model by approximately 50% to obtain a medial knee osteoarthritis (OA model. Two variants of medial knee OA model with congruent and incongruent contact surfaces were analysed to investigate the influence of congruency. A nonlinear static analysis for one compressive load case was performed. The focus of the study was the influence of cartilage degeneration on meniscal extrusion and the values of the contact forces and contact areas.In the model with incongruent contact surfaces, we observed maximal compressive stress on the tibial plateau. In this model, the value of medial meniscus external shift was 95.3% greater, while the contact area between the tibial cartilage and medial meniscus was 50% lower than in the congruent contact surfaces model. After the non-uniform reduction of cartilage thickness, the medial meniscus carried only 48.4% of load in the medial compartment in comparison to 71.2% in the healthy knee model.We have shown that the change in articular cartilage geometry may significantly reduce the role of meniscus in load transmission and the contact area between the meniscus and cartilage. Additionally, medial knee OA may increase the risk of meniscal extrusion in the medial compartment of the knee joint.

  1. Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty.

    Science.gov (United States)

    Pellegrini, Christine A; Ledford, Gwendolyn; Chang, Rowland W; Cameron, Kenzie A

    2017-05-05

    We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m(2)). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes

  2. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses.

    Science.gov (United States)

    Campbell, Kirk A; Saltzman, Bryan M; Mascarenhas, Randy; Khair, M Michael; Verma, Nikhil N; Bach, Bernard R; Cole, Brian J

    2015-11-01

    The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested. Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence. Three meta-analyses met the eligibility criteria and ranged in quality from Level II to Level IV evidence. All studies compared outcomes of treatment with intra-articular platelet-rich plasma (IA-PRP) versus control (intra-articular hyaluronic acid or intra-articular placebo). Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months. It is unclear if the use of multiple PRP injections, the double-spinning technique, or activating agents leads to better outcomes. Patients with less radiographic evidence of arthritis benefit more from PRP treatment. The use of multiple PRP injections may increase the risk of self-limited local adverse reactions. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected and all showed that IA-PRP provided clinically relevant improvements in pain and function compared with the control treatment. IA-PRP is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months. There appears to be an increased risk of local adverse

  3. The effect of kinesiology tape on knee proprioception in healthy subjects.

    Science.gov (United States)

    Torres, Rui; Trindade, Raquel; Gonçalves, Rui Soles

    2016-10-01

    Kinesiology tape can improve athletic performance; however, due to cutaneous stimulation its application can have an influence on proprioception. To determine the effects of kinesiology tape on knee proprioception applied to quadriceps, namely in the joint position sense (JPS) and in the threshold to detect passive movement (TTDPM), both immediately after and 24 h after its application. Thirty young healthy participants were randomly divided into experimental and control group. In the experimental group, a kinesiology tape on the quadriceps muscle was applied. The JPS and the TTDPM of the knee was assessed before, immediately after and 24 h after the kinesiology tape intervention. No significant differences were found in the assessment made before intervention. The Friedman Test showed that kinesiology tape had no influence on JPS in either group over time (p > 0.05). However, the TTDPM decreased significantly immediately after and 24 h after its application (p < 0.05). Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project

    Science.gov (United States)

    Navarro-Sarabia, F; Coronel, P; Collantes, E; Navarro, F J; de la Serna, A Rodriguez; Naranjo, A; Gimeno, M; Herrero-Beaumont, G

    2011-01-01

    Objective AMELIA (OsteoArthritis Modifying Effects of Long-term Intra-articular Adant) was designed to compare against placebo the efficacy and safety of repeated injections of hyaluronic acid (HA) and its effect on disease progression over 40 months. Methods A multicentre, randomised, patient and evaluator-blinded, controlled study in 306 patients fulfilling American College of Rheumatology criteria for knee osteoarthritis, radiological grades II–III (Kellgren–Lawrence) and joint space width ≥2 mm. Patients received four cycles of five intra-articular HA or placebo injections with a follow-up of 6 months after the first and second cycles, and 1 year after the third and fourth cycles. Osteoarthritis Research Society International (OARSI) 2004 responder criteria were used to assess efficacy. The consumption of rescue medication was a secondary outcome. Adverse events were recorded for safety purposes. Results At the 40-month visit significantly more patients responded to HA compared with placebo (OARSI 2004, p=0.004). The number of responders to HA increased through the study, whereas those to placebo did not change. Significant differences were also found in favour of HA for each individual component of the OARSI 2004. No safety problems were recorded. Conclusions The results of AMELIA offer pioneer evidence that repeated cycles of intra-articular injections of HA not only improve knee osteoarthritis symptoms during the in-between cycle period but also exert a marked carry-over effect for at least 1 year after the last cycle. In this respect, it is not possible to establish if this carry-over effect reflects true osteoarthritis remission or just a modification of the disease's natural course. ClinicalTrials.gov number, NCT00669032 PMID:21852252

  5. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy

    NARCIS (Netherlands)

    de Vries, Astrid J.; van den Akker-Scheek, Inge; Diercks, Ron L.; Zwerver, Johannes; van der Worp, Henk

    Objectives: The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of

  6. Changes in proprioceptive weighting during quiet standing in women with early and established knee osteoarthritis compared to healthy controls.

    Science.gov (United States)

    Mahmoudian, Armaghan; van Dieen, Jaap H; Baert, Isabel A C; Jonkers, Ilse; Bruijn, Sjoerd M; Luyten, Frank P; Faber, Gert S; Verschueren, Sabine M P

    2016-02-01

    Knee osteoarthritis (OA) is highly prevalent in people above the age of 60, and is typically associated with pain, stiffness, muscle weakness and proprioceptive deficits. Muscle-tendon vibration has been used to assess the spatial reweighting of proprioceptive input during standing. The current study aimed to investigate whether weighting of proprioceptive input is altered in patients with early and established knee OA compared to asymptomatic controls. The upright posture of 27 participants with early OA, 26 with established OA, and 27 asymptomatic controls was perturbed by vibrating (frequency: 70Hz and amplitude: approximately 0.5mm) ankle muscles (i.e. tibialis anterior and triceps surae) and knee muscles (vastus medialis). Center of pressure displacements of the participants were recorded using a force plate. Both patients with early and established OA were more sensitive to triceps surae vibration compared to their healthy peers (Pmuscles between patients with knee OA and healthy controls. These results suggest that the early stages of knee OA may already lead to reweighting of proprioceptive information, suggesting more reliance on ankle proprioceptive input for postural control. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Comparison of kinematics of ACL-deficient and healthy knees during passive flexion and isometric leg press.

    Science.gov (United States)

    Esfandiarpour, Fateme; Shakourirad, Ali; Talebian Moghaddam, Saeed; Olyaei, Gholamreza; Eslami, Abouzar; Farahmand, Farzam

    2013-12-01

    Studying the kinematics of the ACL deficient (ACLD) knees, during different physiological activities and muscle contraction patterns, can improve our understanding of the joint's altered biomechanics due to ACL deficiency as well as the efficacy and safety of the rehabilitations exercises. Twenty-five male volunteers, including 11 normal and 14 unilateral ACLD subjects, participated in this study. The kinematics of the injured knees of the ACLD subjects was compared with their intact knees and the healthy group during passive flexion and isometric leg press with the knees flexed from full extension to 45° flexion, with 15° intervals. An accurate registration algorithm was used to obtain the three dimensional kinematical parameters, from magnetic resonance images. The ACL deficiency mainly altered the tibial anterior translation, and to some extent its internal rotation, with the change in other parameters not significant. During leg press, the anterior translation of the ACLD knees was significantly larger than that of the normal knees at 30° flexion, but not at 45°. Comparison of the anterior translations of the ACLD knees during leg press with that of the passive flexion revealed improved consistency (CVs changed from 1.2 and 4.0 to 0.6 and 0.6, at 30° and 45° flexion, respectively), but considerable larger translations (means increased by 6.2 and 4.9mm, at 30° and 45° flexion, respectively). The simultaneous contraction of the quadriceps and hamstrings during leg press, although reduces the knee laxity, cannot compensate for the loss of the ACL to restore the normal kinematics of the joint, at least during early flexion. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Wear in human knees

    Directory of Open Access Journals (Sweden)

    M.L. Wang

    2015-06-01

    Full Text Available Wear occurs in natural knee joints and plays a pivotal factor in causing articular cartilage degradation in osteoarthritis (OA processes. Wear particles are produced in the wear process and get involved in inflammation of human knees. This review presents progresses in the mechanical and surface morphological studies of articular cartilages, wear particles analysis techniques for wear studies and investigations of human knee synovial fluid in wear of human knees. Future work is also included for further understanding of OA symptoms and their relations which may shed light on OA causes.

  9. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis

    Science.gov (United States)

    Cole, Brian J; Karas, Vasili; Hussey, Kristen; Pilz, Kyle; Fortier, Lisa A

    2017-02-01

    The use of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA) has demonstrated mixed clinical outcomes in randomized controlled trials when compared with hyaluronic acid (HA), an accepted nonsurgical treatment for symptomatic OA. Biological analysis of PRP has demonstrated an anti-inflammatory effect on the intra-articular environment. To compare the clinical and biological effects of an intra-articular injection of PRP with those of an intra-articular injection of HA in patients with mild to moderate knee OA. Randomized controlled trial; Level of evidence, 1. A total of 111 patients with symptomatic unilateral knee OA received a series of either leukocyte-poor PRP or HA injections under ultrasound guidance. Clinical data were collected before treatment and at 4 time points across a 1-year period. Synovial fluid was also collected for analysis of proinflammatory and anti-inflammatory markers before treatment and at 12 and 24 weeks after treatment. Several measures were used to assess results: (1) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) International Knee Documentation Committee (IKDC) subjective knee evaluation, visual analog scale (VAS) for pain, and Lysholm knee score; and (3) difference in intra-articular biochemical marker concentrations. There were 49 patients randomized to treatment with PRP and 50 randomized to treatment with HA. No difference was seen between the groups in the primary outcome measure (WOMAC pain score). In the secondary outcome measure, linear contrasts identified a significantly higher IKDC score in the PRP group compared with the HA group at 24 weeks (mean ± standard error [SE], 65.5 ± 3.6 vs 55.8 ± 3.8, respectively; P = .013) and at final follow-up (52 weeks) (57.6 ± 3.37 vs 46.6 ± 3.76, respectively; P = .003). Linear contrasts also identified a statistically lower VAS score in the PRP group versus the HA group at 24 weeks (mean ± SE, 34.6 ± 3.24 vs 48.6 ± 3

  10. Combination Intravenous and Intra-Articular Tranexamic acid compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study

    Directory of Open Access Journals (Sweden)

    Chris Buntting

    2016-07-01

    This study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence. Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone

  11. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year

    DEFF Research Database (Denmark)

    Jørgensen, Anette; Stengaard-Pedersen, Kristian; Simonsen, Lars Ole

    2010-01-01

    osteoarthritis (clinical and laboratory) and with a Lequesne algofunctional index score (LFI) of 10 or greater. Patients received a hyaluronan product (sodium hyaluronate; Hyalgan) (n= 167) or saline (n= 170) intra-articularly weekly for 5 weeks and were followed up to 1 year. Time to recurrence was the primary...

  12. Principles of brain plasticity in improving sensorimotor function of the knee and leg in healthy subjects

    DEFF Research Database (Denmark)

    Ageberg, Eva; Bjorkman, Anders; Rosen, Birgitta

    2009-01-01

    and foot to improve sensorimotor function can be applied on the knee. We hypothesized that temporary anesthesia of the skin area above and below the knee would improve sensorimotor function of the ipsilateral knee and leg. METHODS: In this first double-blind exploratory study, 28 uninjured subjects (mean...... age 26 years, range 19-34, 50% women) were randomized to temporary local cutaneous application of anesthetic (EMLA) (n=14) or placebo cream (n=14). Fifty grams of EMLA, or placebo, was applied on the leg 10 cm above and 10 cm below the center of patella, leaving the area around the knee without cream...

  13. Accurate intra-articular knee joint injection in the obese? 'Fat Chance!'-A clinical lesson and recommendations for secondary referral.

    LENUS (Irish Health Repository)

    McGarry, James G

    2011-04-12

    Abstract Corticosteroid joint injections are perceived as being an effective treatment for symptomatic knee osteoarthritis, with a very low risk of complications. While the procedure is often performed in secondary care by orthopaedic surgeons and rheumatologists (and trainees in either specialty), the role of general practitioners (GPs) in chronic disease management has long existed with joint injections also frequently performed in primary care. The perception that serious complications from corticosteroid knee joint injections are rare and that their benefits in treating symptomatic knee osteoarthritis significantly outweigh the risks has not been well addressed. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee pain and radiographic changes consistent with osteoarthritis. She was administered a corticosteroid joint injection, which gave minimal relief, and over the next few days resulted in worsening severe pain, erythema and swelling. She returned to the GP who commenced oral antibiotics and referred her to casualty. A large knee abscess was diagnosed and intravenous antibiotics were commenced. The patient was admitted under the orthopaedic surgeons with her treatment consisting of multiple surgical procedures over a prolonged duration. Although lengthy, her postoperative recovery was unremarkable. Based on this case report and our review of the literature, we highlight the potential complications associated with corticosteroid knee joint injections and suggest certain patients for whom we would recommend secondary referral before any intervention in primary care.

  14. Reproducibility of a knee and hip proprioception test in healthy older adults

    NARCIS (Netherlands)

    Arvin, M.; Hoozemans, M.J.M.; Burger, B.J.; Verschueren, S.M.; van Dieen, J.H.; Pijnappels, M.A.G.M.

    2015-01-01

    Background: Proprioception can be assessed by measuring joint position sense (JPS). Most studies have focused on JPS of the knee joint while literature for other joints especially for hip JPS is scarce. Although some studies have evaluated proprioception of the knee joint, the reproducibility of

  15. THE EFFECTS OF KNEE JOINT EFFUSION ON QUADRICEPS ELECTROMYOGRAPHY DURING JOGGING

    Directory of Open Access Journals (Sweden)

    William I. Sterett

    2005-03-01

    Full Text Available To investigate and describe the influence of intra-articular effusion on knee joint kinematics and electromyographic (EMG profiles during jogging. Thirteen individuals underwent a 20 cc 0.9% saline insufflation of the knee joint capsule and completed 8 jogging trials. Stance phase, sagittal plane knee joint kinematics and thigh muscular EMG profiles were compared pre- and post-insufflation utilizing a paired t-test (p = 0.05. Mild knee effusion caused a reduction in vastus medialis (p = 0.005 and lateralis (p = 0.006 EMG activity. The rectus femoris, biceps femoris and medial hamstring muscles did not exhibit changes due to this protocol. There were no changes in the sagittal plane knee joint kinematic pattern. Twenty cc effusion can cause quadriceps inhibition in the vastus medialis and the vastus lateralis in otherwise healthy individuals during jogging. This study provides baseline data for the effects of mild knee joint effusion on thigh musculature during jogging.

  16. Associations of three-dimensional T1 rho MR mapping and three-dimensional T2 mapping with macroscopic and histologic grading as a biomarker for early articular degeneration of knee cartilage.

    Science.gov (United States)

    Sasho, T; Katsuragi, J; Yamaguchi, S; Haneishi, H; Aizimu, T; Tanaka, T; Watanabe, A; Sato, Y; Akagi, R; Matsumoto, K; Uno, T; Motoori, K

    2017-04-29

    T1 rho and T2 mapping are magnetic resonance imaging (MRI) techniques to detect early degenerative changes in cartilage. Recent advancements have enabled 3D acquisition for both techniques. The objective of the present study was to examine the correlation of 3D T1 rho and 3D T2 mapping with macroscopic and histological characteristics of knee cartilage. Twenty-one patients who underwent total knee arthroplasty due to osteoarthritis with involvement of the medial compartment but with minimum involvement of the lateral compartment were enrolled. Prior to surgery, five series of MRI were acquired with a 3-T scanner. 3D T1 rho/T2 analyses were performed following determination of regions to be assessed using in-house software that incorporated three series of MRI acquisitions data (3D-MERGE, 3D-SPGR, and 3D-CUBE). During surgery, the cartilage of the lateral compartment was macroscopically assessed with the International Cartilage Research Society (ICRS) articular classification system. The extracted specimens were histologically assessed using the OARSI histology score. Three regions of interest (ROI) were assessed for each slice (two slices per knee): the central lateral femoral condyle (cLFC), the posterior portion of the lateral femoral condyle (pLFC), and the lateral tibia plateau (LTP). For each ROI, the mean T1 rho and T2 relaxation time, the ICRS grade, and the OARSI score were compared. Neither the T1 rho nor the T2 reflected the macroscopic grading. The T1 rho could discriminate between histological grades 1 and 2. However, the T2 could not. The T1 rho relaxation time was higher in the pLFC than in the cLFC even in the same grade. Compared to T2 mapping, T1 rho mapping may have an advantage in differentiating grades I and II cartilage degeneration on OARSI histological grading system.

  17. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Zhi-Xin Zhao

    2015-01-01

    Full Text Available Background: The goal of total knee arthroplasty (TKA is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0-135° flexion. Results: Both the output data trends and the measured values derived from the normal knee′s kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, "rollback" compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis.

  18. Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls.

    Science.gov (United States)

    Fältström, Anne; Hägglund, Martin; Kvist, Joanna

    2017-02-01

    Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams. Cross-sectional study; Level of evidence, 3. This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses. The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended

  19. The effect of shoe design and lateral wedges on knee load and neuromuscular control in healthy subjects during walking

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kersting, Uwe G.

    2014-01-01

    design/type on the effectiveness of lateral wedging has not been investigated so far. The Purpose of the present study was to explore alterations in knee loading due to lateral foot wedges in three different shoes. Methods: Thirteen healthy participants with no history of knee pain were tested using...... wedging is effective regardless of shoe design. Differences between the three neutral walking conditions underline the importance of footwear choice in individuals. It is safe to apply lateral wedges without jeopardising muscular control during walking regardless of shoe type. Possible effects of altering...... three-dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analysed. The shoes were tested both with and without a 10-degree full-length laterally wedged insole. Results: There were significant shoe wedge interactions on the first...

  20. Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho Eficacia analgésica del uso de dosis alta de morfina intra-articular en pacientes sometidos a la artroplastia total de rodilla Analgesic efficacy of the intra-articular administration of high Doses of morphine in patients undergoing total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia Garcia

    2010-02-01

    promote better results and consequently decrease postoperative analgesic consumption, characterizing a dose-dependent peripheral action. A controlled, randomized, double-blind study was undertaken to evaluate the efficacy of the intra-articular administration of 10 mg of morphine in patients undergoing total knee arthroplasty. METHODS: Fifty patients undergoing total knee arthroplasty were randomly divided into two groups: the treatment group received 10 mg (1 mL of intra-articular morphine diluted in 19 mL of NS, while the control group received the intra-articular administration of 20 mL of NS, both after closure of the capsule at the end of the surgery. On demand subcutaneous morphine was available for residual pain. The following parameters were evaluated: pain severity according to the numeric scale (NS, 2 h (M1, 6 h (M2, 12 h (M3, and 24 h (M4 after the IA injection; time until the first request of analgesic; analgesic consumption, and side effects. CONCLUSIONS: The treatment group had lower NS than the control group in M1 and M2, while significant differences were not observed in the other moments. The time until the first request of analgesics was significantly higher in the treatment group, and analgesic consumption in the first 24 hours was also lower in this group. The incidence of side effects did not differ between both groups. We concluded that the postoperative IA administration of 10 mg of morphine promoted a longer period without rescue analgesics and reduced their consumption in the first 24 hours.

  1. Effects of different mode high-intensity movement training on articular cartilage in histology - a randomised controlled trial on rabbit knee

    Directory of Open Access Journals (Sweden)

    Ch Qi

    2008-12-01

    Full Text Available Objective: To study the “starting mechanism” and pathological process of knee cartilage injury in different movement training with high intensity. Materials and Methods: 72 New Zealand white rabbits were divided into 3 groups randomly: Untreated Control Group (CTRL, n=8, animals were untreated by any intervention processing; Running Training Group (RG, n=32, animals were trained running in a treadmill daily; Jumping Training Group (JG, n=32, animals were trained jumping in an electric stimulation cage daily. Rabbits in RT and JT were euthanized at 4 week and 8 week respectively, and knee joints were taken out to be examined histologically. GAG content, thickness of cartilage and subchondral bone, dead cell ratio and Mankin grades were measured respectively. Results: By microexaminations, different pathological changes of early sport injury of knee cartilage in RG and JG were found. Animals receiving jumping training displayed a significantly higher degree of grossly and cartilage matrix detectable degeneration on the weight-loading region of the femur condyles than did animals receiving running training; on the contrary, animals receiving running training displayed a significantly higher degree of chondrocyte damage than did animals receiving jumping training in the earlier stage (4-week. Conclusions: Repetitive and high-intensity jumping exercise can do more harm to cartilage matrix than to chondrocyte in knee joint, the pathogenesis displays as “cartilage matrix starting mechanism”; on the contrary, running exercise can do more harm to chondrocyte than to cartilage matrix, the pathogenesis displays as “chondrocyte starting mechanism”. In addition, the difference in pathogenesis and cartilage damage phenotype by different exercises may have a close correlation with the different loading rate of stress on knee cartilage surface.

  2. Reduction of intra-articular adhesion by topical application of ...

    African Journals Online (AJOL)

    Background: Intra-articular adhesion is the commonest complication that is faced by orthopedic surgeons after knee surgery. Thus, the present investigation evaluates the effect of daidzein on intra-articular adhesion in rabbits. Material and methods: All the rabbits were separated in to four different groups each group carries ...

  3. Does an unloader brace reduce knee loading in normally aligned knees?

    Science.gov (United States)

    Ebert, Jay R; Hambly, Karen; Joss, Brendan; Ackland, Timothy R; Donnelly, Cyril J

    2014-03-01

    Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking. The purpose of this study was to investigate the effect of varus and valgus adjustments to one commercially available unloader knee brace on tibiofemoral joint loading and knee muscle activation in populations with normal knee alignment. The gait of 20 healthy participants (mean age 28.3 years; body mass index 22.9 kg/m(2)) was analyzed with varus and valgus knee brace conditions and without a brace. Spatiotemporal variables were calculated as were knee adduction moments and muscle activation during stance. A directed cocontraction ratio was also calculated to investigate the relative change in the activation of muscles with medial (versus lateral) moment arms about the knee. Group differences were investigated using analysis of variance. The numbers available would have provided 85% power to detect a 0.05 increase or decrease in the knee adduction moment (Nm/kg*m) in the braced condition compared with the no brace condition. With the numbers available, there were no differences between the braced and nonbraced conditions in kinetic or muscle activity parameters. Both varus (directed cocontraction ratio 0.29, SD 0.21, effect size 0.95, p = 0.315) and valgus (directed cocontraction ratio 0.28, SD 0.24, effect size 0.93, p = 0.315) bracing conditions increased the relative activation of muscles with lateral moment arms compared with no brace (directed cocontraction ratio 0.49, SD 0.21). Results revealed inconsistencies in knee kinetics and muscle activation strategies after varus and valgus bracing conditions. Although in this pilot study the results were not statistically significant, the magnitudes of the observed effect sizes were moderate to large and represent suitable pilot data for future work. Varus bracing increased knee

  4. [Intra-articular reinforcement of a partially torn anterior cruciate ligament (ACL) using newly developed UHMWPE biomaterial in combination with Hexalon ACL/PCL screws: ex-vivo mechanical testing of an animal knee model].

    Science.gov (United States)

    Fedorová, P; Srnec, R; Pěnčík, J; Dvořák, M; Krbec, M; Nečas, A

    2015-01-01

    PURPOSE OF THE STUDY Recent trends in the experimental surgical management of a partial anterior cruciate ligament (ACL) rupture in animals show repair of an ACL lesion using novel biomaterials both for biomechanical reinforcement of a partially unstable knee and as suitable scaffolds for bone marrow stem cell therapy in a partial ACL tear. The study deals with mechanical testing of the newly developed ultra-high-molecular-weight polyethylene (UHMWPE) biomaterial anchored to bone with Hexalon biodegradable ACL/PCL screws, as a new possibility of intra-articular reinforcement of a partial ACL tear. MATERIAL AND METHODS Two groups of ex vivo pig knee models were prepared and tested as follows: the model of an ACL tear stabilised with UHMWPE biomaterial using a Hexalon ACL/PCL screw (group 1; n = 10) and the model of an ACL tear stabilised with the traditional, and in veterinary medicine used, extracapsular technique involving a monofilament nylon fibre, a clamp and a Securos bone anchor (group 2; n = 11). The models were loaded at a standing angle of 100° and the maximum load (N) and shift (mm) values were recorded. RESULTS In group 1 the average maximal peak force was 167.6 ± 21.7 N and the shift was on average 19.0 ± 4.0 mm. In all 10 specimens, the maximum load made the UHMWPE implant break close to its fixation to the femur but the construct/fixation never failed at the site where the material was anchored to the bone. In group 2, the average maximal peak force was 207.3 ± 49.2 N and the shift was on average 24.1 ± 9.5 mm. The Securos stabilisation failed by pullout of the anchor from the femoral bone in nine out of 11 cases; the monofilament fibre ruptured in two cases. CONCLUSIONS It can be concluded that a UHMWPE substitute used in ex-vivo pig knee models has mechanical properties comparable with clinically used extracapsular Securos stabilisation and, because of its potential to carry stem cells and bioactive substances, it can meet the requirements for

  5. Magnetic resonance image segmentation using semi-automated software for quantification of knee articular cartilage - initial evaluation of a technique for paired scans

    Energy Technology Data Exchange (ETDEWEB)

    Brem, M.H. [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Friedrich-Alexander-University Erlangen Nurenberg, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Erlangen (Germany); Lang, P.K.; Neumann, G.; Schlechtweg, P.M.; Yoshioka, H.; Pappas, G.; Duryea, J. [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Schneider, E. [LLC, SciTrials, Rocky River, OH (United States); Cleveland Clinic, Imaging Institute, Cleveland, OH (United States); Jackson, R.; Yu, J. [Ohio State University, Diabetes and Metabolism and Radiology, Department of Endocrinology, Columbus, OH (United States); Eaton, C.B. [Center for Primary Care and Prevention and the Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, Providence, RI (United States); Hennig, F.F. [Friedrich-Alexander-University Erlangen Nurenberg, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Erlangen (Germany)

    2009-05-15

    Software-based image analysis is important for studies of cartilage changes in knee osteoarthritis (OA). This study describes an evaluation of a semi-automated cartilage segmentation software tool capable of quantifying paired images for potential use in longitudinal studies of knee OA. We describe the methodology behind the analysis and demonstrate its use by determination of test-retest analysis precision of duplicate knee magnetic resonance imaging (MRI) data sets. Test-retest knee MR images of 12 subjects with a range of knee health were evaluated from the Osteoarthritis Initiative (OAI) pilot MR study. Each subject was removed from the magnet between the two scans. The 3D DESS (sagittal, 0.456 mm x 0.365 mm, 0.7 mm slice thickness, TR 16.5 ms, TE 4.7 ms) images were obtained on a 3-T Siemens Trio MR system with a USA Instruments quadrature transmit-receive extremity coil. Segmentation of one 3D-image series was first performed and then the corresponding retest series was segmented by viewing both image series concurrently in two adjacent windows. After manual registration of the series, the first segmentation cartilage outline served as an initial estimate for the second segmentation. We evaluated morphometric measures of the bone and cartilage surface area (tAB and AC), cartilage volume (VC), and mean thickness (ThC.me) for medial/lateral tibia (MT/LT), total femur (F) and patella (P). Test-retest reproducibility was assessed using the root-mean square coefficient of variation (RMS CV%). For the paired analyses, RMS CV % ranged from 0.9% to 1.2% for VC, from 0.3% to 0.7% for AC, from 0.6% to 2.7% for tAB and 0.8% to 1.5% for ThC.me. Paired image analysis improved the measurement precision of cartilage segmentation. Our results are in agreement with other publications supporting the use of paired analysis for longitudinal studies of knee OA. (orig.)

  6. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of 177Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience

    Science.gov (United States)

    Shinto, Ajit S.; Kamaleshwaran, K. K.; Chakraborty, Sudipta; Vyshakh, K.; Thirumalaisamy, S. G.; Karthik, S.; Nagaprabhu, V. N.; Vimalnath, K. V.; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using 177Lu-labeled hydroxyapatite (177Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of 177Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of 177Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those with more

  7. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of (177)Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience.

    Science.gov (United States)

    Shinto, Ajit S; Kamaleshwaran, K K; Chakraborty, Sudipta; Vyshakh, K; Thirumalaisamy, S G; Karthik, S; Nagaprabhu, V N; Vimalnath, K V; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using (177)Lu-labeled hydroxyapatite ((177)Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of (177)Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of (177)Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those

  8. Patellar tendinopathy caused by a para-articular/extraskeletal osteochondroma in the lateral infrapatellar region of the knee: a case report

    OpenAIRE

    Ozturan, Kutay Engin; Yucel, Istemi; Cakici, Husamettin; Guven, Melih; Gurel, Kamil; Dervisoglu, Sergulen

    2009-01-01

    Patellar tendinopathy is characterized by activity-related anterior knee pain. It is most commonly related to sports activity, but has also been reported in the non-athletic population. Most injuries are caused by microtrauma, resulting in tendinitis or tendinosis. Extraskeletal paraarticular osteochondromas, which occur in the soft tissues near the joint, are rare. The infrapatellar fat pad and joint capsule are the most common sites of these tumors. Here, a case of patellar tendinitis cause...

  9. The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts.

    Science.gov (United States)

    Roessler, Philip P; Schüttler, Karl F; Heyse, Thomas J; Wirtz, Dieter C; Efe, Turgay

    2016-03-01

    The anterolateral ligament of the knee (ALL) has caused a lot of rumors in orthopaedics these days. The structure that was first described by Segond back in 1879 has experienced a long history of anatomic descriptions and speculations until its rediscovery by Claes in 2013. Its biomechanical properties and function have been examined recently, but are not yet fully understood. While the structure seems to act as a limiter of internal rotation and lateral meniscal extrusion its possible proprioceptive effect remains questionable. Its contribution to the pivot shift phenomenon has been uncovered in parts, therefore it has been recognized that a concomitant anterolateral stabilization together with ACL reconstruction may aid in prevention of postoperative instability after severe ligamentous knee damages. However, there are a lot of different methods to perform this procedure and the clinical outcome has yet to be examined. This concise review will give an overview on the present literature to outline the long history of the ALL under its different names, its anatomic variances and topography as well as on histologic examinations, imaging modalities, arthroscopic aspects and methods for a possible anterolateral stabilization of the knee joint.

  10. Musculoskeletal MR: knee

    Energy Technology Data Exchange (ETDEWEB)

    Staebler, A.; Glaser, C.; Reiser, M. [Dept. of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilian Universitaet Muenchen (Germany)

    2000-02-01

    Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage. (orig.)

  11. The elephant knee joint: morphological and biomechanical considerations.

    Science.gov (United States)

    Weissengruber, G E; Fuss, F K; Egger, G; Stanek, G; Hittmair, K M; Forstenpointner, G

    2006-01-01

    Elephant limbs display unique morphological features which are related mainly to supporting the enormous body weight of the animal. In elephants, the knee joint plays important roles in weight bearing and locomotion, but anatomical data are sparse and lacking in functional analyses. In addition, the knee joint is affected frequently by arthrosis. Here we examined structures of the knee joint by means of standard anatomical techniques in eight African (Loxodonta africana) and three Asian elephants (Elephas maximus). Furthermore, we performed radiography in five African and two Asian elephants and magnetic resonance imaging (MRI) in one African elephant. Macerated bones of 11 individuals (four African, seven Asian elephants) were measured with a pair of callipers to give standardized measurements of the articular parts. In one Asian and three African elephants, kinematic and functional analyses were carried out using a digitizer and according to the helical axis concept. Some peculiarities of healthy and arthrotic knee joints of elephants were compared with human knees. In contrast to those of other quadruped mammals, the knee joint of elephants displays an extended resting position. The femorotibial joint of elephants shows a high grade of congruency and the menisci are extremely narrow and thin. The four-bar mechanism of the cruciate ligaments exists also in the elephant. The main motion of the knee joint is extension-flexion with a range of motion of 142 degrees . In elephants, arthrotic alterations of the knee joint can lead to injury or loss of the cranial (anterior) cruciate ligament.

  12. Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up

    OpenAIRE

    Ulstein, Svend; Årøen, Asbjørn; Røtterud, Jan Harald; Løken, Sverre; Engebretsen, Lars; Heir, Stig

    2014-01-01

    Purpose To compare long-term functional and radiological outcome following microfracture technique (MF) versus osteochondral autologous transplantation (OAT) mosaicplasty for treating focal chondral lesions of the knee. Methods Twenty-five patients (mean age 32.3 years, SD 7.7) with a full-thickness (International Cartilage Repair Society grade 3 or 4) chondral lesion of the articulating surface of the femur were randomized to either MF (n = 11) or OAT mosaicplasty (n = 14). At a median follo...

  13. The Associations between Pain Sensitivity and Knee Muscle Strength in Healthy Volunteers

    DEFF Research Database (Denmark)

    Henriksen, Marius; Klokker, Louise; Bartholdy, Cecilie

    2013-01-01

    Objectives. To investigate associations between muscle strength and pain sensitivity among healthy volunteers and associations between different pain sensitivity measures. Methods. Twenty-eight healthy volunteers (21 females) participated. Pressure pain thresholds (PPTs) were obtained from 1...

  14. In vivo kinematics of the knee during weight bearing high flexion.

    Science.gov (United States)

    Qi, Wei; Hosseini, Ali; Tsai, Tsung-Yuan; Li, Jing-Sheng; Rubash, Harry E; Li, Guoan

    2013-05-31

    Achieving high flexion is an objective of contemporary total knee arthoplasty; however little is known on the knee biomechanics at high flexion under weight-bearing conditions. This study investigates the 6DOF kinematics and tibiofemoral cartilage contact biomechanics of the knee during weight-bearing flexion from full extension to maximal flexion. Eight knees from seven healthy subjects with no history of injuries or chronic pain were recruited. The knees were MRI scanned to create 3D models of the tibia and femur, including their articular cartilage surfaces. The subjects were then imaged using a dual fluoroscopic image system while performing a weight-bearing quasi-static single-legged lunge from full extension to maximal flexion. The 6DOF kinematics and the articular cartilage contact locations were measured along the flexion path of the knee. The result indicated that the internal tibial rotation increased sharply at low flexion angles (full extension to 30°), maintained a small variation in the middle range of flexion (30-120°, and then sharply increased again at high flexion angles (120° to maximal flexion). The contact point moved similarly in the medial and lateral compartments before 120° of flexion, but less on the medial compartment at high flexion angles. The results indicated that the knee motion could not be described using one character in the entire range of flexion, especially in high flexion. The knee kinematic data in the entire range of flexion of the knee could be instrumental for designing new knee prostheses to achieve physical high flexion and improving rehabilitation protocols after knee injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Successful total knee arthroplasty in the presence of sporotrichal arthritis.

    NARCIS (Netherlands)

    Koeter, S.; Jackson, R.W.

    2006-01-01

    Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of

  16. Resultados de un plan de gestión de listas de espera quirúrgica de prótesis articulares Results of a management plan for surgical waiting lists for hip and knee replacements

    Directory of Open Access Journals (Sweden)

    Josep Martí-Valls

    2006-06-01

    Full Text Available Se describe un plan de gestión de las listas de espera quirúrgicas de prótesis articulares de cadera y rodilla y sus resultados a los 3 años. El plan de gestión se basó en la unificación de la información y programación, depuración periódica, guía clínica, gestión de la demanda, priorización por necesidad e incremento de la oferta. Durante el primer año se consiguió aflorar la lista de espera real, con un 23% más de pacientes de los contabilizados hasta entonces. A los 3 años, se depuró la lista en un 16% de los pacientes, se disminuyó la estancia media de estos procedimientos en 4 días, se evaluó el 59,5% de los pacientes con un instrumento de priorización y se incrementó la actividad de artroplastias en un 16%. Se redujo en un 14,7% los pacientes en espera de prótesis articulares y el tiempo de resolución de estos procedimientos disminuyó en 3 meses para las artroplastias de rodilla y en un mes para las de cadera.This study describes the implementation of a management plan for surgical joint replacement waiting lists and its results after 3 years. The plan was based on the following: unification of information and scheduling, periodic review, clinical guidelines, management of demand, prioritization according to need, and increasing the services provided. During the first year, the plan succeeded in revealing the real waiting list, with 23% more patients than previously included. Three years later, 16% of the patients had not turned up for surgery after being scheduled; the mean length of hospital stay for joint replacements had been reduced by 4 days; 59.5% of the patients joining the list had been assessed with a prioritization instrument, and the number of joint replacements had increased by 16% with a reduction of 14.7% in patients waiting for joint replacements. The resolution time for these procedures had also deceased by 3 months for knee arthroplasty and by 1 month for hip arthroplasty.

  17. Impact of a daily exercise dose on knee joint cartilage - a systematic review and meta-analysis of randomized controlled trials in healthy animals

    DEFF Research Database (Denmark)

    Bricca, A; Juhl, C B; Grodzinsky, A J

    2017-01-01

    OBJECTIVE: To investigate the impact of a daily exercise dose on cartilage composition and thickness, by conducting a systematic review of randomized controlled trials (RCTs) involving healthy animals. METHODS: A narrative synthesis of the effect of a daily exercise dose on knee cartilage aggrecan...

  18. Comparison of the T2 relaxation time of the temporomandibular joint articular disk between patients with temporomandibular disorders and asymptomatic volunteers.

    Science.gov (United States)

    Kakimoto, N; Shimamoto, H; Chindasombatjaroen, J; Tsujimoto, T; Tomita, S; Hasegawa, Y; Murakami, S; Furukawa, S

    2014-07-01

    T2 relaxation time is a quantitative MR imaging parameter used to detect degenerated cartilage in the knee and lumbar intervertebral disks. We measured the T2 relaxation time of the articular disk of the temporomandibular joint in patients with temporomandibular disorders and asymptomatic volunteers to demonstrate an association between T2 relaxation time and temporomandibular disorder MR imaging findings. One hundred forty-four patients with temporomandibular disorders and 17 volunteers were enrolled in this study. An 8-echo spin-echo sequence for measuring the T2 relaxation times was performed in the closed mouth position, and the T2 relaxation time of the entire articular disk was measured. Patients were classified according to the articular disk location and function, articular disk configuration, presence of joint effusion, osteoarthritis, and bone marrow abnormalities. The T2 relaxation time of the entire articular disk was 29.3 ± 3.8 ms in the volunteer group and 30.7 ± 5.1 ms in the patient group (P = .177). When subgroups were analyzed, however, the T2 relaxation times of the entire articular disk in the anterior disk displacement without reduction group, the marked or extensive joint effusion group, the osteoarthritis-positive group, and the bone marrow abnormality-positive group were significantly longer than those in the volunteer group (P temporomandibular joint in patients with progressive temporomandibular disorders were longer than those of healthy volunteers. © 2014 by American Journal of Neuroradiology.

  19. Synovial and systemic pharmacokinetics (PK) of triamcinolone acetonide (TA) following intra-articular (IA) injection of an extended-release microsphere-based formulation (FX006) or standard crystalline suspension in patients with knee osteoarthritis (OA).

    Science.gov (United States)

    Kraus, V B; Conaghan, P G; Aazami, H A; Mehra, P; Kivitz, A J; Lufkin, J; Hauben, J; Johnson, J R; Bodick, N

    2018-01-01

    Intra-articular (IA) corticosteroids relieve osteoarthritis (OA) pain, but rapid absorption into systemic circulation may limit efficacy and produce untoward effects. We compared the pharmacokinetics (PK) of IA triamcinolone acetonide (TA) delivered as an extended-release, microsphere-based formulation (FX006) vs a crystalline suspension (TAcs) in knee OA patients. This Phase 2 open-label study sequentially enrolled 81 patients who received a single IA injection of FX006 (5 mL, 32 mg delivered dose, N = 63) or TAcs (1 mL, 40 mg, N = 18). Synovial fluid (SF) aspiration was attempted in each patient at baseline and one post-IA-injection visit (FX006: Week 1, Week 6, Week 12, Week 16 or Week 20; TAcs: Week 6). Blood was collected at baseline and multiple post-injection times. TA concentrations (validated LC-MS/MS, geometric means (GMs)), PK (non-compartmental analysis models), and adverse events (AEs) were assessed. SF TA concentrations following FX006 were quantifiable through Week 12 (pg/mL: 231,328.9 at Week 1; 3590.0 at Week 6; 290.6 at Week 12); post-TAcs, only two of eight patients had quantifiable SF TA at Week 6 (7.7 pg/mL). Following FX006, plasma TA gradually increased to peak (836.4 pg/mL) over 24 h and slowly declined to <110 pg/mL over Weeks 12-20; following TAcs, plasma TA peaked at 4 h (9628.8 pg/mL), decreased to 4991.1 pg/mL at 24 h, and was 149.4 pg/mL at Week 6, the last post-treatment time point assessed. AEs were similar between groups. In knee OA patients, microsphere-based TA delivery via a single IA injection prolonged SF joint residency, diminished peak plasma levels, and thus reduced systemic TA exposure relative to TAcs. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. The effects of two different frequencies of whole-body vibration on knee extensors strength in healthy young volunteers: a randomized trial

    Science.gov (United States)

    Esmaeilzadeh, S.; Akpinar, M.; Polat, S.; Yildiz, A.; Oral, A.

    2015-01-01

    The aim of this study was to investigate the effects of two different frequencies of whole-body vibration (WBV) training on knee extensors muscle strength in healthy young volunteers. Twenty-two eligible healthy untrained young women aged 22-31 years were allocated randomly to the 30-Hz (n=11) and 50-Hz (n=11) groups. They participated in a supervised WBV training program that consisted of 24 sessions on a synchronous vertical vibration platform (peak-to-peak displacement: 2-4 mm; type of exercises: semi-squat, one-legged squat, and lunge positions on right leg; set numbers: 2-24) three times per week for 8 weeks. Isometric and dynamic strength of the knee extensors were measured prior to and at the end of the 8-week training. In the 30-Hz group, there was a significant increase in the maximal voluntary isometric contraction (p=0.039) and the concentric peak torque (p=0.018) of knee extensors and these changes were significant (p<0.05) compared with the 50-Hz group. In addition, the eccentric peak torque of knee extensors was increased significantly in both groups (p<0.05); however, there was no significant difference between the two groups (p=0.873). We concluded that 8 weeks WBV training in 30 Hz was more effective than 50 Hz to increase the isometric contraction and dynamic strength of knee extensors as measured using peak concentric torque and equally effective with 50 Hz in improving eccentric torque of knee extensors in healthy young untrained women. PMID:26636279

  1. Articular manifestations in patients with Lyme disease.

    Science.gov (United States)

    Vázquez-López, María Esther; Díez-Morrondo, Carolina; Sánchez-Andrade, Amalia; Pego-Reigosa, Robustiano; Díaz, Pablo; Castro-Gago, Manuel

    To determine the percentage of Lyme patients with articular manifestations in NW Spain and to know their evolution and response to treatment. A retrospective study (2006-2013) was performed using medical histories of confirmed cases of Lyme disease showing articular manifestations. Clinical and laboratory characteristics, together with the treatment and evolution of the patients, were analysed. Seventeen out of 108 LD confirmed patients (15.7%) showed articular manifestations. Regarding those 17 patients, 64.7%, 29.4% and 5.9% presented arthritis, arthralgia and bursitis, respectively. The knee was the most affected joint. Articular manifestations were often associated to neurological, dermatological and cardiac pathologies. Otherwise, most patients were in Stage III. The 11.8% of the cases progressed to a recurrent chronic arthritis despite the administration of an appropriate treatment. Lyme disease patients showing articular manifestations should be included in the diagnosis of articular affections in areas of high risk of hard tick bite, in order to establish a suitable and early treatment and to avoid sequels. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  2. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2016-04-01

    The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of a patellar strap between participants with low and high proprioceptive acuity and if possible predictors of effectiveness can be determined. Case-control. The threshold to detect passive motion with and without a patellar strap was assessed in 22 healthy participants and 21 unilateral PT patients. The results from the mixed model analysis show that in both groups of participants a small but statistically significant improvement in proprioception was found, primarily in those who had low proprioceptive acuity. A notable finding was that in the symptomatic leg of the PT group no improvement in proprioception by wearing a strap could be determined. Male gender and having fewer symptoms were possible predictors of effectiveness in PT patients. As proprioception plays a role in optimising movements and reducing load to joint-related structures like tendons and ligaments, it is considered an important protection mechanism. Although the improvements in proprioception as a result of wearing the strap are small, it might be that the use of a patellar strap can potentially play a role in injury prevention since poor proprioception can be a risk factor for (re)-injury. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  3. Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia Analgesia intra-articular con morfina, bupivacaína o fentanil después de operación de rodilla por videoartroscopia Intra-articular analgesia with morphine, bupivacaine or fentanyl after knee video-arthroscopy surgery

    Directory of Open Access Journals (Sweden)

    Rogério Helcias de Souza

    2002-09-01

    por vía intra-articular después de operación de rodilla por videoartroscopia. MÉTODO: Sesenta pacientes fueron divididos de forma aleatoria, en cuatro grupos: GI (n=15 - 10 ml de solución fisiológica; GII (n = 15 - 2 mg de morfina diluidos para 10 ml de solución fisiológica; GIII (n = 15 - 10 ml de bupivacaína a 0,25%; GIV (n = 15 - 100 µg de fentanil diluidos para 10 ml de solución fisiológica, inyectados al término de la operación. Todos los pacientes fueron sometidos a anestesia subaracnóidea con 15 mg de bupivacaína hiperbárica. La intensidad del dolor fue evaluada por la escala analógica visual (inmediatamente después del término de la operación y después 6, 12, 18 y 24 horas, bien como la necesidad de complemento analgésico (dipirona 1 g por vía venosa. Fueron anotados los posibles efectos colaterales. RESULTADOS: No hubo diferencia significativa en la intensidad del dolor entre los grupos, en la casi totalidad de los tiempos estudiados. Hubo diferencia estadística hasta seis horas, cuando el grupo fentanil presentó intensidad de dolor significativamente menor. El grupo morfina necesitó de mayor número de complementos con dipirona. Los efectos colaterales fueron mínimos, sin significación estadística. CONCLUSIONES: No hubo diferencia significativa entre la analgesia promovida por las soluciones estudiadas en la mayoría de los tiempos investigados.BACKGROUND AND OBJECTIVES: Methods to promote knee pain analgesia without impairing motor function have been widely researched. This study aimed at comparing intra-articular morphine, bupivacaine, and fentanyl analgesic effects (as compared to saline solution, after knee video-arthroscopy. METHODS: Participated in this study 60 patients who were randomly distributed in four groups: GI (n = 15 10 ml saline solution; GII (n = 15 2 mg morphine diluted in 10 ml saline solution; GIII (n = 15 10 ml of 0.25% bupivacaine; GIV (n = 15 100 µg fentanyl diluted in 10 ml saline solution, injected at

  4. Characterization of cutaneous and articular sensory neurons.

    Science.gov (United States)

    da Silva Serra, Ines; Husson, Zoé; Bartlett, Jonathan D; Smith, Ewan St John

    2016-01-01

    A wide range of stimuli can activate sensory neurons and neurons innervating specific tissues often have distinct properties. Here, we used retrograde tracing to identify sensory neurons innervating the hind paw skin (cutaneous) and ankle/knee joints (articular), and combined immunohistochemistry and electrophysiology analysis to determine the neurochemical phenotype of cutaneous and articular neurons, as well as their electrical and chemical excitability. Immunohistochemistry analysis using RetroBeads as a retrograde tracer confirmed previous data that cutaneous and articular neurons are a mixture of myelinated and unmyelinated neurons, and the majority of both populations are peptidergic. In whole-cell patch-clamp recordings from cultured dorsal root ganglion neurons, voltage-gated inward currents and action potential parameters were largely similar between articular and cutaneous neurons, although cutaneous neuron action potentials had a longer half-peak duration (HPD). An assessment of chemical sensitivity showed that all neurons responded to a pH 5.0 solution, but that acid-sensing ion channel (ASIC) currents, determined by inhibition with the nonselective acid-sensing ion channel antagonist benzamil, were of a greater magnitude in cutaneous compared to articular neurons. Forty to fifty percent of cutaneous and articular neurons responded to capsaicin, cinnamaldehyde, and menthol, indicating similar expression levels of transient receptor potential vanilloid 1 (TRPV1), transient receptor potential ankyrin 1 (TRPA1), and transient receptor potential melastatin 8 (TRPM8), respectively. By contrast, significantly more articular neurons responded to ATP than cutaneous neurons. This work makes a detailed characterization of cutaneous and articular sensory neurons and highlights the importance of making recordings from identified neuronal populations: sensory neurons innervating different tissues have subtly different properties, possibly reflecting different

  5. Predicted knee kinematics and kinetics during functional activities using motion capture and musculoskeletal modelling in healthy older people.

    Science.gov (United States)

    Worsley, Peter; Stokes, Maria; Taylor, Mark

    2011-02-01

    Knowledge of joint forces and moments is essential for comparisons between healthy people and those with pathological conditions, with observed changes at joints providing basis for a particular intervention. Currently the literature analysing both kinematics and kinetics at the knee has been limited to small samples, typically of young subjects or those who have undergone joint arthroplasty. In this study, we examined tibiofemoral joint (TFJ) kinematics and kinetics during gait, sit-stand-sit, and step-descent in 20 healthy older subjects (aged 53-79 years) using motion capture data and inverse dynamic musculoskeletal models. Mean peak distal-proximal force in the TFJ were 3.1, 1.6, and 3.5 times body weight (N/BW) for gait, sit-stand, and step-descent respectively. There were also significant posterior-anterior forces, with sit-stand activity peaking at 1.6 N/BW. Moments about the TFJ peaked at a mean of 0.07 Nm/BW during the sit-stand activity. One of the most important findings of this study was variability found across the subjects, who spanned a wide age range, showing large standard deviations in all of the activities for both kinematics and kinetics. These data have provided an initial prediction for assessing kinematics and kinetics in the older population. Larger studies are needed to refine the database, in particular to reduce the variability in the results by studying sub-populations, to enable more robust comparisons between healthy and pathological TFJ kinematics and kinetics. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Estimation of ligament loading and anterior tibial translation in healthy and ACL-deficient knees during gait and the influence of increasing tibial slope using EMG-driven approach.

    Science.gov (United States)

    Shao, Qi; MacLeod, Toran D; Manal, Kurt; Buchanan, Thomas S

    2011-01-01

    The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated muscle forces were used as inputs to a knee model that incorporated a knee-ligament model in order to solve for ATT and ligament forces. The model took advantage of using EMGs as inputs, and could account for the abnormal muscle activation patterns of ACL-deficient gait. We validated our model by comparing the calculated results with previous in vitro, in vivo, and numerical studies of healthy and ACL-deficient knees, and this gave us confidence on the accuracy of our model calculations. Our model predicted that ATT increased throughout stance phase for the ACL-deficient knee compared with the healthy knee. The medial collateral ligament functioned as the main passive restraint to anterior shear force in the ACL-deficient knee. Although strong co-contraction of knee flexors was found to help restrain ATT in the ACL-deficient knee, it did not counteract the effect of ACL rupture. Posterior inclination angle of the tibial plateau was found to be a crucial parameter in determining knee mechanics, and increasing the tibial slope inclination in our model would increase the resulting ATT and ligament forces in both healthy and ACL-deficient knees.

  7. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study

    OpenAIRE

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-01-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint posit...

  8. Effects of intra articular tramadol on articular cartilage and synovium of rats

    Directory of Open Access Journals (Sweden)

    Musa Kola

    2015-12-01

    Full Text Available Objective: To investigate the effects of intra articular tramadol injection on articular cartilage and synovium in rat knee joint. Methods: After Animal Ethical Committee approval, a total of 20 Sprague-Dawley rats were used and divided into 4 groups. Each group was composed of 5 rats. 0.2 ml of tramadol HCl was injected into the right knee joints and left knee joints of all the rats were considered as control. Control side joints received saline injection. Rats were sacrificed with ketamin on 1st, 7th, 14th and 21st days and knee joints were removed. Obtained tissue samples were decalcified and were dyed with Hematoxylin-eosin and Masson’s trichrome stain and examined by light microscopy for the presence of inflammation in periarticular area and synovia. Results: Congestion of synovial veins and perivascular cell infiltration were observed in tramadol group on days 1 and 7 (P < 0.05. The inflammation process was replaced by fibrosis on day 14 and fibrosis was significantly decreased on day 21. Conclusion: Intra articular tramadol should be used cautiously, keeping in mind that it may cause synovial inflammation in early phases and fibrosis in late phases. J Clin Exp Invest 2015; 6 (4: 337-342

  9. Effects of immobilization on thickness of superficial zone of articular cartilage of patella in rats

    Directory of Open Access Journals (Sweden)

    Khadija Iqbal

    2012-01-01

    Conclusion: Each segment of superficial zone behaves differentially on immobilization and remobilization. Perhaps a much longer duration of remobilization is required to reverse changes of immobilization in articular cartilage and plays a significant role in knee joint movements.

  10. Radiation synovectomy stimulates glycosaminoglycan synthesis by normal articular cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Myers, S.L.; Slowman, S.D.; Brandt, K.D.

    1989-07-01

    Radiation synovectomy has been considered a therapeutic alternative to surgical synovectomy. Whether intraarticular irradiation affects the composition or biochemistry, and therefore the biomechanical properties, of normal articular cartilage has not been established. In the present study, yttrium 90 silicate was injected into one knee of nine normal adult dogs, and three other dogs received nonradioactive yttrium silicate. When the animals were killed 4 to 13 weeks after the injection, synovium from the irradiated knees showed areas of necrosis and fibrosis. Up to 29% less hyaluronate was synthesized in vitro by the synovial intima from irradiated knees than by the intima from the contralateral knees (mean difference 18%). Morphologic abnormalities were not observed in articular cartilage from either the irradiated or control knees, nor did the water content or concentrations of uronic acid or DNA in cartilage from the irradiated knees differ from that in cartilage from the contralateral knees. However, net /sup 35/SO/sub 4/-labeled glycosaminoglycan synthesis in organ cultures of cartilage from irradiated knees was increased (mean difference 21%, p = 0.03) in comparison with that in cultures of contralateral knee cartilage.

  11. Ultrasonographic Diagnosis of the Knee

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Il; Cho, Kil Ho [Dept. of Radiology, College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Kim, Mi Jeong [Dept. of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2012-06-15

    Knee ultrasonography is a feasible and useful diagnostic method not only for the evaluation of periarticular soft tissues but also for intra-articular lesions and for the diagnosis of tumorous disease. Joint effusion, synovial thickening, intra-articular loose bodies, bursal and/or other fluid collection, ganglionic cysts, ligament and tendon injuries, tendinosis, osteomyelitis, and symptoms related to metallic hardware can be diagnosed using ultrasonography.

  12. Sensorimotor changes and functional performance in patients with knee osteoarthritis.

    Science.gov (United States)

    Hurley, M V; Scott, D L; Rees, J; Newham, D J

    1997-11-01

    Muscles are essential components of our sensorimotor system that help maintain balance and perform a smooth gait, but it is unclear whether arthritic damage adversely affects muscle sensorimotor function. Quadriceps sensorimotor function in patients with knee osteoarthritis (OA) was investigated, and whether these changes were associated with impairment of functional performance. Quadriceps strength, voluntary activation, and proprioceptive acuity (joint position sense acuity) were assessed in 103 patients with knee OA and compared with 25 healthy control subjects. In addition, their postural stability, objective functional performance (the aggregate time for four activities of daily living), and disabilities (lequesne index) were also investigated. Compared with the control subjects, the patients with knee OA had weaker quadriceps (differences between group mean 100N, CI 136, 63N), poorer voluntary activation (20% CI 13, 25%) that was associated with quadriceps weakness, and impaired acuity of knee joint position sense (1.28 degrees, CI 0.84, 1.73 degrees). As a group the patients were more unstable (p = 0.0017), disabled (10, CI 7, 11), and had poorer functional performance (19.6 seconds, CI 14.3, 24.9 seconds). The most important predictors of disability were objective functional performance and quadriceps strength. In patients with knee OA, articular damage may reduce quadriceps motoneurone excitability, which decreases voluntary quadriceps activation thus contributing to quadriceps weakness, and diminishes proprioceptive acuity. The arthrogenic impairment in quadriceps sensorimotor function and decreased postural stability was associated with reduced functional performance of the patients.

  13. Comparison between the effects of 4 different electrical stimulation current waveforms on isometric knee extension torque and perceived discomfort in healthy women.

    Science.gov (United States)

    Dantas, Lucas Ogura; Vieira, Amilton; Siqueira, Aristides Leite; Salvini, Tania Fatima; Durigan, João Luiz Quagliotti

    2015-01-01

    We studied the effects of different neuromuscular electrical stimulation (NMES) currents, 2 kHz-frequency alternating currents (KACs, Russian and Aussie) and 2 pulsed currents (PCs), on isometric knee extension torque and discomfort level, both in isolation and combined, with maximum voluntary contraction (MVC). Twenty-one women (age 21.6 ± 2.5 years) were studied. We evaluated torque evoked by NMES or NMES combined with maximum voluntary contraction of the quadriceps muscle of healthy women. Discomfort level was measured using a visual analog pain scale. Despite comparable levels of discomfort, evoked torque was lower for Russian current compared with the other modalities (Russian 50.8%, Aussie 71.7%, PC500 76.9%, and PC200 70.1%; P Russian current for inducing isometric knee extension torque. This information is important in guiding decision making with regard to NMES protocols for muscle strengthening. © 2014 Wiley Periodicals, Inc.

  14. Unicondylar fracture of the femur associated with intra-articular ...

    African Journals Online (AJOL)

    Distal femoral fracture associated with knee extensor apparatus injury is a rare event. The authors report the case of a 19-year-old boy featuring an unicondylar femoral fracture with an intra-articular dislocation of the ipsilateral patella. Both injuries were treated surgically. Emphasis is placed on the mechanism of the lesions ...

  15. Oncogene expression in the peri-articular osteophytes | Alonge ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to ascertain the proliferative and probably reparative potentials of the peri-articular osteophytes by evaluating the sites of expression of c-myc, c-jun and c-fos oncogenes in this neoplastic repair tissue. Materials and Methods: Sections of osteophytes were obtained from knees of patients ...

  16. Changes in proprioceptive weighting during quiet standing in women with early and established knee osteoarthritis compared to healthy controls

    OpenAIRE

    Mahmoudian, A.; van Dieen, J.H.; Baert, I.C.A; Jonkers, I.; Bruijn, S.M.; Luyten, F P; Faber, G.S.; Verschueren, S.M.

    2016-01-01

    Objectives: Knee osteoarthritis (OA) is highly prevalent in people above the age of 60, and is typically associated with pain, stiffness, muscle weakness and proprioceptive deficits. Muscle-tendon vibration has been used to assess the spatial reweighting of proprioceptive input during standing. The current study aimed to investigate whether weighting of proprioceptive input is altered in patients with early and established knee OA compared to asymptomatic controls. Methods: The upright postur...

  17. REGENERATION OF ARTICULAR CARTILAGE UNDER THE IMPLANTATION OF BONE MATRIX

    Directory of Open Access Journals (Sweden)

    Yuri M. Iryanov, Nikolay A. Kiryanov, Olga V. Dyuriagina , Tatiana Yu. Karaseva, Evgenii A. Karasev

    2015-07-01

    Full Text Available Background: The damage or loss of articular cartilage is costly medical problem. The purpose of this work – morphological analysis of reparative chondrogenesis when implanted in the area of the knee joint cartilage of granulated mineralized bone matrix. Material and Methods: The characteristic features of the knee cartilage regeneration studied experimentally in pubertal Wistar rats after modeling a marginal perforated defect and implantation of granulated mineralized bone matrix obtained according to original technology without heat and demineralizing processing into the injury zone. Results: This biomaterial established to have pronounced chondro- and osteoinductive properties, and to provide prolonged activation of reparative process, accelerated organotypical remodeling and restoration of the articular cartilage injured. Conclusion: The data obtained demonstrate the efficacy of МВМ in clinical practice for the treatment of diseases and injuries of the articular cartilage.

  18. [Analysis of acute distal radius fractures with the articular sagittal index (ASI)].

    Science.gov (United States)

    Herzberg, G; Atzori, M; Al Saati, M; Izem, Y

    2009-10-01

    Displacements of articular fragments are not always visible on initial radiographs of acute distal radius fractures. Despite the wide use of CT scan, it may be useful to know a simple index that could suggest an articular displaced fracture from the initial standard radiographs. The authors describe an articular sagittal index (ASI) of the distal radius and provide reference values from a study of 100 healthy volunteers. An increase of the ASI index suggests a displaced articular distal radius fracture with possible impaction.

  19. Knee MRI

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Knee Magnetic resonance imaging (MRI) of the knee ... of a knee MRI? What is a Knee MRI? MRI of the knee provides detailed images of ...

  20. Runner's Knee

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Runner's Knee KidsHealth / For Teens / Runner's Knee What's in this ... told he had runner's knee. What Is Runner's Knee? Runner's knee is the term doctors use for ...

  1. Reliability and reference values of two clinical measurements of dynamic and static knee position in healthy children

    DEFF Research Database (Denmark)

    Ortqvist, Maria; Moström, Eva B; Roos, Ewa M.

    2011-01-01

    PURPOSE: The purposes of this study were to evaluate reliability of the Single-limb mini squat test (a dynamic measure of medio-lateral knee position) and the Quadriceps-angle (Q-angle) (a static measure of medio-lateral knee position), present paediatric reference values of the Q-angle, and eval......PURPOSE: The purposes of this study were to evaluate reliability of the Single-limb mini squat test (a dynamic measure of medio-lateral knee position) and the Quadriceps-angle (Q-angle) (a static measure of medio-lateral knee position), present paediatric reference values of the Q......-angle measurements was found. Reference values for the Q-angle (mean 13.5° (1.9)-15.3° (2.8)) varies with age and gender. No associations were found between dynamic and static measures. CONCLUSIONS: The Single-limb mini squat test showed a moderate reliability and the Q-angle showed a fair to moderate reliability....... A difference found for age and gender was lower than 5° and may not be clinical significant. No association were found between the two tests, indicating dynamic and static knee position being two different concepts. In a clinical perspective, we suggest that the Single-limb mini squat test is a contribution...

  2. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial

    DEFF Research Database (Denmark)

    Lundsgaard, C.; Dufour, N.; Fallentin, E.

    2008-01-01

    criteria were age over 59 years and daily knee pain more than 20 mm on a 100-mm visual analogue scale (VAS) without satisfactory response to analgesics. During the trial, rescue analgesic were allowed. The primary outcome was pain on movement. The secondary outcomes were pain at rest, pain during the night......L, and physiological saline 2 mL did not differ significantly in reducing knee pain, knee function, or consumption of analgesics. Using OARSI criteria, no significant differences were found. The VAS and KOOS outcomes all improved significantly over time (pregardless of intervention group. No adverse events...

  3. Topographic deformation patterns of knee cartilage after exercises with high knee flexion: an in vivo 3D MRI study using voxel-based analysis at 3T

    Energy Technology Data Exchange (ETDEWEB)

    Horng, Annie; Stockinger, M.; Notohamiprodjo, M. [Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Raya, J.G. [New York University Langone Medical Center, Center for Biomedical Imaging, New York, NY (United States); Pietschmann, M. [Ludwig-Maximilians-University Hospital Munich, Department of Orthopedic Surgery, Munich (Germany); Hoehne-Hueckstaedt, U.; Glitsch, U.; Ellegast, R. [Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin (Germany); Hering, K.G. [Miner' s Hospital, Department of Diagnostic Radiology, Dortmund (Germany); Glaser, C. [Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); RZM Zentrum, Munich (Germany)

    2015-06-01

    To implement a novel voxel-based technique to identify statistically significant local cartilage deformation and analyze in-vivo topographic knee cartilage deformation patterns using a voxel-based thickness map approach for high-flexion postures. Sagittal 3T 3D-T1w-FLASH-WE-sequences of 10 healthy knees were acquired before and immediately after loading (kneeling/squatting/heel sitting/knee bends). After cartilage segmentation, 3D-reconstruction and 3D-registration, colour-coded deformation maps were generated by voxel-based subtraction of loaded from unloaded datasets to visualize cartilage thickness changes in all knee compartments. Compression areas were found bifocal at the peripheral medial/caudolateral patella, both posterior femoral condyles and both anterior/central tibiae. Local cartilage thickening were found adjacent to the compression areas. Significant local strain ranged from +13 to -15 %. Changes were most pronounced after squatting, least after knee bends. Shape and location of deformation areas varied slightly with the loading paradigm, but followed a similar pattern consistent between different individuals. Voxel-based deformation maps identify individual in-vivo load-specific and posture-associated strain distribution in the articular cartilage. The data facilitate understanding individual knee loading properties and contribute to improve biomechanical 3 models. They lay a base to investigate the relationship between cartilage degeneration patterns in common osteoarthritis and areas at risk of cartilage wear due to mechanical loading in work-related activities. (orig.)

  4. Estimation of Ligament Loading and Anterior Tibial Translation in Healthy and ACL-Deficient Knees During Gait and the Influence of Increasing Tibial Slope Using EMG-Driven Approach

    OpenAIRE

    Shao, Qi; MacLeod, Toran D.; Manal, Kurt; Buchanan, Thomas S.

    2010-01-01

    The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated m...

  5. Finite element analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics.

    Science.gov (United States)

    Peña, E; Calvo, B; Martínez, M A; Palanca, D; Doblaré, M

    2005-06-01

    Many authors have suggested that the high levels of shear and tensile stresses that appear in the articular cartilage after meniscectomy are partly responsible for cartilage pathologies, such as osteoarthrosis. In this paper, we investigate the effect of meniscal tears and meniscectomies on the human knee joint. Solid models of the tibia, femur, menisci and cartilage were generated from MRI images. A three-dimensional finite element model was developed that included the femur, tibia, cartilage layers, menisci and ligaments. The femur and tibia were considered to be rigid, the articular cartilage and menisci to be linearly elastic, isotropic and homogeneous and the ligaments were modelled as hyperelastic. Three different situations were compared: a healthy tibio-femoral joint, a tibio-femoral joint with tears in one meniscus and a tibio-femoral joint after meniscectomy. The minimal principal stresses corresponding to a compressive load at 0 degrees flexion were obtained for the posterior zone of the medial meniscus and the corresponding region of the articular cartilage. Under an axial femoral compressive load, the maximal contact stress in the articular cartilage after meniscectomy was about twice that of a healthy joint. This fact could partially explain the cartilage damage and degeneration that have been observed after meniscectomy.

  6. Patterns of compensation of functional deficits of the knee joint in patients with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Beata Żuk

    2015-09-01

    Full Text Available Objectives: Juvenile idiopathic arthritis (JIA is a group of pathological syndromes of unknown aetiology, observed at the developmental age. Their common feature is sustained chronic arthritis with flares and remissions. Clinical signs and symptoms include joint pain, periarticular tissue oedema or articular exudate, frequently associated with hypertrophy of the synovial membrane. The intra- and extra-articular structural damage impairs the motion range and smoothness. The disease process may involve any joint. The knee joint is the most frequently affected in oligo- and polyarthritis. The aim of the study was to determine a direct correlation between disorders of knee joint function and the change in the range of motion of the ankle and hip joints of both lower extremities, and the so--called indirect impact of these changes on patients’ posture. Material and methods : The study included 36 JIA patients and 56 healthy controls aged 8–16 years. The evaluation was based on physical examination. Results : The results showed differences in the values of quality and range of motion between patients and controls. In the patient group pes planovalgus was more frequently associated with knee joint dysfunction along with the inherent restriction of dorsal flexion of the foot. Shortening of the iliotibial band, increased outward rotation of the right lower extremity with enlarged joint contour and augmented inward rotation of the contralateral healthy extremity all proved significant. Changes in motion range in the joints below and over the knee were associated with alterations of antero-posterior spine curvatures and vertebral rotation along the long spinal axis. Based on the results, the mechanism of the compensation is outlined. Conclusions : The observed differences in the range and quality of motion in the ankle, hip and spinal joints between patients and healthy children provide evidence that dysfunction of the knee joint affects the function

  7. MR Evaluation of Radiation Synovectomy of the Knee by Means of Intra-articular Injection of Holmium-166-Chitosan Complex in Patients with Rheumatoid Arthritis: Results at 4-month Follow-up

    National Research Council Canada - National Science Library

    Lee, Sang Hoon; Suh, Jin Suck; Kim, Ho Seok; Lee, Jong Doo; Song, Jungsik; Lee, Soo Kon

    2003-01-01

    .... MR images were acquired both prior to and 4-months after treatment. Clinical evaluation included the use of visual analog scales to assess pain, and the circumference of the knee and its range of motion were also determined...

  8. Enhanced regulatory gene expressions in the blood and articular cartilage of patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Elena Vasilyevna Chetina

    2012-01-01

    Full Text Available Objective: to study the expression ratio of the non-tissue specific regulatory genes mTOR, р21, ATG1, caspase 3, tumor necrosis factor-а (TNF-а, and interleukin-6 (IL-6, as well as matrix metalloproteinase 13 (MMP-13 and X type collagen (COL10A1, cartilage resorption-associated MMP13 and COL10A1 in the blood and knee articular cartilage in patients with rheumatoid arthritis (RA. Subjects and methods. Twenty-five specimens of the distal femoral articular cartilage condyles were studied in 15 RA patients (mean age 52.4+9.1 years after endoprosthetic knee joint replacement and in 10 healthy individuals (mean age 36.0+9.1 years included into the control group. Twenty-eight blood samples taken from 28 RA patients (aged 52+7.6 years prior to endoprosthetic knee joint replacement and 27 blood samples from healthy individuals (mean age 53.6+8.3 years; a control group were also analyzed. Real-time quantitative polymerase chain reaction was applied to estimate the expression of the mTOR, p21, ATG1, caspase 3, TNF-а, IL- 6, COL0A1, and MMP-13 genes. The levels of a protein equivalent in the p70-S6K(activated by mTOR, p21, and caspase 3 genes concerned was measured in the isolated lymphocyte lysates, by applying the commercially available ELISA kits. Total protein in the cell extracts was determined using the Bradford assay procedure. Results. The cartilage samples from patients with end-stage RA exhibited a significantly higher mTOR, ATG1, p21, TNFа, MMP-13, and COL10A1 gene expressions than did those from the healthy individuals. At the same time, IL6 gene expression was much lower than that in the control group. The expressions of the mTOR, ATG1, p21, TNFа, and IL 6 genes in the blood of RA patients were much greater than those in the donors. Caspase 3 expression did not differ essentially in the bloods of the patients with RA and healthy individuals. The bloods failed to show MMP-13 and COL10A1 expressions. High mTOR and p21 gene expressions were

  9. Influence of model complexity and problem formulation on the forces in the knee calculated using optimization methods.

    Science.gov (United States)

    Hu, Chih-Chung; Lu, Tung-Wu; Chen, Sheng-Chang

    2013-03-07

    Predictions of the forces transmitted by the redundant force-bearing structures in the knee are often performed using optimization methods considering only moment equipollence as a result of simplified knee modeling without ligament contributions. The current study aimed to investigate the influence of model complexity (with or without ligaments), problem formulation (moment equipollence with or without force equipollence) and optimization criteria on the prediction of the forces transmitted by the force-bearing structures in the knee. Ten healthy young male adults walked in a gait laboratory while their kinematic and ground reaction forces were measured simultaneously. A validated 3D musculoskeletal model of the locomotor system with a knee model that included muscles, ligaments and articular surfaces was used to calculate the joint resultant forces and moments, and subsequently the forces transmitted in the considered force-bearing structures via optimization methods. Three problem formulations with eight optimization criteria were evaluated. Among the three problem formulations, simultaneous consideration of moment and force equipollence for the knee model with ligaments and articular contacts predicted contact forces (first peak: 3.3-3.5 BW; second peak: 3.2-4.2 BW; swing: 0.3 BW) that were closest to previously reported theoretical values (2.0-4.0 BW) and in vivo data telemetered from older adults with total knee replacements (about 2.8 BW during stance; 0.5 BW during swing). Simultaneous consideration of moment and force equipollence also predicted more physiological ligament forces (problem formulation affect the prediction of the forces transmitted by the force-bearing structures at the knee during normal level walking. Inclusion of the ligaments in a knee model enables the simultaneous consideration of equations of force and moment equipollence, which is required for accurately estimating the contact and ligament forces, and is more critical than the

  10. T2 Relaxation Values of the Talar Trochlear Articular Cartilage: Comparison Between Patients With Lateral Instability of the Ankle Joint and Healthy Volunteers.

    Science.gov (United States)

    Park, So Yoon; Yoon, Young Cheol; Cha, Jang Gyu; Sung, Ki Sun

    2016-01-01

    The purpose of this study was to evaluate the difference between the T2 relaxation values of the talar trochlear cartilage in patients with lateral instability of the ankle joint and the values in healthy volunteers. A retrospective assessment was conducted of images from 13 MRI examinations of the ankles of 12 patients who underwent lateral ankle ligament repair with an arthroscopically proven normal talar trochlear cartilage. Thirteen ankle MRI examinations of 12 healthy age- and sex-matched volunteers were prospectively performed. Two radiologists independently measured the T2 relaxation values of the talar trochlear cartilage in two layers (superficial and deep) in the following six compartments: medial anterior (M1), medial middle (M2), medial posterior (M3), lateral anterior (L1), lateral middle (L2), and lateral posterior (L3). The T2 relaxation values of patients were compared with those of healthy volunteers. Both readers found that the mean T2 relaxation values of all six compartments of the superficial layer were significantly higher in patients than in control subjects. For reader 1, the M1 findings were 46.2 for patients and 39.6 for healthy volunteers; M2, 50.4 and 41.1; M3, 52.1 and 46.2; L1, 43.1 and 37.9; L2, 47.8 and 41.8; and L3, 53.8 and 49.8. For reader 2, the M1 findings were 45.0 and 40.2; M2, 48.8 and 41.1; M3, 53.2 and 45.6; L1, 42.8 and 38.5; L2, 48.0 and 42.1; and L3, 55.0 and 49.0 (p L1 deep (0.75). The T2 relaxation values of arthroscopically proven normal talar trochlear cartilage of patients with lateral instability were higher than those of healthy volunteers, especially in the superficial layer and the M2 deep layer.

  11. Movement detection impaired in patients with knee osteoarthritis compared to healthy controls: A cross-sectional case-control study

    DEFF Research Database (Denmark)

    Lund, H.; Juul-Kristensen, B.; Hansen, K.

    2008-01-01

    . The absolute error (AE) for JPS (i.e., absolute difference in degrees between target and estimated position) and for TDPM (i.e., the difference in degrees at movement start and response when recognizing the movement) was calculated. For TDPM a higher AE (mean [SE]) was found in the involved knees in patients...

  12. Changes in proprioceptive weighting during quiet standing in women with early and established knee osteoarthritis compared to healthy controls

    NARCIS (Netherlands)

    Mahmoudian, A.; van Dieen, J.H.; Baert, I.C.A; Jonkers, I.; Bruijn, S.M.; Luyten, F.P.; Faber, G.S.; Verschueren, S.M.

    Objectives: Knee osteoarthritis (OA) is highly prevalent in people above the age of 60, and is typically associated with pain, stiffness, muscle weakness and proprioceptive deficits. Muscle-tendon vibration has been used to assess the spatial reweighting of proprioceptive input during standing. The

  13. The association of dorsiflexion flexibility on knee kinematics and kinetics during a drop vertical jump in healthy female athletes.

    Science.gov (United States)

    Malloy, Philip; Morgan, Alexander; Meinerz, Carolyn; Geiser, Christopher; Kipp, Kristof

    2015-12-01

    While previous studies have examined the association between ankle dorsiflexion flexibility and deleterious landing postures, it is not currently known how landing kinetics are influenced by ankle dorsiflexion flexibility. The purpose of this study was to examine whether ankle dorsiflexion flexibility was associated with landing kinematics and kinetics that have been shown to increase the risk of anterior cruciate ligament (ACL) injury in female athletes. Twenty-three female collegiate soccer players participated in a preseason screening that included the assessment of ankle dorsiflexion flexibility and lower-body kinematics and kinetics during a drop vertical jump task. The results demonstrated that females with less ankle dorsiflexion flexibility exhibited greater peak knee abduction moments (r = -.442), greater peak knee abduction angles (r = .355), and less peak knee flexion angles (r = .385) during landing. The range of dorsiflexion flexibility for the current study was between 9° and 23° (mean = 15.0°; SD 3.9°). Dorsiflexion flexibility may serve as a useful clinical measure to predict poor landing postures and external forces that have been associated with increased knee injury risk. Rehabilitation specialists can provide interventions aimed at improving dorsiflexion flexibility in order to ameliorate the impact of this modifiable factor on deleterious landing kinematics and kinetics in female athletes. II.

  14. Application of a semi-automatic cartilage segmentation method for biomechanical modeling of the knee joint.

    Science.gov (United States)

    Liukkonen, Mimmi K; Mononen, Mika E; Tanska, Petri; Saarakkala, Simo; Nieminen, Miika T; Korhonen, Rami K

    2017-10-01

    Manual segmentation of articular cartilage from knee joint 3D magnetic resonance images (MRI) is a time consuming and laborious task. Thus, automatic methods are needed for faster and reproducible segmentations. In the present study, we developed a semi-automatic segmentation method based on radial intensity profiles to generate 3D geometries of knee joint cartilage which were then used in computational biomechanical models of the knee joint. Six healthy volunteers were imaged with a 3T MRI device and their knee cartilages were segmented both manually and semi-automatically. The values of cartilage thicknesses and volumes produced by these two methods were compared. Furthermore, the influences of possible geometrical differences on cartilage stresses and strains in the knee were evaluated with finite element modeling. The semi-automatic segmentation and 3D geometry construction of one knee joint (menisci, femoral and tibial cartilages) was approximately two times faster than with manual segmentation. Differences in cartilage thicknesses, volumes, contact pressures, stresses, and strains between segmentation methods in femoral and tibial cartilage were mostly insignificant (p > 0.05) and random, i.e. there were no systematic differences between the methods. In conclusion, the devised semi-automatic segmentation method is a quick and accurate way to determine cartilage geometries; it may become a valuable tool for biomechanical modeling applications with large patient groups.

  15. Time to Stabilization of Anterior Cruciate Ligament–Reconstructed Versus Healthy Knees in National Collegiate Athletic Association Division I Female Athletes

    Science.gov (United States)

    Webster, Kathryn A.; Gribble, Phillip A.

    2010-01-01

    Abstract Context: Jump landing is a common activity in collegiate activities, such as women's basketball, volleyball, and soccer, and is a common mechanism for anterior cruciate ligament (ACL) injury. It is important to better understand how athletes returning to competition after ACL reconstruction are able to maintain dynamic postural control during a jump landing. Objective: To use time to stabilization (TTS) to measure differences in dynamic postural control during jump landing in ACL-reconstructed (ACLR) knees compared with healthy knees among National Collegiate Athletic Association Division I female athletes. Design: Case-control study. Setting: University athletic training research laboratory. Patients or Other Participants: Twenty-four Division I female basketball, volleyball, and soccer players volunteered and were assigned to the healthy control group (n  =  12) or the ACLR knee group (n  =  12). Participants with ACLR knees were matched to participants with healthy knees by sport and by similar age, height, and mass. Intervention(s): At 1 session, participants performed a single-leg landing task for both limbs. They were instructed to stabilize as quickly as possible in a single-limb stance and remain as motionless as possible for 10 seconds. Main Outcome Measure(s): The anterior-posterior TTS and medial-lateral TTS ground reaction force data were used to calculate resultant vector of the TTS (RVTTS) during a jump landing. A 1-way analysis of variance was used to determine group differences on RVTTS. The means and SDs from the participants' 10 trials in each leg were used for the analyses. Results: The ACLR group (2.01 ± 0.15 seconds, 95% confidence interval [CI]  =  1.91, 2.10) took longer to stabilize than the control group (1.90 ± 0.07 seconds, 95% CI  =  1.86, 1.95) (F1,22  =  4.28, P  =  .05). This result was associated with a large effect size and a 95% CI that did not cross zero (Cohen d  =  1.0, 95% CI  =  0

  16. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  17. Knee Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Knee Injuries KidsHealth / For Teens / Knee Injuries What's in ... can do to protect them. What's in a Knee? The knee is a joint , actually the largest ...

  18. Pendulum mass affects the measurement of articular friction coefficient.

    Science.gov (United States)

    Akelman, Matthew R; Teeple, Erin; Machan, Jason T; Crisco, Joseph J; Jay, Gregory D; Fleming, Braden C

    2013-02-01

    Friction measurements of articular cartilage are important to determine the relative tribologic contributions made by synovial fluid or cartilage, and to assess the efficacy of therapies for preventing the development of post-traumatic osteoarthritis. Stanton's equation is the most frequently used formula for estimating the whole joint friction coefficient (μ) of an articular pendulum, and assumes pendulum energy loss through a mass-independent mechanism. This study examines if articular pendulum energy loss is indeed mass independent, and compares Stanton's model to an alternative model, which incorporates viscous damping, for calculating μ. Ten loads (25-100% body weight) were applied in a random order to an articular pendulum using the knees of adult male Hartley guinea pigs (n=4) as the fulcrum. Motion of the decaying pendulum was recorded and μ was estimated using two models: Stanton's equation, and an exponential decay function incorporating a viscous damping coefficient. μ estimates decreased as mass increased for both models. Exponential decay model fit error values were 82% less than the Stanton model. These results indicate that μ decreases with increasing mass, and that an exponential decay model provides a better fit for articular pendulum data at all mass values. In conclusion, inter-study comparisons of articular pendulum μ values should not be made without recognizing the loads used, as μ values are mass dependent. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. [Clinical and gait analytical investigation of valgus knee bracing in therapy for medial degenerative joint disease of the knee].

    Science.gov (United States)

    Müller-Rath, R; Cho, H Y; Siebert, C H; Miltner, O

    2011-04-01

    The non-operative treatment of medial degenerative joint disease of the knee has proven to be difficult due to the underlying deformity and the pathological mechanical loading. Valgus knee bracing offers the possibility to directly address the mechanical deficit. The aim of this study was to analyse whether or not part-time valgus knee bracing in patients with medial osteoarthrits can effectively reduce knee pain and lead to reproducible changes in the gait analysis in comparison to an elastic knee bandage and an untreated control group. In a prospective trial, 33 patients with symptomatic medial osteoarthritis of the knee joint with a minimum of grade 2 according to the radiographic classification of Kellegren & Lawrence were randomised into a treatment group with a valgus brace (n = 13; M4 OA®, Medi) and an elastic knee bandage (n = 10; Genumedi®, Medi). Both supportive devices were to be applied for 2-4 hours per day, especially during activity. The control group (n = 10) consisted of untreated individuals. The deviation of the leg axis and the degree of degenerative joint disease were evaluated radiographically at the onset of the study by a standing whole leg X-ray. The evaluation at the beginning of the study and after 16 weeks consisted of a clinical examination including various knee scores (Insall score, Lequesne score, HSS score, Tegner score, WOMAC, and VAS for pain). Additionally, at both times a 3-dimensional, instrumented gait analysis was carried out to document the joint angles of the affected knee in all planes. The obtained knee joint angles from all groups at both time points were compared to a control group of healthy persons without a history of knee pain by qualitative measurement. Radiographically, the medial deviation of the load axis from the knee joint centre (MAD) was 29 mm. In 27 patients we found a combination of femoral, intra-articular and tibial changes contributing to the varus alignment. The joint line conversion angle (JLCA) was

  20. Ultrasound imaging for the rheumatologist XXX. Sonographic assessment of the painful knee.

    Science.gov (United States)

    Meenagh, G; Filippucci, E; Delle Sedie, A; Iagnocco, A; Scirè, C A; Riente, L; Montecucco, C; Valesini, G; Bombardieri, S; Grassi, W

    2010-01-01

    The knee joint is a frequent focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound findings in patients presenting with a variety of rheumatic disorders and knee pain. US imaging provides for a sensitive and detailed identification of different intra- and peri-articular pathology responsible for knee pain.

  1. Safety and Efficacy of NEXT-II®, a Novel Water-Soluble, Undenatured Type II Collagen inHealthy Human SubjectsSuffering from Occasional Knee Joint Pain

    Directory of Open Access Journals (Sweden)

    Orie Yoshinari

    2015-07-01

    Full Text Available Background: Oral administration of a novel water-soluble undenatured type II collagen (NEXT-II® has been demonstrated to ameliorate the signs and symptoms of rheumatoid arthritis (RA in animal models. In the present investigation, we conducted a pilot study to examine the efficacy and safety of NEXT-II® in borderline subjects defined as healthy and non-diseased state, but with potential risks in knee joint health. Method: We employed Western Ontario McMaster Index (WOMAC score and Visual Analog Scale (VAS scores to assess the extent of improvement in the knee joints in these volunteers following supplementation of 40 mg NEXT-II® (10 mg as undenatured type II collagen over a period of 12 weeks. Result: The results demonstrated that NEXT-II® treatment significantly reduced WOMAC and VAS scores compared to subjects at baseline. Specifically, in the evaluation using VAS, the borderline subjects at resting, walking, and going up and down the stairs revealed significant improvement when compared to the baseline. Conclusion: The results of the studies demonstrated that NEXT-II® might be an ingredient which is safe and effective in the application of dietary supplement in ameliorating joint pain and symptoms of the borderline subjects without any adverse events.

  2. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

    DEFF Research Database (Denmark)

    Henriksen, Marius; Nielsen, Thomas Graven; Aaboe, Jens

    2010-01-01

    Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease...... progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients....

  3. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction.

    Science.gov (United States)

    Vundelinckx, Bart; Herman, Benjamin; Getgood, Alan; Litchfield, Robert

    2017-01-01

    After anterior cruciate ligament (ACL) rupture, anteroposterior and rotational laxity in the knee causes instability, functional symptoms, and damage to other intra-articular structures. Surgical reconstruction aims to restore the stability in the knee, and to improve function and ability to participate in sports. It also protects cartilage and menisci from secondary injuries. Because of persistent rotational instability after ACL reconstruction, combined intra-articular and extra-articular procedures are more commonly performed. In this article, an overview of anatomy, biomechanical studies, current gold standard procedures, techniques, and research topics are summarized. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Experimental articular cartilage repair in the Göttingen minipig

    DEFF Research Database (Denmark)

    Christensen, Bjørn Borsøe; Foldager, Casper Bindzus; Olesen, Morten Lykke

    2015-01-01

    BACKGROUND: A gold standard treatment for articular cartilage injuries is yet to be found, and a cost-effective and predictable large animal model is needed to bridge the gap between in vitro studies and clinical studies. Ideally, the animal model should allow for testing of clinically relevant...... repair techniques and evaluating the use of two defects per knee. METHODS: Sixteen fully mature Göttingen minipigs were used. The minipigs received bilateral trochlear osteochondral drill-hole defects or chondral defects (Ø 6 mm), either one defect per knee or two defects per knee. The defects were...... minipig model was easy to handle, cost-effective and provided predictable outcome. Based on this study the use of two defects per knee, one in the medial and one in the lateral trochlear facet, in male Göttingen minipigs is recommended....

  5. [Peri-articular ossifications].

    Science.gov (United States)

    Guastavino, V; Dijs, H; Herheyen, G; Driessens, M

    1990-01-01

    Restriction of motion of the joints due to peri-articular ossifications constitute a major problem in the rehabilitation of patients with transverse spinal cord lesion. The therapeutic possibilities as well as the preventive measurements are described and illustrated with a few case reports.

  6. Treatment of knee osteoarthritis.

    Science.gov (United States)

    Ringdahl, Erika; Pandit, Sandesh

    2011-06-01

    Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.

  7. Experimental knee pain reduces muscle strength

    DEFF Research Database (Denmark)

    Henriksen, Marius; Mortensen, Sara Rosager; Aaboe, Jens

    2011-01-01

    Pain is the principal symptom in knee pathologies and reduced muscle strength is a common observation among knee patients. However, the relationship between knee joint pain and muscle strength remains to be clarified. This study aimed at investigating the changes in knee muscle strength following...... experimental knee pain in healthy volunteers, and if these changes were associated with the pain intensities. In a crossover study, 18 healthy subjects were tested on 2 different days. Using an isokinetic dynamometer, maximal muscle strength in knee extension and flexion was measured at angular velocities 0....... Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P knee extension and flexion at all angular velocities. The reduction in muscle strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension...

  8. Intra-articular Injections of Platelet-Rich Plasma Releasate Reduce Pain and Synovial Inflammation in a Mouse Model of Osteoarthritis.

    Science.gov (United States)

    Khatab, Sohrab; van Buul, Gerben M; Kops, Nicole; Bastiaansen-Jenniskens, Yvonne M; Bos, P Koen; Verhaar, Jan A; van Osch, Gerjo J

    2018-01-01

    Osteoarthritis (OA) is a degenerative joint disease leading to pain and disability for which no curative treatment exists. A promising biological treatment for OA is intra-articular administration of platelet-rich plasma (PRP). PRP injections in OA joints can relieve pain, although the exact working mechanism is unclear. To examine the effects of PRP releasate (PRPr) on pain, cartilage damage, and synovial inflammation in a mouse OA model. Controlled laboratory study. OA was induced unilaterally in the knees of male mice (n = 36) by 2 intra-articular injections of collagenase at days -7 and -5. At day 0, pain was measured by registering weight distribution on the hindlimbs, after which mice were randomly divided into 2 groups. Mice received 3 intra-articular injections of PRP or saline in the affected knee. Seven mice per group were euthanized at day 5 for assessment of early synovial inflammation and cartilage damage. Pain in the remaining mice was registered for a total of 3 weeks. These mice were euthanized at day 21 for assessment of cartilage damage and synovial inflammation on histological evaluation. Antibodies against iNOS, CD163, and CD206 were used to identify different subtypes of macrophages in the synovial membrane. Mice in the PRPr group increased the distribution of weight on the affected joint in 2 consecutive weeks after the start of the treatment ( P < .05), whereas mice in the saline group did not. At day 21, PRPr-injected knees had a thinner synovial membrane ( P < .05) and a trend toward less cartilage damage in the lateral joint compartment ( P = .053) than saline-injected knees. OA knees treated with saline showed less anti-inflammatory (CD206+ and CD163+) cells at day 5 than healthy knees, an observation that was not made in the PRPr-treated group. A higher level of pain at day 7 was associated with a thicker synovial membrane at day 21. The presence of CD206+ cells was negatively associated with synovial membrane thickness. In a murine OA

  9. Estimating joint space of the knee during weight-bearing squatting activity using motion capture ? preliminary results of a new method

    OpenAIRE

    CLEMENT, Julien; CRESSON, T.; HAGEMEISTER, Nicola; DUMAS, Raphaël; DE GUISE, Jaques A

    2015-01-01

    Over the last 10 years, several studies analyzed 3D joint space of the knee and deduced articular contact kinematics during various weight-bearing activities. Joint space and articular contact kinematics provide relevant data on how the intrinsic biomechanics of the knee is altered after a disease or a surgical procedure, such as knee osteoarthritis (OA) or total knee arthroplasty. Although very accurate, the methods employed by these studies require complex acquisition protocols, implying 3D...

  10. Human Adipose-Derived Mesenchymal Progenitor Cells Engraft into Rabbit Articular Cartilage

    Directory of Open Access Journals (Sweden)

    Wen Wang

    2015-05-01

    Full Text Available Mesenchymal stem cells (MSCs are known to have the potential for articular cartilage regeneration, and are suggested for the treatment of osteoarthritis (OA. Here, we investigated whether intra-articular injection of xenogeneic human adipose-derived mesenchymal progenitor cells (haMPCs promoted articular cartilage repair in rabbit OA model and engrafted into rabbit articular cartilage. The haMPCs were cultured in vitro, and phenotypes and differentiation characteristics of cells were evaluated. OA was induced surgically by anterior cruciate ligament transection (ACLT and medical meniscectomy of knee joints. At six weeks following surgery, hyaluronic acid (HA or haMPCs was injected into the knee joints, the contralateral knee served as normal control. All animals were sacrificed at the 16th week post-surgery. Assessments were carried out by macroscopic examination, hematoxylin/eosin (HE and Safranin-O/Fast green stainings and immunohistochemistry. The data showed that haMPC treatment promoted cartilage repair. Signals of human mitochondrial can be directly detected in haMPC treated cartilage. The haMPCs expressed human leukocyte antigen I (HLA-I but not HLA-II-DR in vivo. These results suggest that intra-articular injection of haMPCs promotes regeneration of articular cartilage in rabbit OA model, and support the notion that MPCs are transplantable between HLA-incompatible individuals.

  11. Haemodynamics in acute arthritis of the knee in puppies

    DEFF Research Database (Denmark)

    Bünger, C; Hjermind, J; Harving, S

    1984-01-01

    In order to study the haemodynamic changes of the juvenile knee in acute arthritis, an experimental model was developed in puppies by unilateral intra-articular injections of Carragheenin solution into the knee. Tissue blood flow was studied by the tracer microsphere technique in eight dogs and s...

  12. Functioning Before and After Total Hip or Knee Arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid)

    2009-01-01

    textabstractOsteoarthritis (OA) of the hip or knee is a common locomotor disease characterized by degradation of articular cartilage. In the Netherlands, in the year 2000 about 257,400 persons above the age of 55 years had hip OA and about 335,700 persons had knee OA. Because the prevalence of OA

  13. Label-free characterization of degenerative changes in articular cartilage by Raman spectroscopy

    Science.gov (United States)

    Oshima, Yusuke; Akehi, Mayu; Kiyomatsu, Hiroshi; Miura, Hiromasa

    2017-04-01

    Osteoarthritis (OA) is very common joint disease in the aging population. Main symptom of OA is accompanied by degenerative changes of articular cartilage. Raman spectroscopy is a label-free technique which enables to analyze molecular composition in degenerative cartilage. We generated an animal OA model surgically induced by knee joint instability and performed Raman spectroscopic analysis for the articular cartilage. In the result, Raman spectral data of the articular cartilage showed drastic changes in comparison between OA and control side. The relative intensity of phosphate band increases in the degenerative cartilage.

  14. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects

    OpenAIRE

    Rice, David A; McNair, Peter J; Lewis, Gwyn N.

    2011-01-01

    Introduction A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether γ-loop dysfunction contributes to AMI in people with knee joint OA. Methods Fifteen subjects with knee joint OA and 15 controls with no history of knee joint p...

  15. STRATEGY OF VISUAL PROPRIOCEPTIVE CONTROL IN PATIENTS WITH INJURY TO THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE AND HEALTHY INDIVIDUALS (SOCCER PLAYERS

    Directory of Open Access Journals (Sweden)

    Tomasz Piontek

    2012-01-01

    Full Text Available Objective: Knee joint dysfunction resulting from injury to the anterior crucial ligament (ACL is associated not only with mechanical joint instability but also with damage of ligamentous receptors responsible for the joint proprioception. It was found that disturbances of signals from the damaged joint produce disorders in movement perception and position of the analogous joint in the normal limb. This study is aimed at evaluating the control strategy in patients with an injury to the anterior crucial ligament.Design: Cohort study; Level of evidence, 3. Subjects/Patients- 84 men, aged 15 to 55 years (mean age 27 years were included in this study. Methods- Patients were divided into two groups: those with unilateral injury to the ACL (33 patients and a control group of healthy volunteers (soccer players; 51 men. Anterior crucial ligament damage was confirmed with arthroscopic knee joint examination in every patient. The way of visual proprioceptive control was assessed with both dynamic (DRT and static (SRT Riva tests standing on one leg. Tests were performed with the Delos Postural Proprioceptive System (Delos s.r.l., Corso Lecce, Torino, Italy in the biomechanical evaluation laboratory at Rehasport Clinic in Poznań. Results: A statistically significant difference for deviations from the averaged axis in SRT (static Riva test with closed eyes was found between the limb with a damaged ACL and the normal limb in the group of patients with injury to the ACL (p=0.006 and between the limb with a damaged ACL and normal limbs in healthy volunteers (p=0.022. A statistically significant difference for deviations from the averaged axis in SRT with closed eyes was also found between the dominant and non-dominant limb in healthy volunteers (p=0.013. No significant differences in the results of tests with open eyes were noted. Conclusions: The results of systems and their contribution to the visual proprioceptive control suggest an important role of the

  16. Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II).

    Science.gov (United States)

    Lamo-Espinosa, José M; Mora, Gonzalo; Blanco, Juan F; Granero-Moltó, Froilán; Nuñez-Córdoba, Jorge M; Sánchez-Echenique, Carmen; Bondía, José M; Aquerreta, Jesús Dámaso; Andreu, Enrique J; Ornilla, Enrique; Villarón, Eva M; Valentí-Azcárate, Andrés; Sánchez-Guijo, Fermín; Del Cañizo, María Consuelo; Valentí-Nin, Juan Ramón; Prósper, Felipe

    2016-08-26

    Mesenchymal stromal cells are a promising option to treat knee osteoarthritis. Their safety and usefulness must be confirmed and the optimal dose established. We tested increasing doses of bone marrow mesenchymal stromal cells (BM-MSCs) in combination with hyaluronic acid in a randomized clinical trial. A phase I/II multicenter randomized clinical trial with active control was conducted. Thirty patients diagnosed with knee OA were randomly assigned to intraarticularly administered hyaluronic acid alone (control), or together with 10 × 10(6) or 100 × 10(6) cultured autologous BM-MSCs, and followed up for 12 months. Pain and function were assessed using VAS and WOMAC and by measuring the knee motion range. X-ray and magnetic resonance imaging analyses were performed to analyze joint damage. No adverse effects were reported after BM-MSC administration or during follow-up. BM-MSC-administered patients improved according to VAS during all follow-up evaluations and median value (IQR) for control, low-dose and high-dose groups change from 5 (3, 7), 7 (5, 8) and 6 (4, 8) to 4 (3, 5), 2 (1, 3) and 2 (0,4) respectively at 12 months (low-dose vs control group p = 0.005 and high-dose vs control group p cells are administered. These results pave the way for a future phase III clinical trial. gov identifier NCT02123368. Nº EudraCT: 2009-017624-72.

  17. Leptin plays a catabolic role on articular cartilage.

    Science.gov (United States)

    Bao, Jia-peng; Chen, Wei-ping; Feng, Jie; Hu, Peng-fei; Shi, Zhong-li; Wu, Li-dong

    2010-10-01

    Leptin has been shown to play a crucial role in the regulation of body weight. There is also evidence that this adipokine plays a key role in the process of osteoarthritis. However, the precise role of leptin on articular cartilage metabolism is not clear. We investigate the role of leptin on articular cartilage in vivo in this study. Recombinant rat leptin (100 μg) was injected into the knee joints of rats, 48 h later, messenger RNA (mRNA) expression and protein levels of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), cathepsin D, and collagen II from articular cartilage were analyzed by real-time quantitative polymerase chain reaction (PCR) and western blot. Two important aggrecanases ADAMTS-4 and -5 (a disintegrin and metalloproteinase with thrombospondin motifs 4 and 5) were also analyzed by real-time quantitative PCR. Besides, articular cartilage was also assessed for proteoglycan/GAG content by Safranin O staining. Leptin significantly increased both gene and protein levels of MMP-2, MMP-9, cathepsin D, and collagen II, while decreased bFGF markedly in cartilage. Moreover, the gene expression of ADAMTS-4 and -5 were markedly increased, and histologically assessed depletion of proteoglycan in articular cartilage was observed after treatment with leptin. These results strongly suggest that leptin plays a catabolic role on cartilage metabolism and may be a disadvantage factor involve in the pathological process of OA.

  18. Topographic deformation patterns of knee cartilage after exercises with high knee flexion: an in vivo 3D MRI study using voxel-based analysis at 3T.

    Science.gov (United States)

    Horng, Annie; Raya, J G; Stockinger, M; Notohamiprodjo, M; Pietschmann, M; Hoehne-Hueckstaedt, U; Glitsch, U; Ellegast, R; Hering, K G; Glaser, C

    2015-06-01

    To implement a novel voxel-based technique to identify statistically significant local cartilage deformation and analyze in-vivo topographic knee cartilage deformation patterns using a voxel-based thickness map approach for high-flexion postures. Sagittal 3T 3D-T1w-FLASH-WE-sequences of 10 healthy knees were acquired before and immediately after loading (kneeling/squatting/heel sitting/knee bends). After cartilage segmentation, 3D-reconstruction and 3D-registration, colour-coded deformation maps were generated by voxel-based subtraction of loaded from unloaded datasets to visualize cartilage thickness changes in all knee compartments. Compression areas were found bifocal at the peripheral medial/caudolateral patella, both posterior femoral condyles and both anterior/central tibiae. Local cartilage thickening were found adjacent to the compression areas. Significant local strain ranged from +13 to -15 %. Changes were most pronounced after squatting, least after knee bends. Shape and location of deformation areas varied slightly with the loading paradigm, but followed a similar pattern consistent between different individuals. Voxel-based deformation maps identify individual in-vivo load-specific and posture-associated strain distribution in the articular cartilage. The data facilitate understanding individual knee loading properties and contribute to improve biomechanical 3 models. They lay a base to investigate the relationship between cartilage degeneration patterns in common osteoarthritis and areas at risk of cartilage wear due to mechanical loading in work-related activities. • 3D MRI helps differentiate true knee-cartilage deformation from random measurement error • 3D MRI maps depict in vivo topographic distribution of cartilage deformation after loading • 3D MRI maps depict in vivo intensity of cartilage deformation after loading • Locating cartilage contact areas might aid differentiating common and work-related osteoarthritis.

  19. Quality of life in young patients after bone tumor surgery around the knee joint and comparison with healthy controls.

    NARCIS (Netherlands)

    Bekkering, W.P.; Vliet Vlieland, T.P.M.; Koopman, H.M.; Schaap, G.R.; Schreuder, H.W.B.; Beishuizen, A.; Tissing, W.J.; Hoogerbrugge, P.M.; Anninga, J.K.; Taminiau, A.H.M.

    2010-01-01

    BACKGROUND: This study aimed to compare the health related quality of life (HRQoL) of children and adolescents after malignant bone tumor surgery of the leg with healthy controls. PROCEDURE: Patients between 8 and 25 years old were cross-sectional recruited. Patients under 16 years of age received

  20. Quality of life in young patients after bone tumor surgery around the knee joint and comparison with healthy controls

    NARCIS (Netherlands)

    Bekkering, W. Peter; Vliet Vlieland, Theodora P. M.; Koopman, Hendrik M.; Schaap, Gerard R.; Schreuder, H. W. Bart; Beishuizen, Auke; Tissing, Wim J. E.; Hoogerbrugge, Peter M.; Anninga, Jacob K.; Taminiau, Antonie H. M.

    2010-01-01

    This study aimed to compare the health related quality of life (HRQoL) of children and adolescents after malignant bone tumor surgery of the leg with healthy controls. Patients between 8 and 25 years old were cross-sectional recruited. Patients under 16 years of age received the TNO (Netherlands

  1. Quality of Life in Young Patients After Bone Tumor Surgery Around the Knee Joint and Comparison With Healthy Controls

    NARCIS (Netherlands)

    Bekkering, W. Peter; Vlieland, Theodora P. M. Vliet; Koopman, Hendrik M.; Schaap, Gerard R.; Schreuder, H. W. Bart; Beishuizen, Auke; Tissing, Wim J. E.; Hoogerbrugge, Peter M.; Anninga, Jacob K.; Taminiau, Antonie H. M.

    Background. This study aimed to compare the health related quality of life (HRQoL) of children and adolescents after malignant bone tumor surgery of the leg with healthy controls. Procedure. Patients between 8 and 25 years old were cross-sectional recruited. Patients under 16 years of age received

  2. Lifestyle and biomechanical determinants of knee joint structure and symptoms

    OpenAIRE

    Teichtahl, Andrew

    2017-01-01

    Osteoarthritis (OA) is the most common form of arthritis and commonly affects weight-bearing joints, such as the knee. With the growing obesity endemic and aging population, the prevalence of knee OA will increase over the coming decades. Since the advent of Magnetic resonance imaging (MRI), OA is now considered a whole-organ disease, affecting multiple articular structures. No cure exists for knee OA and the only definitive management is joint replacement surgery, indicated for painful end-s...

  3. Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Patel, J.J. [Dept. of Radiology, Baystate Medical Center, Springfield, MA (United States)

    1999-11-01

    Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent ''fat stripe'' sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury. (orig.)

  4. Influence of site and age on biochemical characteristics of the collagen network of equine articular cartilage

    NARCIS (Netherlands)

    Brama, P.A.J.; TeKoppele, J.M.; Bank, R.A.; Weeren, P.R. van; Barneveld, A.

    1999-01-01

    Objective - To determine variations in biochemical characteristics of equine articular cartilage in relation to age and the degree of predisposition for osteochondral disease at a specific site. Sample Population - Articular cartilage specimens from 53 horses 4 to 30 years old. Procedure - Healthy

  5. The effect of fixed charge density and cartilage swelling on mechanics of knee joint cartilage during simulated gait.

    Science.gov (United States)

    Räsänen, Lasse P; Tanska, Petri; Zbýň, Štefan; van Donkelaar, Corrinus C; Trattnig, Siegfried; Nieminen, Miika T; Korhonen, Rami K

    2017-08-16

    The effect of swelling of articular cartilage, caused by the fixed charge density (FCD) of proteoglycans, has not been demonstrated on knee joint mechanics during simulated walking before. In this study, the influence of the depth-wise variation of FCD was investigated on the internal collagen fibril strains and the mechanical response of the knee joint cartilage during gait using finite element (FE) analysis. The FCD distribution of tibial cartilage was implemented from sodium ( 23 Na) MRI into a 3-D FE-model of the knee joint ("Healthy model"). For comparison, models with decreased FCD values were created according to the decrease in FCD associated with the progression of osteoarthritis (OA) ("Early OA" and "Advanced OA" models). In addition, a model without FCD was created ("No FCD" model). The effect of FCD was studied with five different collagen fibril network moduli of cartilage. Using the reference fibril network moduli, the decrease in FCD from "Healthy model" to "Early OA" and "Advanced OA" models resulted in increased axial strains (by +2 and +6%) and decreased fibril strains (by -3 and -13%) throughout the stance, respectively, calculated as mean values through cartilage depth in the tibiofemoral contact regions. Correspondingly, compared to the "Healthy model", the removal of the FCD altogether in "NoFCD model" resulted in increased mean axial strains by +16% and decreased mean fibril strains by -24%. This effect was amplified as the fibril network moduli were decreased by 80% from the reference. Then mean axial strains increased by +6, +19 and +49% and mean fibril strains decreased by -9, -20 and -32%, respectively. Our results suggest that the FCD in articular cartilage has influence on cartilage responses in the knee during walking. Furthermore, the FCD is suggested to have larger impact on cartilage function as the collagen network degenerates e.g. in OA. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Alinhamento frontal estático do joelho e cargas plantares durante a marcha de adultos jovens assintomáticos Static frontal knee alignment and plantar loads during gait in healthy young adults

    Directory of Open Access Journals (Sweden)

    Isabel C.N. Sacco

    2009-03-01

    Full Text Available Na prática fisioterapêutica, pressupõe-se que alterações posturais do membro inferior influenciem a biomecânica e função dos demais complexos durante o movimento. No entanto, a literatura sobre a relação entre desalinhamentos estáticos do joelho e possíveis alterações dinâmicas ainda é escassa e inconclusiva. Assim, buscou-se avaliar o efeito do alinhamento frontal estático do joelho sobre a distribuição da pressão plantar durante a marcha. Foram avaliados inicialmente 44 adultos jovens assintomáticos. Por fotogrametria digital, mediu-se o ângulo frontal do joelho, classificado como normal (170° a 175°, valgo 175°. Dado o baixo número de valgos, foram analisados dois grupos: de joelhos normais (n=18 e de joelhos varos (n=23. A distribuição da pressão plantar foi avaliada durante a marcha em cinco áreas. Os grupos mostraram-se estatistica-mente semelhantes em todas as variáveis cinéticas avaliadas em todas as áreas plantares. Joelhos normais apresentaram significativa correlação com o tempo de contato no antepé lateral e médio-pé; e os varos, correlação com a área e tempo de contato em duas e três áreas plantares, e com a pressão integral no antepé lateral. Os resultados mostraram que o desalinhamento frontal de 3° do joelho, embora com moderada correlação, não influencia a distribuição de cargas na superfície plantar durante a marcha. Sugere-se pois que a avaliação clínica não se limite à avaliação articular estática do joelho, mas inclua atividades dinâmicas.In physical therapy practice, it is assumed that lower-limb posture changes may influence other complexes' biomechanics or function during movement. However, literature on the relationship between static knee alignment and possible dynamic changes is still scarce and inconclusive. This study assessed the effect of static frontal knee alignment on plantar pressure distribution during gait. At first 44 young asymptomatic adults were

  7. Analysis and multiclass classification of pathological knee joints using vibroarthrographic signals.

    Science.gov (United States)

    Kręcisz, Krzysztof; Bączkowicz, Dawid

    2018-02-01

    Vibroarthrography (VAG) is a method developed for sensitive and objective assessment of articular function. Although the VAG method is still in development, it shows high accuracy, sensitivity and specificity when comparing results obtained from controls and the non-specific, knee-related disorder group. However, the multiclass classification remains practically unknown. Therefore the aim of this study was to extend the VAG method classification to 5 classes, according to different disorders of the patellofemoral joint. We assessed 121 knees of patients (95 knees with grade I-III chondromalacia patellae, 26 with osteoarthritis) and 66 knees from 33 healthy controls. The vibroarthrographic signals were collected during knee flexion/extension motion using an acceleration sensor. The genetic search algorithm was chosen to select the most relevant features of the VAG signal for classification. Four different algorithms were used for classification of selected features: logistic regression with automatic attribute selection (SimpleLogistic in Weka), multilayer perceptron with sigmoid activation function (MultilayerPerceptron), John Platt's sequential minimal optimization algorithm implementation of support vector classifier (SMO) and random forest tree (RandomForest). The generalization error of classification algorithms was evaluated by stratified 10-fold cross-validation. We obtained levels of accuracy and AUC metrics over 90%, more than 93% sensitivity and more than 84% specificity for the logistic regression-based method (SimpleLogistic) for a 2-class classification. For the 5-class method, we obtained 69% and 90% accuracy and AUC respectively, and sensitivity and specificity over 91% and 69%. The results of this study confirm the high usefulness of quantitative analysis of VAG signals based on classification techniques into normal and pathological knees and as a promising tool in classifying signals of various knee joint disorders and their stages. Copyright

  8. Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial.

    Science.gov (United States)

    Sharma, Saurab; Balthillaya, Ganesh; Rao, Roopa; Mani, Ramakrishnan

    2016-01-01

    To investigate the added benefit of nerve-biased interventions over static stretching in hamstring flexibility and to compare the effectiveness of two types of nerve-biased interventions over a week. Three-arm assessor-blinded randomized controlled trial. University Laboratory. Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone. Knee extension angle (KEA) in degrees. Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another. This clinical trial is registered in Clinical Trials Registry- India (CTRI) with registration number CTRI/2012/05/002619. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Safety, tolerability, pharmacokinetics, and efficacy of AMG 403, a human anti-nerve growth factor monoclonal antibody, in two phase I studies with healthy volunteers and knee osteoarthritis subjects.

    Science.gov (United States)

    Gow, Jason M; Tsuji, Wayne H; Williams, Gary J; Mytych, Daniel; Sciberras, David; Searle, Shawn L; Mant, Tim; Gibbs, John P

    2015-10-08

    Nerve growth factor plays a key role in the pathology of osteoarthritis (OA) related chronic pain. The aim of these studies was to evaluate the safety, tolerability, pharmacokinetics, and clinical response of AMG 403, a human anti-nerve growth factor monoclonal antibody, in healthy volunteers and subjects with knee OA. Two phase I, randomized, placebo-controlled, double-blind studies were conducted. The single-ascending dose study randomized healthy volunteers (n = 48) 3:1 to receive AMG 403 (1, 3, 10, or 30 mg intravenously; or 10 or 30 mg subcutaneously; n = 8 per group) or placebo. The multiple-ascending dose study randomized knee OA subjects (n = 18) 3:1 to receive AMG 403 (3, 10, or 20 mg subcutaneously once monthly for four doses) or placebo. Safety, tolerability, and pharmacokinetics (PK) were assessed for both studies. Patient's and physician's disease assessments and total WOMAC score were determined in knee OA subjects. AMG 403 appeared to be well-tolerated after single and multiple doses, except for subject-reported hyperesthesia, pain, and paresthesia (mild to moderate severity). These treatment-emergent neurosensory events showed evidence of reversibility and a possible dose-dependence. Three serious adverse events were reported in AMG 403 treated subjects, but were not considered treatment related. AMG 403 PK was linear with an estimated half-life of 19.6 to 25.8 days. After multiple doses, AMG 403 PK showed modest accumulation (≤2.4-fold increase) in systemic exposure. Knee OA diagnosis, body weight, and anti-drug antibody development did not appear to affect AMG 403 PK. Patient's and physician's disease assessments and total WOMAC score showed improvement in AMG 403 treated knee OA subjects compared with placebo. AMG 403 was generally safe and well-tolerated in both healthy volunteers and knee OA patients, and exhibited linear pharmacokinetics. Preliminary clinical efficacy was observed in knee OA subjects. ClinicalTrials.gov NCT02348879

  10. Sources of Variability in Musculo-Articular Stiffness Measurement

    Science.gov (United States)

    Ditroilo, Massimiliano; Watsford, Mark; Murphy, Aron; De Vito, Giuseppe

    2013-01-01

    The assessment of musculo-articular stiffness (MAS) with the free-oscillation technique is a popular method with a variety of applications. This study examined the sources of variability (load applied and frequency of oscillation) when MAS is assessed. Over two testing occasions, 14 healthy men (27.7±5.2 yr, 1.82±0.04 m, 79.5±8.4 kg) were measured for isometric maximum voluntary contraction and MAS of the knee flexors using submaximal loads relative to the individual's maximum voluntary contraction (MAS%MVC) and a single absolute load (MASABS). As assessment load increased, MAS%MVC (coefficient of variation (CV)  =  8.1–12.1%; standard error of measurement (SEM)  =  51.6–98.8 Nm−1) and frequency (CV  =  4.8–7.0%; SEM  =  0.060–0.075 s−1) variability increased consequently. Further, similar levels of variability arising from load (CV  =  6.7%) and frequency (CV  =  4.8–7.0%) contributed to the overall MAS%MVC variability. The single absolute load condition yielded better reliability scores for MASABS (CV  =  6.5%; SEM  =  40.2 Nm−1) and frequency (CV  =  3.3%; SEM  =  0.039 s−1). Low and constant loads for MAS assessment, which are particularly relevant in the clinical setting, exhibited superior reliability compared to higher loads expressed as a percentage of maximum voluntary contraction, which are more suitable for sporting situations. Appropriate sample size and minimum detectable change can therefore be determined when prospective studies are carried out. PMID:23667662

  11. Coronal tibial slope is associated with accelerated knee osteoarthritis: data from the Osteoarthritis Initiative

    National Research Council Canada - National Science Library

    Driban, Jeffrey B; Stout, Alina C; Duryea, Jeffrey; Lo, Grace H; Harvey, William F; Price, Lori Lyn; Ward, Robert J; Eaton, Charles B; Barbe, Mary F; Lu, Bing; McAlindon, Timothy E

    2016-01-01

    .... The geometry of an articular surface (e.g., coronal tibial slope), which is a determinant of altered joint biomechanics, may be an important risk factor for incident accelerated knee osteoarthritis...

  12. Conservative treatment of acute knee osteoarthritis: A review of the Cochrane Library

    Directory of Open Access Journals (Sweden)

    Emerito Carlos Rodriguez-Merchan

    2016-05-01

    Conclusions: Five main strategies for the conservative treatment of knee osteoarthritis exist that must be used before indicating surgical treatment: medical treatment, physical medicine and rehabilitation, intra-articular injections, acupuncture, and self-management education programs.

  13. The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA

    DEFF Research Database (Denmark)

    Luna, Iben E; Kehlet, Henrik; Jensen, Claus M

    2017-01-01

    In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthr...

  14. Histological and biochemical evaluation of perichondrial transplants in human articular cartilage defects

    NARCIS (Netherlands)

    Bouwmeester, P; Kuijer, R; Terwindt-Rouwenhorst, E; van der Linden, Ton; Bulstra, K

    1999-01-01

    From 1986 to 1992, 88 patients with articular defects in the knee were treated with a perichondrial arthroplasty. In this study, we report on the results for 22 biopsies of grafted tissue with a mean follow-up of 21 months. Biopsies were obtained at routine arthroscopy after approximately 1 year or

  15. The ultrastructure of the peri-articular osteophytes - an evaluation by ...

    African Journals Online (AJOL)

    Methods: Sections of periarticular osteophytes and osteophyte-normal articular cartilage composite tissues were obtained during total knee replacement for osteoarthritis (OA). These sections were routinely processed and examined using the scanning electron microscope with emphasis on the osteophytic cartilage mantle ...

  16. Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Chao-Pin Yang

    2005-02-01

    Full Text Available Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty-nine patients with either ischemic or hemorrhagic stroke-induced right or left hemiplegia were recruited to evaluate soft-tissue and intra-articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft-tissue changes and intra-articular lesions in hemiplegic knees of stroke patients.

  17. The effect of proprioceptive knee bracing on knee stability during three different sport related movement tasks in healthy subjects and the implications to the management of Anterior Cruciate Ligament (ACL) injuries.

    Science.gov (United States)

    Hanzlíková, I; Richards, J; Tomsa, M; Chohan, A; May, K; Smékal, D; Selfe, J

    2016-07-01

    Proprioceptive knee braces have been shown to improve knee mechanics, however much of the work to date has focused on tasks such as slow step down tasks rather than more dynamic sporting tasks. This study aimed to explore if such improvements in stability may be seen during faster sports specific tasks as well as slower tasks. Twelve subjects performed a slow step down, single leg drop jump and pivot turn jump with and without a silicone web brace. 3D kinematics of the knee were collected using a ten camera Qualisys motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the Calibrated Anatomical Systems Technique. A two way ANOVA with repeated measures was performed with post-hoc pairwise comparison to explore the differences between the two conditions and three tasks. Significant differences were seen in the knee joint angles and angular velocities in the sagittal, coronal and transverse planes between the tasks. The brace showed a reduction in knee valgum and internal rotation across all tasks, with the most notable effect during the single leg drop jump and pivot turn jump. The transverse plane also showed a significant reduction in the external rotation knee angular velocity when wearing the brace. The brace influenced the knee joint kinematics in coronal and transverse planes which confirms that such braces can have a significant effect on knee control during dynamic tasks. Further studies are required exploring the efficacy of proprioceptive braces in athletic patient cohort. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Relationships Between Tibiofemoral Contact Forces and Cartilage Morphology at 2 to 3 Years After Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction and in Healthy Knees

    OpenAIRE

    Saxby, David John; Adam L Bryant; Wang, Xinyang; Modenese, Luca; Gerus, Pauline; Konrath, Jason M.; Bennell, Kim L; Fortin, Karine; Wrigley, Tim; Cicuttini, Flavia M; Vertullo, Christopher J.; Feller, Julian A; Whitehead, Tim; Gallie, Price; Lloyd, David G.

    2017-01-01

    Background: Prevention of knee osteoarthritis (OA) following anterior cruciate ligament (ACL) rupture and reconstruction is vital. Risk of postreconstruction knee OA is markedly increased by concurrent meniscal injury. It is unclear whether reconstruction results in normal relationships between tibiofemoral contact forces and cartilage morphology and whether meniscal injury modulates these relationships. Hypotheses: Since patients with isolated reconstructions (ie, without meniscal injury) ar...

  19. TIBIAL PLATEAU PROXIMAL AND DISTAL BONE BEHAVE SIMILARLY: BOTH ARE ASSOCIATED WITH FEATURES OF KNEE OSTEOARTHRITIS

    Science.gov (United States)

    There is a growing imperative to understand how changes in peri-articular bone relate to pathological progression of knee osteoarthritis (KOA). Peri-articular bone density can be measured using dual x-ray absorptiometry (DXA). The medial:lateral tibial BMD ratio (M:L BMD) is associated with MRI and...

  20. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  1. Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Beltran, J.; Marty-Delfaut, E.; Bencardino, J.; Rosenberg, Z.S. [Department of Radiology, Hospital for Joint Diseases, New York, NY (United States); Steiner, G. [Department of Pathology, Hospital for Joint Diseases, New York, NY (United States); Aparisi, F. [Department of Radiology, Residencia Sanitaria ``La Fe``, Valencia (Spain); Padron, M. [Clinica San Camilo, Madrid (Spain)

    1998-07-01

    Purpose. To determine the ability of MRI to detect the presence of crystals of calcium pyrophosphate in the articular cartilage of the knee. Design and patients. The MR studies of 12 knees (11 cases) were reviewed retrospectively and correlated with radiographs (12 cases) and the findings at arthroscopy (2 cases) and surgery (1 case). A total of 72 articular surfaces were evaluated. Radiographic, surgical or arthroscopic demonstration of chondrocalcinosis was used as the gold standard. Additionally, two fragments of the knee of a patient who underwent total knee replacement and demonstrated extensive chondrocalcinosis were studied with radiography and MRI using spin-echo T1-, T2- and proton-density-weighted images as well as two- and three-dimensional fat saturation (2D and 3D Fat Sat) gradient recalled echo (GRE) and STIR sequences. Results. MRI revealed multiple hypointense foci within the articular cartilage in 34 articular surfaces, better shown on 2D and 3D GRE sequences. Radiographs showed 12 articular surfaces with chondrocalcinosis. In three cases with arthroscopic or surgical correlation, MRI demonstrated more diffuse involvement of the articular cartilage than did the radiographs. The 3D Fat Sat GRE sequences were the best for demonstrating articular calcification in vitro. In no case was meniscal calcification identified with MRI. Hyperintense halos around some of the calcifications were seen on the MR images. Conclusion. MRI can depict articular cartilage calcification as hypointense foci using GRE techniques. Differential diagnosis includes loose bodies, post-surgical changes, marginal osteophytes and hemosiderin deposition. (orig.) With 4 figs., 14 refs.

  2. Fracture of the Fabella: An Uncommon Injury in Knee

    Directory of Open Access Journals (Sweden)

    Taoufik Cherrad

    2015-01-01

    Full Text Available The fabella is a sesamoid bone that may contribute to the stabilization of the posterolateral knee corner and it can very occasionally act as a source of atypical and rare knee pain and functional impairment. Fracture of the fabella is a rare but important clinical entity which may be overlooked clinically and radiographically. However, it causes an intermittent mechanical pain of the knee and it can mistakenly harm another knee pathology like intra-articular loose body. We report a case of a 21-year-old man who was sustaining a fracture of fabella following vehicle accident.

  3. Knee arthroscopy

    Science.gov (United States)

    ... be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year. If you also have arthritis in your knee, you will still have arthritis symptoms after surgery ...

  4. Knee Bursitis

    Science.gov (United States)

    ... volleyball — can increase your risk of knee bursitis. Runners can develop pain and inflammation in the pes anserine bursa, situated on the inner side of your knee below the joint. Obesity and osteoarthritis. Pes anserine bursitis, affecting the inner ...

  5. Aberrant Calreticulin Expression in Articular Cartilage of Dio2 Deficient Mice.

    Directory of Open Access Journals (Sweden)

    Nils Bomer

    Full Text Available To identify intrinsic differences in cartilage gene expression profiles between wild-type- and Dio2-/--mice, as a mechanism to investigate factors that contribute to prolonged healthy tissue homeostasis.Previously generated microarray-data (Illumina MouseWG-6 v2 of knee cartilage of wild-type and Dio2 -/- -mice were re-analyzed to identify differential expressed genes independent of mechanical loading conditions by forced treadmill-running. RT-qPCR and western blot analyses of overexpression and knockdown of Calr in mouse chondro-progenitor cells (ATDC5 were applied to assess the direct effect of differential Calr expression on cartilage deposition.Differential expression analyses of articular cartilage of Dio2-/- (N = 9 and wild-type-mice (N = 11 while applying a cutoff threshold (P |1,5| resulted in 1 probe located in Calreticulin (Calr that was found significantly downregulated in Dio2-/- mice (FC = -1.731; P = 0.044. Furthermore, overexpression of Calr during early chondrogenesis in ATDC5 cells leads to decreased proteoglycan deposition and corresponding lower Aggrecan expression, whereas knocking down Calr expression does not lead to histological differences of matrix composition.We here demonstrate that the beneficial homeostatic state of articular cartilage in Dio2-/- mice is accompanied with significant lower expression of Calr. Functional analyses further showed that upregulation of Calr expression could act as an initiator of cartilage destruction. The consistent association between Calr and Dio2 expression suggests that enhanced expression of these genes facilitate detrimental effects on cartilage integrity.

  6. Randomised controlled trial of referral to a telephone-based weight management and healthy lifestyle programme for patients with knee osteoarthritis who are overweight or obese: a study protocol.

    Science.gov (United States)

    O'Brien, Kate M; Wiggers, John; Williams, Amanda; Campbell, Elizabeth; Wolfenden, Luke; Yoong, Serene; Robson, Emma K; McAuley, James; Haskins, Robin; Kamper, Steven J; Williams, Christopher

    2016-03-03

    Knee osteoarthritis (OA) is one of the most common chronic diseases worldwide and is associated with significant pain and disability. Clinical practice guidelines consistently recommend weight management as a core aspect of care for overweight and obese patients with knee OA; however, provision of such care is suboptimal. Telephone-based interventions offer a novel approach to delivery of weight management care in these patients. The aim of the proposed study is to assess the effectiveness of referral to a telephone-based weight management and healthy lifestyle programme, previously shown to be effective in changing weight, in improving knee pain intensity in overweight or obese patients with knee OA, compared to usual care. A parallel, randomised controlled trial will be undertaken. Patients with OA of the knee who are waiting for an outpatient orthopaedic consultation at a tertiary referral public hospital within New South Wales, Australia, will be allocated to either an intervention or a control group (1:1 ratio). After baseline data collection, patients in the intervention group will receive a 6-month telephone-based intervention, and patients in the control group will continue with usual care. Surveys will be conducted at baseline, 6 and 26 weeks post-randomisation. The study requires 60 participants per group to detect a two-point difference in pain intensity (primary outcome) 26 weeks after baseline. The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015-0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. ACTRN12615000490572, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Arthroscopic knee anatomy in young achondroplasia patients

    Science.gov (United States)

    del Pilar Duque Orozco, M.; Record, N. C.; Rogers, K. J; Bober, M. B.; Mackenzie, W. G.; Atanda, A.

    2017-01-01

    Abstract Purpose Achondroplasia is the most common form of skeletal dysplasia, affecting more than 250 000 individuals worldwide. In these patients, the developing knee undergoes multiple anatomical changes. The purpose of this study was to characterise the intra-articular knee anatomy in children with achondroplasia who underwent knee arthroscopy. Methods Records of achondroplasia patients who underwent knee arthroscopy between 2009 and 2014 were reviewed. Demographic data, operative reports, follow-up notes, MRI and arthroscopy images were reviewed. Bony, cartilaginous and ligamentous changes were noted. The trochlea sulcus angle was measured from intra-operative arthroscopic images. Results A total of 12 knee arthroscopies in nine patients were performed. The mean age at surgery was 16.9 years (12 to 22). In all patients, the indication for surgery was knee pain and/or mechanical symptoms that were refractory to non-operative treatment. Three anatomical variations involving the distal femur were found in all knees: a deep femoral trochlea; a high A-shaped intercondylar notch; and a vertically oriented anterior cruciate ligament. The average trochlea sulcus angle measured 123°. Pathology included: synovial plica (one knee); chondral lesions (three knees); discoid lateral meniscus (11 knees); and meniscal tears (six knees). All patients were pain-free and returned to normal activity at final follow-up. Conclusion Children with achondroplasia have characteristic distal femur anatomy noted during knee arthroscopy. These variations should be considered normal during knee arthroscopy in these patients. Arthroscopic findings confirmed previous MRI findings within this specific population with the addition of a deep trochlear groove which was not previously reported. PMID:28828058

  8. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, ...

  9. Are external knee load and EMG measures accurate indicators of internal knee contact forces during gait?

    Science.gov (United States)

    Meyer, Andrew J; D'Lima, Darryl D; Besier, Thor F; Lloyd, David G; Colwell, Clifford W; Fregly, Benjamin J

    2013-06-01

    Mechanical loading is believed to be a critical factor in the development and treatment of knee osteoarthritis. However, the contact forces to which the knee articular surfaces are subjected during daily activities cannot be measured clinically. Thus, the ability to predict internal knee contact forces accurately using external measures (i.e., external knee loads and muscle electromyographic [EMG] signals) would be clinically valuable. We quantified how well external knee load and EMG measures predict internal knee contact forces during gait. A single subject with a force-measuring tibial prosthesis and post-operative valgus alignment performed four gait patterns (normal, medial thrust, walking pole, and trunk sway) to induce a wide range of external and internal knee joint loads. Linear regression analyses were performed to assess how much of the variability in internal contact forces was accounted for by variability in the external measures. Though the different gait patterns successfully induced significant changes in the external and internal quantities, changes in external measures were generally weak indicators of changes in total, medial, and lateral contact force. Our results suggest that when total contact force may be changing, caution should be exercised when inferring changes in knee contact forces based on observed changes in external knee load and EMG measures. Advances in musculoskeletal modeling methods may be needed for accurate estimation of in vivo knee contact forces. Copyright © 2012 Orthopaedic Research Society.

  10. [Intra-articular treatment with somatostatin 14 in rheumatoid arthritis].

    Science.gov (United States)

    Ciocci, A; Coari, G; Di Franco, M; Di Novi, M R; Mauceri, M T

    1994-12-01

    19 patients with RA underwent six intraarticular injections of 750 micrograms of Somatostatin 14 in one knee at 15-day intervals. In all patients some clinical parameters were evaluated: articular function, pain on pressure, spontaneous pain, pain on movement, duration of morning stiffness. Also some laboratory parameters were examined: complete blood cell count, ESR and CRP. An overall and significant improvement of the symptomatology of the treated knee was seen in all patients especially after the 3rd infiltration and still more after the 5th. At follow up 3 months after the end of treatment 12 patients were controlled, 11 of these showed a persistence of the improvement. No side-effects were seen.

  11. DINAMICS OF KNEE JOINT SPACE ASYMMETRY ON X-RAY AS A MARKER OF KNEE OSTEOARTHRITIS REHABILITATION EFFICACY.

    Science.gov (United States)

    Sheveleva, N; Minbayeva, L; Belyayeva, Y

    2017-03-01

    Reducing of articular cartilage functional volume in knee joint osteoarthritis occurs unevenly and accompanied with pathological changes of lower limb axis as a result of connective tissue and muscle structures dysfunction. Evaluation of X-ray knee joint space asymmetry seems to be informative to analyze the dynamics of lower extremities biomechanical imbalances characteristic for knee joint osteoarthritis. However, standardized method of X-ray joint space determining does not include its symmetry calculation. The purpose of the study was optimization of knee joint radiological examination by developing of X-ray knee joint space asymmetry index calculation method. The proposed method was used for comparative analysis of extracorporeal shock-wave therapy efficacy in 30 patients with knee joint osteoarthritis of 2-3 degrees (Kellgren-Lawrence, 1957). As a result of the conducted treatment statistically significant decrease of the X-ray knee joint space asymmetry index was observed (Me(Q1;Q3): Z=5.20, pX-ray positive dynamics comparable with clinical improvement. Thus, the X-ray knee joint space asymmetry index, calculated according to the proposed method, allows to evaluate dynamics of articular surfaces congruency changes and provide differentiated approach to the treatment of knee joint osteoarthritis.

  12. A STUDY OF EXTRA-ARTICULAR MANIFESTATIONS OF RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Harsha N. S

    2017-10-01

    Full Text Available BACKGROUND Diseases of musculoskeletal system are among the most common human afflictions. Rheumatoid Arthritis (RA is a systemic autoimmune disease of unknown aetiology characterised by symmetric erosive arthritis and in some cases extra-articular involvement. Characteristic feature of RA is persistent inflammatory synovitis usually involving peripheral joints in a symmetric distribution. The aim of the study is to study the extra-articular manifestations of Rheumatoid Arthritis (RA. MATERIALS AND METHODS 50 cases who satisfied the criteria for diagnosis of RA laid down by the American Rheumatism Association Criteria were selected. They were studied for evidence of extra-articular manifestations by clinical, biochemical, radiological, echocardiographic and pulmonary function tests. Data was collected and analysis was made using various statistical parameters. RESULTS Among the 50 cases of RA studied, the disease was common in females and maximum incidence was seen between 30-39 years of age (30%. Morning stiffness, pain and swelling in the joints were the commonest presenting symptoms. The joints of the hand (70% were the most commonly involved followed by wrist, knee, ankle and foot joints. In the present study, 28 (56% had extra-articular manifestations with more incidence in males than females. The commonest one was anaemia (20% followed by cardiac involvement (12%. Next, in the order of involvement were pulmonary, lymphadenopathy, vasculitis and rheumatoid nodule. Pericardial effusion was the most common cardiac finding followed by mitral regurgitation and aortic regurgitation. RA factor was positive in 33 (66% cases. All the patients who had extra-articular manifestation had RA factor positive. CONCLUSION Although, the rheumatoid arthritis was common among females, the extra-articular manifestations were common among males. Longer duration of disease and positive RA factor were associated with higher incidence of extra-articular

  13. Secondary Knee Osteoarthritis due to Neurofibromatosis Type 1 Treated with above the Knee Amputation: A Case Report

    Directory of Open Access Journals (Sweden)

    Jay Patel

    2013-01-01

    Full Text Available Background. Neurofibromatosis Type 1 (NF-1 has a variety of associated orthopaedic manifestations that have been previously reported. We report a case of severe, grade 4 knee osteoarthritis (OA with recurrent subluxation and joint laxity due to multiple extra-articular neurofibromas ultimately treated with Above the Knee Amputation (AKA. Case Description. A 39-year-old man presented with multiple neurofibromas and lymphedema leading to degenerative changes of the knee. Conservative treatment failed due to the severity of the knee degeneration and patient discomfort. Likewise, arthroplasty was not possible due to poor bone quality and joint instability. Therefore, AKA was selected to relieve symptoms and provide functional improvement. six months after the procedure the patient has increased functional capacity for ambulation and activities of daily living, as well as significant decrease in pain and discomfort. Clinical Relevance. Extra-articular neurofibromas causing severe secondary OA in relatively young patients can be functionally improved with AKA and prosthetic device use.

  14. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  15. Radiologic findings of hemophilic arthropathy of the knee : Focusing on MR imaging and plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Jin; Choi, Jae Young; Cha, Sung Suk; Eun, Choong Kie [Inje Univ., College of Medicine, Pusan (Korea, Republic of); Park, Dong Woo [Hanyang Univ., College of Medicine, Seoul (Korea, Republic of)

    1996-12-01

    To evaluate the characteristic MR findings of hemophilic arthropathy of the knee. Seven keens in six patients with hemophilia (five hemophilia A and one hemophilia B) were retrospectively studied with MR images and plain radiographs. Patients were aged between 2 and 20 years (mean, 11) and all had a clinical history of repeated hemarthrosis. MR images of the knee were analyzed with respect to intra- and extra-articular hemorrhage, the state of synovial tissue, articular cartilage, bone, menisci, and ligaments. Synovial hypertrophy and articular cartilage destruction were revealed in all seven knees ; pannus was found in four, and was seen as low signal intensity on T1-weighted image and high signal intensity on T2-weighted images. All five instances of synovial hypertrophy and pannus were enhanced. Joint effusion, presented in five of seven knees, demonstrated slightly low signal intensity on T1-weighted image and high signal intensity on T2-weighted images, and was associated with peripheral low signal intensity of hemosiderin. Subchondral and marginal erosion was seen in six cases, patellar deformity in three, meniscal damage in four and cruciate ligament damage in one case. MR is superior to radiography in demonstrating chronic repeated hemarthrosis (manifested as thick intra-articular effusion), hemosidering, synovial hypertrophy, erosion or destruction of articular cartilage and bone, and meniscal or cruciate ligament injury of hemophilic arthropathy of the knee. MR is therefore thought to be a useful imaging study for accurate evaluation of hemophilic arthropathy of the knee.

  16. The Evaluation of Changes in The Knee Meniscus in vivo at 3T MRI Scanner

    Directory of Open Access Journals (Sweden)

    Lenka Horňáková

    2015-08-01

    Full Text Available Noninvasive imagining of the knee meniscus without the use of the contrast agents is more difficult compared to articular cartilage. Despite the lower signal intensity of the knee meniscus, MRI is considered the best non-invasive imaging method. Thanks to the lower water content in the meniscus compared to the surrounding tissues, it can be distinguished from the environment, but the determination of the boundaries is more complicated than in articular cartilage. There are many studies dealing with the MR imaging of the loaded and also unloaded knee, but they have mainly observed quantitative and geometric changes (movement or deformation of tissue, not targeted qualitative changes in the extracellular matrix (ECM. These changes can be evaluated with T2 relaxation times, which are more sensitive to the interaction of water molecules and the concentration of macromolecules and structures of the ECM, especially in the interaction based on the content, orientation and anisotropy of collagen fibers. Fluid and tissues with the higher water content level have long relaxation time T2. In the healthy meniscus these times are shorter; the reason is a highly organized structure of collagen and lower content of proteoglycans. To quantitatively detect changes, it is necessary to assure a sufficiently high resolution of images throughout choosing appropriate pulse sequences. After that, the acquired data can be processed to produce the T2 maps, to portray non-invasive collagen content, architecture of the ROI, changes in the water content (distribution of interstitial water in the solid matrix and the spatial variation in depth. The aim of this work is firstly to introduce the meaning of T2 relaxation and methods for calculating T2 relaxation times. Further, the aim of this work is to give a brief description of the current pulse sequences used to display menisci.

  17. [Bionic design of articular cartilage].

    Science.gov (United States)

    Qin, Jun; Zhang, Wenguang; Wu, Gang; Wang, Chengtao

    2008-02-01

    Natural articular cartilage is well known as a special connective tissue with multiple effects and functions, which are important and irreplaceable, in human synovial joints. Biomedical, histological and pathological characteristics of articular cartilage, as well as biomaterial, biomechanical and bio-tribological properties thereof, are summarized from a novel aspect of bionics. Bionic design of articualr cartilage at macro-level and micro-level is carried out from three aspects, i.e., structure, material, and function; and a bionic design model of articular cartilage is set up. As a result, this basic research would be helpful to providing theoretical and practical basis for innovational design and manufacturing of new-style artificial joint with "soft-cushion bearing", and of bionic artificial cartilage.

  18. Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Tahami

    2015-10-01

    Full Text Available Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. Method: After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling and microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. Results: The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 year in group 1 and 23.26 points after 6 months and 30.66 after 1 year in group 2, whict was statistically significant (Pvalue

  19. Jumper's Knee (Patellar Tendonitis)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee KidsHealth / For Teens / Jumper's Knee What's in this ... continued damage to the knee. How Does the Knee Work? To understand how jumper's knee happens, it ...

  20. Primary total knee arthroplasty for acute fracture around the knee.

    Science.gov (United States)

    Parratte, S; Ollivier, M; Argenson, J-N

    2018-02-01

    Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high

  1. A variational method for automatic localization of the most pathological ROI in the knee cartilage

    Science.gov (United States)

    Qazi, Arish A.; Dam, Erik B.; Loog, Marco; Nielsen, Mads; Lauze, Francois; Christiansen, Claus

    2008-03-01

    Osteoarthritis (OA) is a degenerative joint disease characterized by degradation of the articular cartilage, and is a major cause of disability. At present, there is no cure for OA and currently available treatments are directed towards relief of symptoms. Recently it was shown that cartilage homogeneity visualized by MRI and representing the biochemical changes undergoing in the cartilage is a potential marker for early detection of knee OA. In this paper based on homogeneity we present an automatic technique, embedded in a variational framework, for localization of a region of interest in the knee cartilage that best indicates where the pathology of the disease is dominant. The technique is evaluated on 283 knee MR scans. We show that OA affects certain areas of the cartilage more distinctly, and these are more towards the peripheral region of the cartilage. We propose that this region in the cartilage corresponds anatomically to the area covered by the meniscus in healthy subjects. This finding may provide valuable clues in the pathology and the etiology of OA and thereby may improve treatment efficacy. Moreover our method is generic and may be applied to other organs as well.

  2. The anterolateral complex of the knee: a pictorial essay.

    Science.gov (United States)

    Herbst, Elmar; Albers, Marcio; Burnham, Jeremy M; Shaikh, Humza S; Naendrup, Jan-Hendrik; Fu, Freddie H; Musahl, Volker

    2017-04-01

    Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.

  3. Total knee arthroplasty for posttraumatic osteoarthritis in military personnel under age 50.

    Science.gov (United States)

    Murtha, Andrew S; Johnson, Anthony E; Buckwalter, Joseph A; Rivera, Jessica C

    2017-03-01

    United States military personnel frequently suffer knee injuries. The resulting progressive posttraumatic osteoarthritis (PTOA) causes significant disability in these young high-demand patients for which total knee arthroplasty (TKA) is the only effective treatment of their pain and impairment. Yet the use of this option for treatment of PTOA has not been studied. This retrospective review identified 74 knees in 64 U.S. military personnel who underwent TKA at ≤50 years of age during an 8-year period at a tertiary-care, academic, military medical center. Fifty-five knees (74.3%) experienced one or more prior ligamentous, meniscal, or chondral injuries prior to arthroplasty. Only one subject had a history of osteochondral intra-articular fracture. The average at injury was 29.2 years (95%CI of ±2.50) with an average age at arthroplasty of 44.3 years (±1.11). The most common injury was anterior cruciate ligament rupture (n = 19) with a mean time to TKA of 23.1 (±10.54) and 18.8 years (±7.01) when concomitant meniscal pathology was noted. Nineteen patients were noted to have radiographic and symptomatic end-stage osteoarthritis without a specified etiology at 41.4 years (±1.47) and underwent subsequent TKA. This is the first study to evaluate treatment of end-stage PT OA in young people treated with TKA, finding that the incidence of PTOA as an indication for arthroplasty is significantly higher than among civilians. In this otherwise healthy, high-demand patient population, the rate of OA progression following knee injury is accelerated and the long term implications can be career and life altering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:677-681, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. The effects of geometric uncertainties on computational modelling of knee biomechanics

    OpenAIRE

    Meng, Q; Fisher, J; Wilcox, RK

    2017-01-01

    The geometry of the articular components of the knee is an important factor in predicting joint mechanics in computational models. There are a number of uncertainties in the definition of the geometry of cartilage and meniscus, and evaluating the effects of these uncertainties is fundamental to understanding the level of reliability of the models. In this study, the sensitivity of knee mechanics to geometric uncertainties was investigated by comparing polynomial-based and image-based knee mod...

  5. The relationship between ultra-short telomeres, aging of articular cartilage and the development of human hip osteoarthritis

    DEFF Research Database (Denmark)

    Harbo, M; Delaisse, J M; Kjaersgaard-Andersen, P

    2013-01-01

    Ultra-short telomeres caused by stress-induced telomere shortening are suggested to induce chondrocyte senescence in human osteoarthritic knees. Here we have further investigated the role of ultra-short telomeres in the development of osteoarthritis (OA) and in aging of articular cartilage in human...

  6. Effects of Neuromuscular Fatigue on Quadriceps Strength and Activation and Knee Biomechanics in Individuals Post-Anterior Cruciate Ligament Reconstruction and Healthy Adults.

    Science.gov (United States)

    Thomas, Abbey C; Lepley, Lindsey K; Wojtys, Edward M; McLean, Scott G; Palmieri-Smith, Riann M

    2015-12-01

    Laboratory-based experiment using a pretest/posttest design. To determine the effects of neuromuscular fatigue on quadriceps strength and activation and sagittal and frontal plane knee biomechanics during dynamic landing following anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps central activation occurs post-ACLR, likely altering lower extremity biomechanics. Neuromuscular fatigue similarly reduces volitional muscle activation and impairs neuromuscular control. Upon return to full activity post-ACLR, individuals likely concurrently experience quadriceps central activation deficits and neuromuscular fatigue, though the effects of fatigue on muscle strength and activation and biomechanics post-ACLR are unknown. Seventeen individuals 7 to 10 months post-ACLR and 16 controls participated. Quadriceps strength and central activation ratio were recorded prefatigue and postfatigue, which was induced via sets of double-leg squats. Knee biomechanics were recorded during a dynamic landing activity prefatigue and postfatigue. Both groups demonstrated smaller knee flexion (initial contact, P = .017; peak, P = .004) and abduction (initial contact, P = .005; peak, P = .009) angles postfatigue. The ACLR group had smaller peak knee flexion angles (Pbiomechanics were present postfatigue in both groups, suggesting that neuromuscular fatigue may increase noncontact ACL injury risk. However, these changes were not exaggerated in those post-ACLR, likely because they already demonstrated a stiff-legged landing strategy prefatigue.

  7. Open Reduction of Neglected Knee Dislocation: Case Report of a Rare Injury

    Directory of Open Access Journals (Sweden)

    Kapil Mani KC

    2016-11-01

    Full Text Available Old neglected dislocation of knee joint is a rare injury. Any orthopaedic surgeon would have faced only a few cases of unreduced neglected dislocation in his life time practice. We report the case of a 30-year old male patient with one month old unreduced knee dislocation which was managed with open reduction and stabilization with two intra-articular crossed Steinman pins for six weeks, followed by removal of the pins and gradual weight bearing in hinged knee brace. At the end of one year, range of movement of knee joint was 0 to 50 degree with minimal knee pain on walking.

  8. Muscle contributions to knee extension in the early stance phase in patients with knee osteoarthritis.

    Science.gov (United States)

    Ogaya, Shinya; Kubota, Ryo; Chujo, Yuta; Hirooka, Eiko; Kwang-Ho, Kim; Hase, Kimitaka

    2017-10-01

    The aim of this study was to analyze individual muscle contributions to knee angular acceleration using a musculoskeletal simulation analysis and evaluate knee extension mechanics in the early stance phase in patients with knee osteoarthritis (OA). The subjects comprised 15 patients with medial knee OA and 14 healthy elderly individuals. All participants underwent gait performance test using 8 infrared cameras and two force plates to measure the kinetic and kinematic data. The simulation was driven by 92 Hill-type muscle-tendon units of the lower extremities and a trunk with 23° of freedom. We analyzed each muscle contribution to knee angular acceleration in the 5%-15% and 15%-25% periods of the stance phase (% SP) using an induced acceleration analysis. We compared accelerations by individual muscles between the two groups using an analysis of covariance for controlling gait speed. Patients with knee OA had a significantly lesser knee extension acceleration by the vasti muscles and higher knee acceleration by hip adductors than those in controls in 5-15% SP. In addition, knee OA resulted in significantly lesser knee extension acceleration by the vasti muscles in 15-25% SP. These results indicate that patients with knee OA have decreased dependency on the vasti muscles to control knee movements during early stance phase. Hip adductor muscles, which mainly control mediolateral motion, partly compensate for the weak knee extension by the vasti muscles in patients with knee OA. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects.

    Science.gov (United States)

    Rice, David A; McNair, Peter J; Lewis, Gwyn N

    2011-01-01

    A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether γ-loop dysfunction contributes to AMI in people with knee joint OA. Fifteen subjects with knee joint OA and 15 controls with no history of knee joint pathology participated in this study. Quadriceps and hamstrings peak isometric torque (Nm) and electromyography (EMG) amplitude were collected before and after 20 minutes of 50 Hz vibration applied to the infrapatellar tendon. Between-group differences in pre-vibration torque were analysed using a one-way analysis of covariance, with age, gender and body mass (kg) as the covariates. If the γ-loop is intact, vibration should decrease torque and EMG levels in the target muscle; if dysfunctional, then torque and EMG levels should not change following vibration. One-sample t tests were thus undertaken to analyse whether percentage changes in torque and EMG differed from zero after vibration in each group. In addition, analyses of covariance were utilised to analyse between-group differences in the percentage changes in torque and EMG following vibration. Pre-vibration quadriceps torque was significantly lower in the OA group compared with the control group (P = 0.005). Following tendon vibration, quadriceps torque (P 0.299). Hamstrings torque and EMG amplitude were unchanged in both groups (all P > 0.204). The vibration-induced changes in quadriceps torque and EMG were significantly different between the OA and control groups (all P torque or EMG (all P > 0.554). γ-loop dysfunction may contribute to AMI in individuals with knee joint OA, partially explaining the marked quadriceps weakness and atrophy that is often observed in this population.

  10. Functional Outcomes of the Knee after Retrograde and Antegrade ...

    African Journals Online (AJOL)

    currently considered the gold standard for treatment of femur shaft fractures although retrograde technique is gaining acceptance. Although introducing the nail through the knee has potential to damage the intra articular structures, several reports have indicated acceptable functional outcome. The results are not known in ...

  11. Functional Outcomes of the Knee after Retrograde and Antegrade ...

    African Journals Online (AJOL)

    Background: Antegrade intramedullary nailing is currently considered the gold standard for treatment of femur shaft fractures although retrograde technique is gaining acceptance. Although introducing the nail through the knee has potential to damage the intra articular structures, several reports have indicated acceptable ...

  12. Clinical efficacy of native drug Adgelon in knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    R M Balabanova

    2009-01-01

    Full Text Available Results of treatment of 76 pts with knee osteoarthritis with native drug Adgelon (glycoprotein possessing biological activity at super low doses are presented. WOMAC index, Lequesne functional index and SF-36 questionnaire show analgesic effect and quality of life improvement after 6 intra-articular adgelon injections during 3 weeks. Subsequent follow up for 2 months revealed aftereffect of the drug.

  13. Postnatal development of articular cartilage

    NARCIS (Netherlands)

    Turnhout, van M.C.

    2010-01-01

    Articular cartilage (AC) is the thin layer of tissue that covers the ends of the bones in the synovial joints in mammals. Functional adult AC has depth-dependent mechanical properties that are not yet present at birth. These depth-dependent mechanical properties in adult life are the result of a

  14. Quantitative characterization of articular cartilage using Mueller matrix imaging and multiphoton microscopy.

    Science.gov (United States)

    Ellingsen, Pål Gunnar; Lilledahl, Magnus Borstad; Aas, Lars Martin Sandvik; Davies, Catharina de Lange; Kildemo, Morten

    2011-11-01

    The collagen meshwork in articular cartilage of chicken knee is characterized using Mueller matrix imaging and multiphoton microscopy. Direction and degree of dispersion of the collagen fibers in the superficial layer are found using a Fourier transform image-analysis technique of the second-harmonic generated image. Mueller matrix images are used to acquire structural data from the intermediate layer of articular cartilage where the collagen fibers are too small to be resolved by optical microscopy, providing a powerful multimodal measurement technique. Furthermore, we show that Mueller matrix imaging provides more information about the tissue compared to standard polarization microscopy. The combination of these techniques can find use in improved diagnosis of diseases in articular cartilage, improved histopathology, and additional information for accurate biomechanical modeling of cartilage.

  15. Irrigating solutions used in arthroscopy and their effect on articular cartilage. An in vivo study

    Energy Technology Data Exchange (ETDEWEB)

    Arciero, R.A.; Little, J.S.; Liebenberg, S.P.; Parr, T.J.

    1986-11-01

    The effect of arthroscopic irrigating solutions on articular cartilage was determined by the use of an animal model. Rabbit knee joints were irrigated continuously for two hours with either normal saline, Ringer's lactate, or sterile water. Subsequently, the rate of incorporation of /sup 35/SO/sub 4/ by articular cartilage was used to measure the effect of the irrigants on chondrocyte metabolism. In addition, the irrigated groups were compared to an unirrigated control group. There was no significant difference in /sup 35/SO/sub 4/ incorporation between the groups. This suggested that none of the irrigating solutions used in this study adversely affected articular cartilage function. On the basis of these findings, it appears that normal saline, Ringer's lactate, and sterile water can be safely used as irrigating solutions during most arthroscopic procedures.

  16. Couple Control Model Implementation on Antagonistic Mono- and Bi-Articular Actuators

    CERN Document Server

    Prattico, Flavio; Yamamoto, Shin-ichiroh

    2014-01-01

    Recently, robot assisted therapy devices are increasingly used for spinal cord injury (SCI) rehabilitation in assisting handicapped patients to regain their impaired movements. Assistive robotic systems may not be able to cure or fully compensate impairments, but it should be able to assist certain impaired functions and ease movements. In this study, a couple control model for lower-limb orthosis of a body weight support gait training system is proposed. The developed leg orthosis implements the use of pneumatic artificial muscle as an actuation system. The pneumatic muscle was arranged antagonistically to form two pair of mono-articular muscles (i.e., hip and knee joints), and a pair of bi-articular actuators (i.e., rectus femoris and hamstring). The results of the proposed couple control model showed that, it was able to simultaneously control the antagonistic mono- and bi-articular actuators and sufficiently performed walking motion of the leg orthosis.

  17. Accuracy evaluation of automatic quantification of the articular cartilage surface curvature from MRI

    DEFF Research Database (Denmark)

    Folkesson, Jenny; Dam, Erik B; Olsen, Ole F

    2007-01-01

    RATIONALE AND OBJECTIVES: To study the articular cartilage surface curvature determined automatically from magnetic resonance (MR) knee scans, evaluate accuracy of the curvature estimates on digital phantoms, and an evaluation of their potential as disease markers for different stages of osteoart......RATIONALE AND OBJECTIVES: To study the articular cartilage surface curvature determined automatically from magnetic resonance (MR) knee scans, evaluate accuracy of the curvature estimates on digital phantoms, and an evaluation of their potential as disease markers for different stages...... for intersubject comparisons. Digital phantoms were created to establish the accuracy of the curvature estimation methods. RESULTS: A comparison of the two curvature estimation methods to ground truth yielded absolute pairwise differences of 1.1%, and 4.8%, respectively. The interscan reproducibility for the two...

  18. How does knee pain affect trunk and knee motion during badminton forehand lunges?

    Science.gov (United States)

    Huang, Ming-Tung; Lee, Hsing-Hsan; Lin, Cheng-Feng; Tsai, Yi-Ju; Liao, Jen-Chieh

    2014-01-01

    Badminton requires extensive lower extremity movement and a precise coordination of the upper extremity and trunk movements. Accordingly, this study investigated motions of the trunk and the knee, control of dynamic stability and muscle activation patterns of individuals with and without knee pain. Seventeen participants with chronic knee pain and 17 healthy participants participated in the study and performed forehand forward and backward diagonal lunges. This study showed that those with knee pain exhibited smaller knee motions in frontal and horizontal planes during forward lunge but greater knee motions in sagittal plane during backward lunge. By contrast, in both tasks, the injured group showed a smaller value on the activation level of the paraspinal muscles in pre-impact phase, hip-shoulder separation angle, trunk forward inclination range and peak centre of mass (COM) velocity. Badminton players with knee pain adopt a more conservative movement pattern of the knee to minimise recurrence of knee pain. The healthy group exhibit better weight-shifting ability due to a greater control of the trunk and knee muscles. Training programmes for badminton players with knee pain should be designed to improve both the neuromuscular control and muscle strength of the core muscles and the knee extensor with focus on the backward lunge motion.

  19. Total Knee Replacement

    Science.gov (United States)

    2005-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness, in terms of pain reduction and functional improvement, and costing of total knee replacement (TKR) for people with osteoarthritis for whom less invasive treatments (such as physiotherapy, analgesics, anti-inflammatory drugs, intra-articular steroids, hyaluronic acids, and arthroscopic surgery) have failed. Clinical Need Osteoarthritis affects an estimated 10% to 12% of Canadian adults. The therapeutic goals of osteoarthritis treatment are to improve joint mobility and reduce pain. Stepwise treatment options include exercise, weight loss, physiotherapy, analgesics, anti-inflammatory drugs, intra-articular steroids and hyaluronic acids, arthroscopic surgery, and, in severe cases, total joint replacement with follow-up rehabilitation. These treatments are delivered by a range of health care professionals, including physiotherapists, occupational therapists, family physicians, internists, rheumatologists, and orthopedic surgeons. TKR is an end-of-line treatment for patients with severe pain and functional limitations. More women than men undergo knee replacement, and most patients are between 55 and 84 years old. The Technology TKR is a surgical procedure in which an artificial joint or prosthesis replaces a damaged knee joint. The primary indication for TKR is pain, followed by functional limitation. Usually, a person’s daily activities must be substantially affected by pain and functional limitations for him or her to be considered a candidate for TKR. There are 3 different types of knee replacement prostheses. Non-constrained prostheses use the patient’s ligaments and muscles to provide the stability for the prosthesis. Semi-constrained prostheses provide some stability for the knee and do not rely entirely on the patient’s ligaments and muscles to provide the stability. Constrained prostheses are for patients whose ligaments and muscles are not able to provide stability for

  20. MR imaging of autologous chondrocyte implantation of the knee

    Energy Technology Data Exchange (ETDEWEB)

    James, S.L.J.; Connell, D.A.; Saifuddin, A.; Skinner, J.A.; Briggs, T.W.R. [RNOH Stanmore, Department of Radiology, Stanmore, Middlesex (United Kingdom)

    2006-05-15

    Autologous chondrocyte implantation (ACI) is a surgical technique that is increasingly being used in the treatment of full-thickness defects of articular cartilage in the knee. It involves the arthroscopic harvesting and in vitro culture of chondrocytes that are subsequently implanted into a previously identified chondral defect. The aim is to produce a repair tissue that closely resembles hyaline articular cartilage that gradually becomes incorporated, restoring joint congruity. Over the long term, it is hoped that this will prevent the progression of full-thickness articular cartilage defects to osteoarthritis. This article reviews the indications and operative procedure performed in ACI. Magnetic resonance imaging (MRI) sequences that provide optimal visualization of articular cartilage in the post-operative period are discussed. Normal appearances of ACI on MRI are presented along with common complications that are encountered with this technique. (orig.)

  1. Dynamic compressive properties of bovine knee layered tissue

    Science.gov (United States)

    Nishida, Masahiro; Hino, Yuki; Todo, Mitsugu

    2015-09-01

    In Japan, the most common articular disease is knee osteoarthritis. Among many treatment methodologies, tissue engineering and regenerative medicine have recently received a lot of attention. In this field, cells and scaffolds are important, both ex vivo and in vivo. From the viewpoint of effective treatment, in addition to histological features, the compatibility of mechanical properties is also important. In this study, the dynamic and static compressive properties of bovine articular cartilage-cancellous bone layered tissue were measured using a universal testing machine and a split Hopkinson pressure bar method. The compressive behaviors of bovine articular cartilage-cancellous bone layered tissue were examined. The effects of strain rate on the maximum stress and the slope of stress-strain curves of the bovine articular cartilage-cancellous bone layered tissue were discussed.

  2. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

    Science.gov (United States)

    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2017-05-01

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Associations between muscle perfusion and symptoms in knee osteoarthritis

    DEFF Research Database (Denmark)

    Bandak, E; Boesen, M; Bliddal, H

    2015-01-01

    was quantified by DCE-MRI in KOA. Regions of interest (ROI) were drawn around the peri-articular muscles, summed and averaged into one single "Total Muscle Volume" volume of interest (VOI). Symptoms were assessed via the Knee injury and Osteoarthritis Outcome Score (KOOS) (0: worst; 100: best). RESULTS: DCE......OBJECTIVE: To investigate the association between muscle perfusion in the peri-articular knee muscles assessed by dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and symptoms in patients with knee osteoarthritis (KOA). DESIGN: In a cross-sectional setting, muscle perfusion......-MRI and clinical data were analyzed in 94 patients. The typical participant was a woman with a mean age of 65 years, and a body mass index (BMI) of 32 kg/m(2). Reduced multiple regression models analyzing the association between KOOS and DCE-MRI perfusion variables of Total Muscle Volume showed a statistically...

  4. A case of synovial lipomatosis with chronic synovitis presenting as acute knee pain

    Directory of Open Access Journals (Sweden)

    Sushma HM, Anoosha K, Vijay Shankar S, Amita K

    2014-07-01

    Full Text Available Background: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion characterized by villous proliferation of the synovium, most commonly affecting the knee joint. The usual presentation is long standing progressive swelling of the affected joint, with or without pain and restriction of movements. Histopathology is confirmatory. Case Report: We present the case of a 35- year old male patient with long standing history of swelling, short history of pain in the left knee joint. X-Ray and magnetic resonance imaging scans of the left knee showed the characteristic features of synovial lipomatosis with chronic synovitis. The patient underwent diagnostic arthroscopy with lavage of left knee joint. Histopathological study confirmed synovial lipomatosis with chronic synovitis. Conclusion: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion. Although rare, clinically it should be considered as an important differential in evaluating neoplastic and non- neoplastic conditions of the knee joint.

  5. Articular cartilage bioreactors and bioprocesses.

    Science.gov (United States)

    Darling, Eric M; Athanasiou, Kyriacos A

    2003-02-01

    This review summarizes the major approaches for developing articular cartilage, using bioreactors and mechanical stimuli. Cartilage cells live in an environment heavily influenced by mechanical forces. The development of cartilaginous tissue is dependent on the environment that surrounds it, both in vivo and in vitro. Chondrocytes must be cultured in a way that gives them the proper concentration of nutrients and oxygen while removing wastes. A mechanical force must also be applied during the culturing process to produce a phenotypically correct tissue. Four main types of forces are currently used in cartilage-culturing processes: hydrostatic pressure, direct compression, "high"-shear fluid environments, and "low"-shear fluid environments. All these forces have been integrated into culturing devices that serve as bioreactors for articular cartilage. The strengths and weaknesses of each device and stimulus are explored, as is the future of cartilage bioreactors.

  6. Label-free characterization of articular cartilage in osteoarthritis model mice by Raman spectroscopy

    Science.gov (United States)

    Oshima, Yusuke; Akehi, Mayu; Kiyomatsu, Hiroshi; Miura, Hiromasa

    2017-02-01

    Osteoarthritis (OA) is very common joint disease in the aging population. Main symptom of OA is accompanied by degenerative changes of articular cartilage. Cartilage contains mostly type II collagen and proteoglycans, so it is difficult to access the quality and morphology of cartilage tissue in situ by conventional diagnostic tools (X-ray, MRI and echography) directly or indirectly. Raman spectroscopy is a label-free technique which enables to analyze molecular composition in degenerative cartilage. In this study, we generated an animal OA model surgically induced by knee joint instability, and the femurs were harvested at two weeks after the surgery. We performed Raman spectroscopic analysis for the articular cartilage of distal femurs in OA side and unaffected side in each mouse. In the result, there is no gross findings in the surface of the articular cartilage in OA. On the other hand, Raman spectral data of the articular cartilage showed drastic changes in comparison between OA and control side. The major finding of this study is that the relative intensity of phosphate band (960 cm-1) increases in the degenerative cartilage. This may be the result of exposure of subchondral bone due to thinning of the cartilage layer. In conclusion, Raman spectroscopic technique is sufficient to characterize articular cartilage in OA as a pilot study for Raman application in cartilage degeneration and regeneration using animal models and human subjects.

  7. Synovial haemangioma of the knee joint: an unusual cause of knee pain in a 14-month old girl

    Energy Technology Data Exchange (ETDEWEB)

    Wen, D.W.; Rasheed, S. [KK Women' s and Children' s Hospital, Department of Diagnostic and Interventional Imaging, Singapore (Singapore); Tan, T.J. [Changi General Hospital, Department of Radiology, Singapore (Singapore)

    2016-06-15

    We report a histologically proven case of synovial haemangioma of the knee in a 14-month old girl who presented to the emergency department with an acute 1-day history of refusing to weight-bear on the right leg and a preceding 3-week history of a right knee lump. Physical examination revealed a non-tender, soft lump over the lateral infrapatellar region. Radiographs revealed a poorly defined soft tissue density over the infrapatellar fat pad and a suprapatellar joint effusion. Ultrasound was used to confirm the presence of a vascular soft tissue mass compatible with a synovial haemangioma within the infrapatellar fat pad which showed both intra-articular and extra-articular extension. There was good correlation of the ultrasound findings with magnetic resonance imaging (MRI), highlighting the potential clinical utility of ultrasound as an alternative imaging modality in establishing the pre-operative diagnosis and extent of a synovial haemangioma about the knee joint. (orig.)

  8. Knee disarticulation

    Directory of Open Access Journals (Sweden)

    Antun Muljačić

    2009-08-01

    Full Text Available In this paper we presented three patients withknee disarticulation performed according toBaumgartner. The Baumgartner tehnique and theapplication of knee disarticulation prosthesis appearedto be superior in comparisson with othermethods.

  9. Tensorial Electrokinetics in Articular Cartilage

    Science.gov (United States)

    Reynaud, Boris; Quinn, Thomas M.

    2006-01-01

    Electrokinetic phenomena contribute to biomechanical functions of articular cartilage and underlie promising methods for early detection of osteoarthritic lesions. Although some transport properties, such as hydraulic permeability, are known to become anisotropic with compression, the direction-dependence of cartilage electrokinetic properties remains unknown. Electroosmosis experiments were therefore performed on adult bovine articular cartilage samples, whereby fluid flows were driven by electric currents in directions parallel and perpendicular to the articular surface of statically compressed explants. Magnitudes of electrokinetic coefficients decreased slightly with compression (from ∼−7.5 μL/As in the range of 0–20% compression to −6.0 μL/As in the 35–50% range) consistent with predictions of microstructure-based models of cartilage material properties. However, no significant dependence on direction of the electrokinetic coupling coefficient was detected, even for conditions where the hydraulic permeability tensor is known to be anisotropic. This contrast may also be interpreted using microstructure-based models, and provides insights into structure-function relationships in cartilage extracellular matrix and physical mediators of cell responses to tissue compression. Findings support the use of relatively simple isotropic modeling approaches for electrokinetic phenomena in cartilage and related materials, and indicate that measurement of electrokinetic properties may provide particularly robust means for clinical evaluation of cartilage matrix integrity. PMID:16798804

  10. Comparison of drain clamp after bilateral total knee arthroplasty.

    Science.gov (United States)

    Madadi, Firooz; Mehrvarz, Amir Sarshekeh; Madadi, Firoozeh; Boreiri, Majid; Abachizadeh, Kambiz; Ershadi, Ali

    2010-12-01

    Suction drains provide an easy and feasible method for controlling hemorrhage after total knee arthroplasty. However, there has been no compromise regarding the optimum clamping time for these drains. We conducted a randomized clinical trial in 50 patients to compare 12-hour drain clamping and continuous drainage after total knee arthroplasty in terms of wound complications, blood loss, and articular arc of motion. To eliminate any other factor except duration of clamping, we chose to compare only knees belonging to a single patient and to restrict the study to those knees undergoing surgery due to osteoarthritis. From a total of 100 knees (50 patients) studied, the 12-hour-clamping method resulted in a significantly smaller amount of postoperative blood loss (p < 0.001). The passive ranges of motion and wound complications were not significantly different between the two groups.

  11. A rare case of a swollen knee due to disseminated synovial chondromatosis: a case report

    Directory of Open Access Journals (Sweden)

    Gulati Vivek

    2010-04-01

    Full Text Available Abstract Introduction A synovial chondromatosis is a rare benign neoplasm on the synovium. Although described as a benign disease, it can be very destructive and can cause severe osteoarthritis and pain. To the best of our knowledge, we report the first known case of an extensive presentation of this intra-articular and extra-articular disease of the knee joint. Case presentation A 49-year-old Caucasian man presented with right knee pain and stiffness caused by diffuse intra-articular and extra-articular synovial chondromatosis. He underwent careful preoperative imaging and planning followed by a two-stage arthroscopic and open procedure in order to completely eradicate the disease. He has regained full range of movement, but continues to experience residual pain due to severe osteoarthritis. Conclusions Although synovial chondromatosis is described as a benign disease, it can be very destructive and debilitating. A challenging management dilemma arises when confronted with both synovial chondromatosis and osteoarthritis.

  12. Knee Injuries and Disorders

    Science.gov (United States)

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

  13. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Christensen, Malene; Christensen, Stine Sommer

    2010-01-01

    BACKGROUND AND PURPOSE: Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter......-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. METHOD......: The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were...

  14. Knee cartilage morphologic characteristics and muscle status of professional weight lifters and sprinters: a magnetic resonance imaging study.

    Science.gov (United States)

    Gratzke, Christian; Hudelmaier, Martin; Hitzl, Wolfgang; Glaser, Christian; Eckstein, Felix

    2007-08-01

    Whereas muscle and bone mass have been shown to strongly depend on mechanical stimulation (loading history), this relationship has not been established for articular cartilage. Subjects with high muscle strength display thicker knee cartilage and larger joint surface areas than nonathletic volunteers, and knee cartilage morphologic characteristics correlate more strongly with muscle force than with muscle cross-sectional areas. Cross-sectional study; Level of evidence, 3. Fourteen young, healthy adult professional athletes (7 weight lifters and 7 bobsled sprinters) were examined and compared with 14 adult nonathletic volunteers who had never performed strength training. Muscle moments were measured with a dynamometer and muscle cross-sectional areas and knee cartilage morphologic characteristics with magnetic resonance imaging. Weight lifters and sprinters displayed significantly (P < .001) larger extensor muscle moments and cross-sectional areas. They showed significantly greater (P < .01) patellar cartilage thickness than nonathletic volunteers (+14% [95% confidence interval, 6% to 22%] and +17% [95% confidence interval, 9% to 26%], respectively) but no significant differences in the cartilage thickness of the other knee joint cartilage plates or joint surface areas. Muscle moments did not correlate more strongly with knee cartilage volume or thickness than muscle cross-sectional areas of the thigh. Direct measurements of muscle forces do not predict cartilage thickness more accurately than muscle cross-sectional areas. These findings suggest that cartilage thickness has much less ability, if any, to adapt to mechanical loading than muscle. Large cohorts of athletes will need to be studied to detect potentially significant differences in cartilage versus nonathletic controls.

  15. Knee Muscles Power Evolution in Patients with Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ileana Monica BORDA

    2012-09-01

    Full Text Available Purpose: To measure changes in muscle power from before to 6 months after total knee arthroplasty and to compare outcomes with those from a control group of healthy adults. Material and Methods: 26 patients who underwent a total knee replacement were compared with 12 healthy age-matched adults in a prospective cohort study. Patients’ assessment was performed preoperatively, as well as at 1, 2 and 6 months postoperatively, by the isokinetic method. Healthy adults were assessed once by the same method. Isokinetic evaluation of knee extensor and flexor muscles was performed using a Gimnex Iso 2 dynamometer. After a warm-up protocol, measurements were done at angular velocities of 90 and 180°/sec. Results: Compared to healthy adults, patients performed significantly worse at all evaluation times, for both extensors and flexors of the knee, except for the 6-month evaluation at 180°/sec. One month postoperatively losses from preoperative levels were registered in patients, but without statistically significance, except for extension at 180°/sec. At 6 months postoperatively patients surpassed the preoperative levels, with statistical significance at 180°/sec. Conclusions: Power is an important parameter to follow after TKA, in parallel with peak torque. Increasing muscle power should be one of the central issues to address during postoperative rehabilitation.

  16. Swollen Knee (Water on the Knee)

    Science.gov (United States)

    ... buildup in and around the knee joint include: Osteoarthritis Rheumatoid arthritis Infection Gout Pseudogout Bursitis Cysts Tumors Risk factors Age. Your likelihood of developing a swollen knee ...

  17. Kinematic analysis of the knee joint by cine MRI

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, Mamoru; Akisada, Masayoshi; Anno, Izumi; Matsumoto, Kunihiko; Kuno, Shin-ya; Miyakawa, Shunpei (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine); Inouye, Tamon; Kose, Katsumi

    1989-08-01

    In order to obtain the MR imaging of a moving knee joint, we developed a drive system of the knee. A reciprocating reversible motor with a rope and pulleys drove a knee brace with the knee bending and extending every two seconds. Using photo sensor probe for gating cine acquisition, we got 16-time frames/cycle MR images. Such as articular cartilage, ligaments and synovial fluid, the fine components of a moving knee joint were clearly seen. In a dynamic display, these cine images demonstrated 'actual' movement of the knee joint. Moving joint fluid and defect of anterior cruciate ligament were demonstrated in the case of knee injury. These findings were not seen on static images. Cine MR imaging was also helpful for evaluating the chronic joint disease and ligament reconstruction. Through the use of the present drive system and cine acquisition, dynamic MR imaging of a moving knee joint is clearly demonstrated and it may provide useful information in the kinematic analysis of the normal and pathologic knee. (author).

  18. The effects of captive versus wild rearing environments on long bone articular surfaces in common chimpanzees (Pan troglodytes

    Directory of Open Access Journals (Sweden)

    Kristi L. Lewton

    2017-08-01

    Full Text Available The physical environments of captive and wild animals frequently differ in substrate types and compliance. As a result, there is an assumption that differences in rearing environments between captive and wild individuals produce differences in skeletal morphology. Here, this hypothesis is tested using a sample of 42 captive and wild common chimpanzees (Pan troglodytes. Articular surface areas of the humerus, radius, ulna, femur, and tibia were calculated from linear breadth measurements, adjusted for size differences using Mosimann shape variables, and compared across sex and environmental groups using two-way ANOVA. Results indicate that the articular surfaces of the wrist and knee differ between captive and wild chimpanzees; captive individuals have significantly larger distal ulna and tibial plateau articular surfaces. In both captive and wild chimpanzees, males have significantly larger femoral condyles and distal radius surfaces than females. Finally, there is an interaction effect between sex and rearing in the articular surfaces of the femoral condyles and distal radius in which captive males have significantly larger surface areas than all other sex-rearing groups. These data suggest that long bone articular surfaces may be sensitive to differences experienced by captive and wild individuals, such as differences in diet, body mass, positional behaviors, and presumed loading environments. Importantly, these results only find differences due to rearing environment in some long bone articular surfaces. Thus, future work on skeletal morphology could cautiously incorporate data from captive individuals, but should first investigate potential intraspecific differences between captive and wild individuals.

  19. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

    Science.gov (United States)

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W.; Arokoski, Jari P.; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; Saarakkala, Simo

    2016-01-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level. PMID:26926836

  20. RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...

  1. Rapid knee-extensions to increase quadriceps muscle activity in patients with total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...

  2. Physical properties of rabbit articular cartilage after transection of the anterior cruciate ligament.

    Science.gov (United States)

    Sah, R L; Yang, A S; Chen, A C; Hant, J J; Halili, R B; Yoshioka, M; Amiel, D; Coutts, R D

    1997-03-01

    The effect of unilateral transection of the anterior cruciate ligament on the confined compression and swelling properties of the distal femoral articular cartilage of skeletally mature rabbits at 9 weeks after surgery was determined. Gross morphological grading of the transected and contralateral control distal femora stained with India ink confirmed that cartilage degeneration had been induced by ligament transection. Osteochondral cores, 1.8 mm in diameter, were harvested from the medial femoral condyles. The modulus, permeability, and electrokinetic (streaming potential) coefficient of the articular cartilage of the osteochondral cores were assessed by confined compression creep experiments. The properties (mean +/- SD) of control cartilage were: confined compression modulus, 0.75 +/- 0.28 MPa; hydraulic permeability, 0.63 +/- 0.28 x 10(-15) m2/Pa*sec; and electrokinetic coefficient, 0.16 +/- 0.31 x 10(-9) V/Pa. In transected knees, the modulus was reduced by 18% (p = 0.04), while the permeability and electrokinetic coefficient were not detectably altered. The change in modulus was accompanied by a trend (p = 0.07) toward a decrease (-11%) in the glycosaminoglycan density within the tissue, a significant increase (p < 0.001) in the water content of the cartilage after equilibration in 1 x phosphate buffered saline from 70.3 +/- 4.1% in control knees to 75.2 +/- 4.0% in transected knees, and little further swelling after tissue equilibration in hypotonic saline. The compressive modulus of the cartilage from both control and transected knees was positively correlated with the density of tissue glycosaminoglycan. The alterations in the physical properties of the articular cartilage after transection of the anterior cruciate ligament in the rabbit show trends similar to those observed in human and other animal models of osteoarthritis and provide further support for the use of this model in the study of cartilage degeneration.

  3. Dissecting the contribution of knee joint NGF to spinal nociceptive sensitization in a model of OA pain in the rat.

    Science.gov (United States)

    Sagar, D R; Nwosu, L; Walsh, D A; Chapman, V

    2015-06-01

    Although analgesic approaches targeting nerve growth factor (NGF) for the treatment of osteoarthritis (OA) pain remain of clinical interest, neurophysiological mechanisms by which NGF contribute to OA pain remain unclear. We investigated the impact of local elevation of knee joint NGF on knee joint, vs remote (hindpaw), evoked responses of spinal neurones in a rodent model of OA pain. In vivo spinal electrophysiology was carried out in anaesthetised rats with established pain behaviour and joint pathology following intra-articular injection of monosodium iodoacetate (MIA), vs injection of saline. Neuronal responses to knee joint extension and flexion, mechanical punctate stimulation of the peripheral receptive fields over the knee and at a remote site (ipsilateral hind paw) were studied before, and following, intra-articular injection of NGF (10 μg/50 μl) or saline. MIA-injected rats exhibited significant local (knee joint) and remote (lowered hindpaw withdrawal thresholds) changes in pain behaviour, and joint pathology. Intra-articular injection of NGF significantly (P knee extension-evoked firing of spinal neurones and the size of the peripheral receptive fields of spinal neurones (100% increase) over the knee joint in MIA rats, compared to controls. Intra-articular NGF injection did not significantly alter responses of spinal neurones following noxious stimulation of the ipsilateral hind paw in MIA-injected rats. The facilitatory effects of intra-articular injection of NGF on spinal neurones receiving input from the knee joint provide a mechanistic basis for NGF mediated augmentation of OA knee pain, however additional mechanisms may contribute to the spread of pain to remote sites. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage.

    Science.gov (United States)

    Wakitani, S; Goto, T; Pineda, S J; Young, R G; Mansour, J M; Caplan, A I; Goldberg, V M

    1994-04-01

    Osteochondral progenitor cells were used to repair large, full-thickness defects of the articular cartilage that had been created in the knees of rabbits. Adherent cells from bone marrow, or cells from the periosteum that had been liberated from connective tissue by collagenase digestion, were grown in culture, dispersed in a type-I collagen gel, and transplanted into a large (three-by-six-millimeter), full-thickness (three-millimeter) defect in the weight-bearing surface of the medial femoral condyle. The contralateral knee served as a control: either the defect in that knee was left empty or a cell-free collagen gel was implanted. The periosteal and the bone-marrow-derived cells showed similar patterns of differentiation into articular cartilage and subchondral bone. Specimens of reparative tissue were analyzed with use of a semiquantitative histological grading system and by mechanical testing with employment of a porous indenter to measure the compliance of the tissue at intervals until twenty-four weeks after the operation. There was no apparent difference between the results obtained with the cells from the bone marrow and those from the periosteum. As early as two weeks after transplantation, the autologous osteochondral progenitor cells had uniformly differentiated into chondrocytes throughout the defects. This repair cartilage was subsequently replaced with bone in a proximal-to-distal direction, until, at twenty-four weeks after transplantation, the subchondral bone was completely repaired, without loss of overlying articular cartilage. The mechanical testing data were a useful index of the quality of the long-term repair. Twenty-four weeks after transplantation, the reparative tissue of both the bone-marrow and the periosteal cells was stiffer and less compliant than the tissue derived from the empty defects but less stiff and more compliant than normal cartilage. The current modalities for the repair of defects of the articular cartilage have many

  5. Shifting bone marrow edema of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Moosikasuwan, Josh B.; Schultz, Elizabeth [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, NY 11021, Great Neck (United States); Math, Kevin [Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, NY 10003, New York (United States)

    2004-07-01

    The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis. (orig.)

  6. Shifting bone marrow edema of the knee.

    Science.gov (United States)

    Moosikasuwan, Josh B; Miller, Theodore T; Math, Kevin; Schultz, Elizabeth

    2004-07-01

    The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis.

  7. Evaluation of unipodal stance in knee osteoarthritis patients using knee accelerations and center of pressure.

    Science.gov (United States)

    Turcot, K; Hagemeister, N; de Guise, J A; Aissaoui, R

    2011-03-01

    This study aims to compare knee joint instability and postural impairments during the performance of a unipodal stance task between patients having knee osteoarthritis (OA) and healthy elderly subjects using knee accelerations and center of pressure (COP) measurements. Twenty patients with medial knee OA and nine healthy individuals participated in this study. Three-dimensional (3D) knee joint accelerations and COP were measured during unipodal stance. The range and the root mean square (RMS) were extracted from medial lateral (ML) and anterior-posterior (AP) knee accelerations, whereas sway area, velocity, and ML and AP ranges were measured from the COP. The average parameters of three trials for each subject were compared between groups. Results show that knee OA patients exhibited a significantly higher range of knee acceleration in both ML (0.22±0.08 g vs 0.15±0.05 g) and AP (0.17±0.06 g vs 0.06±0.01 g) directions and a lower COP velocity (136.6±22.3 mm/s vs 157.6±18.4 mm/s) than did the healthy age-matched group. Significant correlations between the COP and knee acceleration parameters were also obtained. This study confirmed that patients with knee OA displayed greater body sway than did able-bodied subjects. Moreover, using an accelerometric-based method, this study highlighted the higher knee joint instability in the frontal and sagittal planes in knee OA patients compared with able-bodied subjects during a unipodal standing task. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  8. Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis.

    Science.gov (United States)

    Fantini Pagani, Cynthia H; Willwacher, Steffen; Benker, Rita; Brüggemann, Gert-Peter

    2014-12-01

    Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Controlled laboratory study, repeated measurements. In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle-foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2013.

  9. Correlation between apparent diffusion coefficient and viscoelasticity of articular cartilage in a porcine model.

    Science.gov (United States)

    Aoki, T; Watanabe, A; Nitta, N; Numano, T; Fukushi, M; Niitsu, M

    2012-09-01

    Quantitative MR imaging techniques of degenerative cartilage have been reported as useful indicators of degenerative changes in cartilage extracellular matrix, which consists of proteoglycans, collagen, non-collagenous proteins, and water. Apparent diffusion coefficient (ADC) mapping of cartilage has been shown to correlate mainly with the water content of the cartilage. As the water content of the cartilage in turn correlates with its viscoelasticity, which directly affects the mechanical strength of articular cartilage, ADC can serve as a potentially useful indicator of the mechanical strength of cartilage. The aim of this study was to investigate the correlation between ADC and viscoelasticity as measured by indentation testing. Fresh porcine knee joints (n = 20, age 6 months) were obtained from a local abattoir. ADC of porcine knee cartilage was measured using a 3-Tesla MRI. Indentation testing was performed on an electromechanical precision-controlled system, and viscosity coefficient and relaxation time were measured as additional indicators of the viscoelasticity of cartilage. The relationship between ADC and viscosity coefficient as well as that between ADC and relaxation time were assessed. ADC was correlated with relaxation time and viscosity coefficient (R(2) = 0.75 and 0.69, respectively, p correlation between ADC and viscoelasticity in the superficial articular cartilage. Both molecular diffusion and viscoelasticity were higher in weight bearing than non-weight-bearing articular cartilage areas.

  10. Segmenting articular cartilage automatically using a voxel classification approach

    DEFF Research Database (Denmark)

    Folkesson, Jenny; Dam, Erik B; Olsen, Ole F

    2007-01-01

    agreement with manual segmentations, an interscan reproducibility as good as that of a human expert, and enables the separation between healthy and osteoarthritic populations. While high-field scanners offer high-quality imaging from which the articular cartilage have been evaluated extensively using manual...... and automated image analysis techniques, low-field scanners on the other hand produce lower quality images but to a fraction of the cost of their high-field counterpart. For low-field MRI, there is no well-established accuracy validation for quantitative cartilage estimates, but we show that differences between...

  11. Knee Problems

    Science.gov (United States)

    ... Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath in Infants and Children Shoulder Problems Skin Rashes & Other Skin Problems Throat Problems Tooth Problems Urination Problems Back to Symptoms Step 2 Answering Questions Did your knee pain ...

  12. Knees Lifted High

    Centers for Disease Control (CDC) Podcasts

    2008-08-04

    The Eagle Books are a series of four books that are brought to life by wise animal characters - Mr. Eagle, Miss Rabbit, and Coyote - who engage Rain That Dances and his young friends in the joy of physical activity, eating healthy foods, and learning from their elders about health and diabetes prevention. Knees Lifted High gives children fun ideas for active outdoor play.  Created: 8/4/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/5/2008.

  13. In Vivo Kinematics of the Knee during Weight Bearing in High Flexion

    OpenAIRE

    Qi, Wei; Hosseini, Ali; Tsai, Tsung-Yuan; Li, Jing-Sheng; Rubash, Harry E.; Li, Guoan

    2013-01-01

    Achieving high flexion is an objective of contemporary total knee arthoplasty, however little is known on the knee biomechanics at high flexion under weight-bearing conditions. This study is to investigate the 6DOF kinematics and tibiofemoral cartilage contact biomechanics of the knee during weight-bearing flexion from full extension to maximal flexion. Eight knees from seven healthy subjects with no history of injuries or chronic pain were recruited. The knees were MRI scanned to create 3D m...

  14. Coronal tibial slope is associated with accelerated knee osteoarthritis: data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Driban, Jeffrey B; Stout, Alina C; Duryea, Jeffrey; Lo, Grace H; Harvey, William F; Price, Lori Lyn; Ward, Robert J; Eaton, Charles B; Barbe, Mary F; Lu, Bing; McAlindon, Timothy E

    2016-07-19

    Accelerated knee osteoarthritis may be a unique subset of knee osteoarthritis, which is associated with greater knee pain and disability. Identifying risk factors for accelerated knee osteoarthritis is vital to recognizing people who will develop accelerated knee osteoarthritis and initiating early interventions. The geometry of an articular surface (e.g., coronal tibial slope), which is a determinant of altered joint biomechanics, may be an important risk factor for incident accelerated knee osteoarthritis. We aimed to determine if baseline coronal tibial slope is associated with incident accelerated knee osteoarthritis or common knee osteoarthritis. We conducted a case-control study using data and images from baseline and the first 4 years of follow-up in the Osteoarthritis Initiative. We included three groups: 1) individuals with incident accelerated knee osteoarthritis, 2) individuals with common knee osteoarthritis progression, and 3) a control group with no knee osteoarthritis at any time. We did 1:1:1 matching for the 3 groups based on sex. Weight-bearing, fixed flexion posterior-anterior knee radiographs were obtained at each visit. One reader manually measured baseline coronal tibial slope on the radiographs. Baseline femorotibial angle was measured on the radiographs using a semi-automated program. To assess the relationship between slope (predictor) and incident accelerated knee osteoarthritis or common knee osteoarthritis (outcomes) compared with no knee osteoarthritis (reference outcome), we performed multinomial logistic regression analyses adjusted for sex. The mean baseline slope for incident accelerated knee osteoarthritis, common knee osteoarthritis, and no knee osteoarthritis were 3.1(2.0), 2.7(2.1), and 2.6(1.9); respectively. A greater slope was associated with an increased risk of incident accelerated knee osteoarthritis (OR = 1.15 per degree, 95 % CI = 1.01 to 1.32) but not common knee osteoarthritis (OR = 1.04, 95 % CI = 0

  15. Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee

    DEFF Research Database (Denmark)

    Henriksen, Marius; Christensen, Robin; Klokker, Louise

    2015-01-01

    IMPORTANCE: Osteoarthritis (OA) of the knee is the most frequent form of arthritis and a cause of pain and disability. Combined nonpharmacologic and pharmacologic treatments are recommended as the optimal treatment approach, but no evidence supports the recommendation. OBJECTIVE: To assess...... the clinical benefits of an intra-articular corticosteroid injection given before exercise therapy in patients with OA of the knee. DESIGN, SETTING, AND PARTICIPANTS: We performed a randomized, blinded, placebo-controlled clinical trial evaluating the benefit of intra-articular corticosteroid injection vs...... placebo injection given before exercise therapy at an OA outpatient clinic from October 1, 2012, through April 2, 2014. The participants had radiographic confirmation of clinical OA of the knee, clinical signs of localized inflammation in the knee, and knee pain during walking (score >4 on a scale of 0...

  16. Extra-articular and transcutaneous migration of the poly-l/D-lactide interference screw after popliteal tendon reconstruction

    Directory of Open Access Journals (Sweden)

    Camilo Partezani Helito

    Full Text Available ABSTRACT Knee ligament reconstructions are commonly performed orthopedic procedures. Graft fixation is generally performed with metallic or absorbable interference screws. In a recent study, only ten reports of screw migration were retrieved; of these, only one was not related to the anterior cruciate ligament, and the majority was related to the use of poly-l-lactic acid (PLLA screws. Only one case retrieved in the literature reported screw migration in reconstructions of the posterolateral corner, and that was to the intra-articular region. In the present article, the authors report a case of extra-articular and transcutaneous migration of a poly-l/D-lactide (PDLLA interference screw following popliteal tendon reconstruction. Besides being the first case of popliteal tendon migration with extra-articular screw migration, no reports of PDLLA screw migration were retrieved in the literature.

  17. Cdc42 is essential for both articular cartilage degeneration and subchondral bone deterioration in experimental osteoarthritis.

    Science.gov (United States)

    Hu, Xinhua; Ji, Xing; Yang, Mengting; Fan, Shihao; Wang, Jirong; Lu, Meiping; Shi, Wei; Mei, Liu; Xu, Chengyun; Fan, Xueying; Hussain, Musaddique; Du, Jingyu; Wu, Junsong; Wu, Ximei

    2018-01-03

    Cdc42, a member of Rho family small GTPases, is critical for cartilage development. We investigated the roles of Cdc42 in osteoarthritis and explored the potential mechanism underlying Cdc42-mediated articular cartilage degeneration and subchondral bone deterioration. Cdc42 is highly expressed in both articular cartilage and subchondral bone in a mouse osteoarthritis model with surgical destabilisation of the medial meniscus (DMM) in the knee joints. Specifically, genetic disruption of Cdc42, knockdown of Cdc42 expression, or inhibition of Cdc42 activity robustly attenuates the DMM-induced destruction, hypertrophy, high expression of matrix metallopeptidase-13 and collagen X, and activation of Stat3 in articular cartilages. Notably, genetic disruption of Cdc42, knockdown of Cdc42 expression or inhibition of Cdc42 activity significantly restored the increased numbers of mesenchymal stem cells, osteoprogenitors, osteoblasts, osteoclasts, and neovascularised vessels, the increased bone mass, and the activated Erk1/2, Smad1/5 and Smad2 in subchondral bone of DMM-operated mice. Mechanistically, Cdc42 mediates interleukin-1β-induced interleukin-6 production and subsequent Jak/Stat3 activation to regulate chondrocytic inflammation, and also lies upstream of Erk/Smads to regulate subchondral bone remodelling during transform growth factor-β1 signalling. Cdc42 is apparently required for both articular cartilage degeneration and subchondral bone deterioration of osteoarthritis, thus, interventions targeting Cdc42 have potential in osteoarthritic therapy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

    Science.gov (United States)

    Jakobsen, Thomas Linding; Christensen, Malene; Christensen, Stine Sommer; Olsen, Marie; Bandholm, Thomas

    2010-09-01

    Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC(2,1)) and smallest real difference (SRD) were calculated. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. (c) 2009 John Wiley & Sons, Ltd.

  19. Life-threatening MRSA sepsis with bilateral pneumonia, osteomyelitis, and septic arthritis of the knee in a previously healthy 13-year-old boy

    DEFF Research Database (Denmark)

    Hardgrib, Nina; Wang, Michala; Jurik, Anne Grethe

    2016-01-01

    The incidence and severity of methicillin resistant Staphylococcus aureus (MRSA) infections are increasing and cause high mortality and morbidity. We describe the first pediatric case in Scandinavia with Panton-Valentine leucocidin (PVL) positive MRSA septicemia who developed bilateral pneumonia...... and antimicrobial combination therapy. The outcome was a healthy patient without sequelae, a favorable course unlike those previously described in the literature. This case underlines the necessity of a close interdisciplinary cooperation in children with severe MRSA infection encompassing pneumonia, septic...

  20. Ultrasound-Guided Genicular Nerve Thermal Radiofrequency Ablation for Chronic Knee Pain

    OpenAIRE

    Wong, Joshua; Bremer, Nicholas; Weyker, Paul D.; Webb, Christopher A. J.

    2016-01-01

    Osteoarthritis (OA) of the knee is one of the most common joint diseases affecting adults in the United States. For elderly patients with multiple medical comorbidities who do not wish to undergo total knee arthroplasty (TKA), lifestyle modification, pharmacologic management, and injections are the mainstay of therapy. Previously, pain management interventions were limited to intra-articular joint injections and viscosupplementation with hyaluronic acid. Fluoroscopic-guided techniques for rad...

  1. EFFECTIVENESS OF MANUAL THERAPY VERSUS EXERCISE THERAPY FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IN KARACHI PAKISTAN

    OpenAIRE

    Ayesha Zakir; Syed Imran Ahmed; Saima Aziz; Faisal Yamin; Attiq-ur-Rehman

    2016-01-01

    Introduction: Among musculoskeletal disorders knee Osteoarthritis (OA) is exceedingly prevailing articular disorder affecting people and it is a major cause of disability and socioeconomic burden. It is more common in women than men. Entities with knee OA must often undergo a variety of problems, such as pain and tenderness in joints, movement limitation, crepitus on movement, swelling, recurrent effusion, and local inflammation which ultimately leads to limitation in physical function, like ...

  2. A COMPARATIVE STUDY BETWEEN JOINT MOBILIZATION AND CONVENTIONAL PHYSIOTHERAPY IN KNEE OSTEOARTHRITIS

    OpenAIRE

    Aftab Ahmad, Muhammad Daud

    2016-01-01

    Background: Osteoarthritis (O.A.) is an active disease process involving articular cartilage destruction, subchondral bone thickening and new bone formation. Worldwide osteoarthritis is estimated to be the fourth leading cause of disability, in which 10% are males and 13% are females. Studies from china, Bangladesh and Pakistan have shown high prevalence of knee osteoarthritis. Pharmacological interventions, surgical procedures and Physiotherapy management play important role in knee Osteoart...

  3. Total knee arthroplasty in extra articular deformities: A series of 36 knees

    Directory of Open Access Journals (Sweden)

    Ashok Rajgopal

    2013-01-01

    Conclusion: With a good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension, correction would be possible in majority of extraarticular deformities.

  4. Men's shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.

    Science.gov (United States)

    Kerrigan, D Casey; Karvosky, Mark E; Lelas, Jennifer L; Riley, Patrick O

    2003-03-01

    To determine if men's dress shoes and sneakers increase knee joint torques and play the same role in the development and/or progression of knee osteoarthritis (OA) as women's high-heeled dress shoes. Three-dimensional data regarding lower extremity torques and motion were collected during walking in 22 healthy men while (1) wearing dress shoes, (2) wearing sneakers, and (3) barefoot. Data were plotted and qualitatively compared; major peak values were statistically compared between conditions. The external knee varus torque in early stance was slightly greater with the dress shoes and sneakers, but this slight increase can be explained by the faster walking speed with shoes. No significant increases were found in any other of the sagittal, coronal, or transverse knee torques when walking with dress shoes and sneakers compared to barefoot. Men's dress shoes and sneakers do not significantly affect knee joint torques that may have relevance to the development and/or progression of knee OA.

  5. Polymorphic variation of hypoxia inducible factor-1 A (HIF1A) gene might contribute to the development of knee osteoarthritis: a pilot study.

    Science.gov (United States)

    Fernández-Torres, Javier; Hernández-Díaz, Cristina; Espinosa-Morales, Rolando; Camacho-Galindo, Javier; Galindo-Sevilla, Norma del Carmen; López-Macay, Ámbar; Zamudio-Cuevas, Yessica; Martínez-Flores, Karina; Santamaría-Olmedo, Mónica Guadalupe; Pineda, Carlos; Granados, Julio; Martínez-Nava, Gabriela Angélica; Gutiérrez, Marwin; López-Reyes, Alberto G

    2015-08-21

    Osteoarthritis (OA) is a multifactorial degenerative condition of the whole joint with a complex pathogenesis whose development and progression is significantly mediated by interactions between the joint cartilage and articular tissues, particularly, proinflammatory mediators and oxidative stress, which results in cartilage deterioration and subchondral bone destruction. HIF-1 alpha regulates oxygen homeostasis in hypoxic tissues such as joint cartilage; efficiency of transcriptional activity of the HIF1A gene is strongly influenced by the presence of polymorphic variants. Given the loss of articular cartilage and with intention to restore damaged tissue, WISP-1 participates in the development of subchondral bone; further, its expression is highly increased in chondrocytes of OA patients. The aim of this study was to evaluate gene frequencies of HIF1A and WISP1 polymorphisms in Mexican patients suffering from knee OA. We determined HIF1A rs11549465 (P582S), rs11549467 (A588T), and rs2057482 (C191T), and WISP1 rs2929970 (A2364G) polymorphisms in 70 Mexican patients with knee OA and compare them to those present in 66 ethnically matched healthy controls. Genotyping for these polymorphisms was performed by Real-Time PCR using TaqMan probes. Gene frequencies exhibited a significant increase of the CC genotype of rs11549465 polymorphism in knee OA patients as compared with those present in controls (P = 0.003 OR = 5.7, 95% CI = 1.7-21.6); CT genotype and T allele showed decreased frequency in the knee OA group vs. the controls (P = 0.003 OR = 0.2, CI = 0.05-0.6; and P = 0.004 OR = 0.2, CI = 0.05-0.65, respectively). Allele frequencies of the other polymorphic variants were similar in both patients and controls. These results suggest that the presence of the rs11549465 SNP (HIF1A) plays a role protective in the loss of articular cartilage in our population, and offers the possibility to further study the molecular mechanisms within

  6. Intra-articular injection of the selective cyclooxygenase-2 inhibitor meloxicam (Mobic) reduces experimental osteoarthritis and nociception in rats.

    Science.gov (United States)

    Wen, Z-H; Tang, C-C; Chang, Y-C; Huang, S-Y; Chen, C-H; Wu, S-C; Hsieh, S-P; Hsieh, C-S; Wang, K-Y; Lin, S-Y; Lee, H-L; Lee, C-H; Kuo, H-C; Chen, W-F; Jean, Y-H

    2013-12-01

    To study the effect of intra-articular injection of meloxicam (Mobic) on the development of osteoarthritis (OA) in rats and examine concomitant changes in nociceptive behavior and the expression of mitogen-activated protein kinases (MAPKs) in articular cartilage chondrocytes. OA was induced in Wistar rats by right anterior cruciate ligament transection (ACLT); the left knee was not treated. The OA + meloxicam (1.0 mg) group was injected intra-articularly in the ACLT knee with 1.0 mg of meloxicam once a week for 5 consecutive weeks starting 5 weeks after ACLT. The OA + meloxicam (0.25 mg) group was treated similarly with 0.25 mg meloxicam. The sham group underwent arthrotomy only and received vehicle of 0.1 mL sterile 0.9% saline injections, whereas the naive rats in meloxicam-only groups were treated similarly with 1.0- and 0.25-mg meloxicam. Nociception was measured as secondary mechanical allodynia and hind paw weight-bearing distribution at before (pre-) and 5, 10, 15, and 20 weeks post-ACLT. Histopathology of the cartilage and synovia was examined 20 weeks after ACLT. Immunohistochemical analysis was performed to examine the effect of meloxicam on MAPKs (p38, c-Jun N-terminal kinase (JNK), and extracellular signal-regulated kinase (ERK)) expression in the articular cartilage chondrocytes. OA rats receiving intra-articular meloxicam treatment showed significantly less cartilage degeneration and synovitis than saline-treated controls. Nociception were improved in the OA + meloxicam groups compared with the OA group. Moreover, meloxicam attenuated p38 and JNK but enhanced ERK expression in OA-affected cartilage. Intra-articular injection of meloxicam (1) attenuates the development of OA, (2) concomitantly reduces nociception, and (3) modulates chondrocyte metabolism, possibly through inhibition of cellular p38 and JNK, but enhances ERK expression. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  7. Standing Stability in Knee Osteoarthritis Patients

    Directory of Open Access Journals (Sweden)

    M.T. Karimi

    2016-09-01

    Full Text Available Aims: Being prevalent in the more than 40 years old persons, the knee osteoarthritis is one of the main factors in the function system failure mainly affecting their life. There is a type of instability in the persons with knee osteoarthritis, which is an increase in the domain and frequency of body pressure center. The aim of the present study was to compare the standing stability parameters in persons with knee osteoarthritis and healthy persons. Instrument & Methods: In this case-control, 15 patients with knee osteoarthritis referred to the physiotherapy clinic of the rehabilitation center and Al-Zahra hospital were studied in the muscle-skeletal research center of Isfahan University of Medical Sciences in 2015. The subjects were selected via stratified sampling method. As control group, 15 healthy persons were also studied in Isfahan. Total path length and the domain and frequency of pressure center in different directions were measured to assess the stability. Data was analyzed by SPSS 19 software using descriptive statistics and paired T test. Findings: There were increases in the mean movement domain and the frequency of pressure center in the anterior-posterior and the internal-external directions, as well as in the total path proceeded by the pressure center in the internal-external direction, in the persons with knee osteoarthritis than the healthy persons (p0.05. Conclusion: Standing stability and balance in persons with knee osteoarthritis decreases compared to healthy persons.

  8. The effects of knee extensor eccentric training on functional tests in healthy subjects Os efeitos do treino isocinético excêntrico dos extensores do joelho nos testes funcionais em sujeitos saudáveis

    Directory of Open Access Journals (Sweden)

    Heleodório H. Santos

    2010-08-01

    Full Text Available BACKGROUND: It is well known that eccentric training increases muscle strength and promotes greater neural activation, and therefore has been used in the recovery of knee extensors. The hypothesis of this study was that there would be a strong correlation between knee extensor torque and functional tests. OBJECTIVES: To investigate the relationship between knee extensor peak torque and functional tests of agility (runs and propulsion (hop for distance after short-term isokinetic eccentric training. METHODS: Twenty healthy and active male undergraduate students (age 22.5±2.1 years; height 1.72±0.10 m; weight 67.8±9.5 kg; body mass index: 22.5±2.0 kg/m², with no abnormalities or history of injury of the limbs, performed an isokinetic assessment of the knee extensors and flexors and also functional tests before and after isokinetic training, which consisted of 3 sets of 10 MVECs at 30º/s, with 3 minutes of rest between sets, twice a week for 6 weeks. RESULTS: The eccentric training increased the extensor peak torque (16, 27 and 17%; PCONTEXTUALIZAÇÃO: Sabe-se que o treino excêntrico aumenta a força muscular, promovendo uma maior ativação neural e, portanto, tem sido usado na recuperação do torque extensor. A hipótese deste estudo foi a de que possa existir uma forte correlação entre o torque extensor do joelho e os testes funcionais. OBJETIVOS: Correlacionar o torque extensor do joelho com os testes funcionais de agilidade (corridas e impulsão (saltos em distância após o treino isocinético excêntrico de curta duração. MÉTODOS: Vinte homens universitários, ativos e saudáveis (22,5±2,1 anos; 1,72±0,10 m; 67,8±9,5 kg; IMC 22,5±2,0 kg/m², sem reportar anormalidades ou história de lesão no membro inferior, realizaram avaliação isocinética do torque extensor e flexor do joelho e testes funcionais antes e depois do treino isocinético que consistiu em três séries de 10 CEVM a 30º/s, com 3 minutos de repouso entre as

  9. Remodeled articular surface after surgical fixation of patella fracture in a child

    Directory of Open Access Journals (Sweden)

    Moruf Babatunde Yusuf

    2017-01-01

    Full Text Available Patella fracture is uncommon in pediatric age group and their patella is better preserved in any class of patella fracture. We reported a case of a 13-year-old male with right patella fracture nonunion. He had open reduction and internal fixation using tension band wire device. Fracture union was monitored with serial radiographs and he was followed up for 60 weeks. There was articular surface step after surgical fixation of the patella fracture. At 34 weeks postoperative, there was complete remodeling of the articular surface with good knee function after removal of the tension band wire. Children have good capacity of bone remodeling after fracture. Little retropatella step in a child after patella fracture surgical fixation will remodel with healing.

  10. Estabilidade articular: abordagem biomecânica

    OpenAIRE

    Alex Sandra Oliveira de Cerqueira Soares

    2015-01-01

    A instabilidade articular é responsável pelo desenvolvimento de lesões degenerativas incapacitantes que comprometem o desempenho funcional. Compreender os processos desenvolvidos para estabilização dinâmica articular é um desafio para pesquisadores das mais diversas áreas. O presente estudo propõe o uso da abordagem Biomecânica para reconhecer os mecanismos relacionadas ao processo de estabilização dinâmica articular, por meio de três diferentes condições experimentais. No experimento 1 foi a...

  11. Knee pain (image)

    Science.gov (United States)

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  12. Total Knee Replacement

    Science.gov (United States)

    ... activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and ... Total Knee Replacement cont. Preparing for Surgery Medical Evaluation If you decide to have total knee replacement ...

  13. Water on the Knee

    Science.gov (United States)

    ... your knee joint. Some people call this condition "water on the knee." A swollen knee may be ... Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don't place continuous weight- ...

  14. Preventing Knee Injuries

    Science.gov (United States)

    ... Our Newsletter Donate Blog Skip breadcrumb navigation Preventing Knee Injuries Knee injuries in children and adolescent athletes ... this PDF Share this page: WHAT ARE COMMON KNEE INJURIES? Pain Syndromes One of the most common ...

  15. Knee microfracture surgery

    Science.gov (United States)

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  16. The effect of mud pack therapy on serum YKL-40 and hsCRP levels in patients with knee osteoarthritis.

    Science.gov (United States)

    Güngen, Gonca; Ardic, Fusun; Fındıkoğlu, Gülin; Rota, Simin

    2012-05-01

    The aim of this study was to evaluate the efficacy of treatment with mud pack in knee osteoarthritis (OA) and to determine whether mud pack effects serum levels of YKL-40 and high-sensitivity C-reactive protein (hsCRP) which are reported to be biological markers for articular damage or inflammation in patients with OA. Forty-four patients with the diagnosis of knee OA assigned into two groups were treated with local natural mineral-rich mud pack or hot pack. Treatments were applied for 6 days a week for 2 weeks as a total of 12 sessions. Patients were assessed at baseline, post-treatment, and 3 months after the treatment. VAS, range of motion, 15-m walking time, WOMAC index, Nottingham Health Profile, serum YKL-40, and hsCRP levels were the outcome measures. Pain intensity and joint stiffness decreased in both groups at all follow-ups. Physical activity status was found to persist for 3 months after treatment only in mud pack group. Serum mean YKL-40 and hsCRP levels of the patients were higher compared to healthy control group. Serum YKL-40 level increased significantly only in hot pack group 3 months after the treatment (P 0.05). Mud pack and hot pack therapy were both demonstrated to be effective in symptomatic treatment of knee OA until the end of the 2-week treatment period, whereas only mud pack therapy was shown to be effective in functional status over time. In the hot pack group, increased serum YKL-40 level 3 months after the treatment might indicate persistence of cartilage degradation. Maintenance of YKL-40 level in mud pack therapy seems to slow down the progression of knee OA.

  17. Biochemical (T2, T2* and magnetisation transfer ratio) MRI of knee cartilage: feasibility at ultra-high field (7T) compared with high field (3T) strength

    Energy Technology Data Exchange (ETDEWEB)

    Welsch, Goetz H. [Medical University of Vienna, MR Center, Department of Radiology, Vienna (Austria); University of Erlangen, Department of Trauma Surgery, Erlangen (Germany); Apprich, Sebastian; Zbyn, Stefan; Trattnig, Siegfried [Medical University of Vienna, MR Center, Department of Radiology, Vienna (Austria); Mamisch, Tallal C. [Medical University of Vienna, MR Center, Department of Radiology, Vienna (Austria); University of Berne, Department of Orthopedic Surgery, Berne (Switzerland); Mlynarik, Vladimir [Ecole Polytechnique Federale de Lausanne, Laboratory of Functional and Metabolic imaging, Lausanne (Switzerland); Scheffler, Klaus; Bieri, Oliver [University Hospital Basel, Division of Radiological Physics, Institute of Radiology, Basel (Switzerland)

    2011-06-15

    This study compares the performance and the reproducibility of quantitative T2, T2* and the magnetisation transfer ratio (MTR) of articular cartilage at 7T and 3T. Axial MRI of the patella was performed in 17 knees of healthy volunteers (25.8 {+-} 5.7 years) at 3T and 7T using a comparable surface coil and whole-body MR systems from the same vendor, side-by-side. Thirteen knee joints were assessed once, and four knee joints were measured three times to assess reproducibility. T2 relaxation was prepared by a multi-echo, spin-echo sequence and T2* relaxation by a multi-echo, gradient-echo sequence. MTR was based on a magnetisation transfer-sensitized, steady-state free precession approach. Statistical analysis-of-variance and coefficient-of-variation (CV) were prepared. For T2 and T2*, global values were significantly lower at 7T compared with 3T; the zonal evaluation revealed significantly less pronounced stratification at 7T (p<0.05). MTR provided higher values at 7T (p<0.05). CV, indicating reproducibility, showed slightly lower values at 7T, but only for T2 and T2*. Although lower T2 and T2* relaxation times were expected at 7T, the differences in stratification between the field strengths were reported for the first time. The assessment of MT is feasible at 7T, but requires further investigation. (orig.)

  18. Comparison of intra-articular injections of hyaluronic acid and corticosteroid in the treatment of osteoarthritis of the hip in comparison with intra-articular injections of bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, Sascha; van den Bekerom, Michel P. J.; Bellemans, Johan; Mulier, Michiel

    2010-01-01

    Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still

  19. Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, S.; van den Bekerom, M.P.J.; Bellemans, J.; Mulier, M.

    2010-01-01

    Background: Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this

  20. Patellofemoral Arthralgia, Overuse Syndromes of the Knee, and Chondromalacia Patella

    OpenAIRE

    Welsh, R. Peter

    1985-01-01

    Patellofemoral arthralgia is a very common syndrome affecting athletes. Most often, examination fails to define true pathology. Conservative treatment, an active exercise program, and sports may be undertaken without harm to the knee. The patellofemoral arthralgia syndrome must be differentiated from true chondromalacia patella, where there is actual degeneration of the patella's articular cartilage, and from other sources of internal derangement such as meniscal disease or osteochondral lesi...

  1. Anti-Inflammatory Effects of Intra-Articular Hyaluronic Acid: A Systematic Review.

    Science.gov (United States)

    Altman, Roy; Bedi, Asheesh; Manjoo, Ajay; Niazi, Faizan; Shaw, Peter; Mease, Philip

    2018-02-01

    Objective Osteoarthritis (OA) is one of the leading causes of disability in the adult population. Common nonoperative treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and intra-articular injections of hyaluronic acid (HA). HA is found intrinsically within the knee joint providing viscoelastic properties to the synovial fluid. HA therapy provides anti-inflammatory relief through a number of different pathways, including the suppression of pro-inflammatory cytokines and chemokines. Methods We conducted a systematic review to summarize the published literature on the anti-inflammatory properties of hyaluronic acid in osteoarthritis. Included articles were categorized based on the primary anti-inflammatory responses described within them, by the immediate cell surface receptor protein assessed within the article, or based on the primary theme of the article. Key findings aimed to describe the macromolecules and inflammatory-mediated responses associated with the cell transmembrane receptors. Results Forty-eight articles were included in this systematic review that focused on the general anti-inflammatory effects of HA in knee OA, mediated through receptor-binding relationships with cluster determinant 44 (CD44), toll-like receptor 2 (TLR-2) and 4 (TLR-4), intercellular adhesion molecule-1 (ICAM-1), and layilin (LAYN) cell surface receptors. Higher molecular weight HA (HMWHA) promotes anti-inflammatory responses, whereas short HA oligosaccharides produce inflammatory reactions. Conclusions Intra-articular HA is a viable therapeutic option in treating knee OA and suppressing inflammatory responses. HMWHA is effective in suppressing the key macromolecules that elicit the inflammatory response by short HA oligosaccharides.

  2. Supporting Biomaterials for Articular Cartilage Repair

    Science.gov (United States)

    Duarte Campos, Daniela Filipa; Drescher, Wolf; Rath, Björn; Tingart, Markus

    2012-01-01

    Orthopedic surgeons and researchers worldwide are continuously faced with the challenge of regenerating articular cartilage defects. However, until now, it has not been possible to completely mimic the biological and biochemical properties of articular cartilage using current research and development approaches. In this review, biomaterials previously used for articular cartilage repair research are addressed. Furthermore, a brief discussion of the state of the art of current cell printing procedures mimicking native cartilage is offered in light of their use as future alternatives for cartilage tissue engineering. Inkjet cell printing, controlled deposition cell printing tools, and laser cell printing are cutting-edge techniques in this context. The development of mimetic hydrogels with specific biological properties relevant to articular cartilage native tissue will support the development of improved, functional, and novel engineered tissue for clinical application. PMID:26069634

  3. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait.

    Directory of Open Access Journals (Sweden)

    Jing-Sheng Li

    Full Text Available Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis.

  4. Imaging of intra-articular osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Allen, S.D.; Saifuddin, A. E-mail: asaifuddin@aol.com

    2003-11-01

    Intra-articular osteoid osteoma accounts for approximately 13% of all osteoid osteomas and presents as a monoarthropathy. Radiographs commonly do not identify the nidus, and in this event, MRI is likely to be the next imaging investigation. MRI may show a variety of appearances depending upon the age of the lesion. This article illustrates the imaging features of intra-articular osteoid osteoma, with emphasis on MRI. CT remains the investigation of choice for identifying the nidus.

  5. Comparative Evaluation of Core and Knee Extensor Mechanism Muscle Activation Patterns in a Stair Stepping Task in Healthy Controls and Patellofemoral Pain Patients

    Directory of Open Access Journals (Sweden)

    Alireza Motealleh

    2014-12-01

    Full Text Available Background: Patellofemoral pain (PFP is a common affliction and complex clinical entity. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFPS. Comparative evaluation of core and extensor mechanism muscle activation patterns between healthy group and patients involved by patellofemoral pain syndrome (PFPS in a stair stepping task is the aim of this study. Methods: In this non-randomized interventional study fifteen males with PFPS and fifteen asymptomatic controls participated. Electromyographic (EMG activity of Vastusmedialisobliquus (VMO, Vastuslateralis (VL, Gluteus medius (GMED, Gluteus Maximus (GMAX, Internal oblique (IO and Erector spinae (ES were recorded and EMG onsets were assessed in both stepping up (SU and down (SD. The time of foot contact determined by a foot switch. Results: During SU: Onset times of all muscles except, VL and ES in the controls were significantly less than PFPS group (P<0.05. In PFPS group the temporal sequence of ES, VL and VMO were different from control groups. During SD: Onset times of all muscles except, GMAX and ES in the control group were significantly less than PFP group (P<0.05. The sequence of muscle activity in both healthy and PFP groups were the same. Conclusion: Our findings are in line with previous researches about the effects of core on function and control of lower extremity. Activation patterns of core and vasti muscles are different between control and PFPS group during stair stepping task. Designing exercises to correct inappropriate timing of core muscles may have a role in management of PFPS and it needs more future researches.

  6. The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers.

    Science.gov (United States)

    Schmidt, Kai; Duarte, Jaime E; Grimmer, Martin; Sancho-Puchades, Alejandro; Wei, Haiqi; Easthope, Chris S; Riener, Robert

    2017-01-01

    Muscle weakness-which can result from neurological injuries, genetic disorders, or typical aging-can affect a person's mobility and quality of life. For many people with muscle weakness, assistive devices provide the means to regain mobility and independence. These devices range from well-established technology, such as wheelchairs, to newer technologies, such as exoskeletons and exosuits. For assistive devices to be used in everyday life, they must provide assistance across activities of daily living (ADLs) in an unobtrusive manner. This article introduces the Myosuit, a soft, wearable device designed to provide continuous assistance at the hip and knee joint when working with and against gravity in ADLs. This robotic device combines active and passive elements with a closed-loop force controller designed to behave like an external muscle (exomuscle) and deliver gravity compensation to the user. At 4.1 kg (4.6 kg with batteries), the Myosuit is one of the lightest untethered devices capable of delivering gravity support to the user's knee and hip joints. This article presents the design and control principles of the Myosuit. It describes the textile interface, tendon actuators, and a bi-articular, synergy-based approach for continuous assistance. The assistive controller, based on bi-articular force assistance, was tested with a single subject who performed sitting transfers, one of the most gravity-intensive ADLs. The results show that the control concept can successfully identify changes in the posture and assist hip and knee extension with up to 26% of the natural knee moment and up to 35% of the knee power. We conclude that the Myosuit's novel approach to assistance using a bi-articular architecture, in combination with the posture-based force controller, can effectively assist its users in gravity-intensive ADLs, such as sitting transfers.

  7. The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers

    Directory of Open Access Journals (Sweden)

    Kai Schmidt

    2017-10-01

    Full Text Available Muscle weakness—which can result from neurological injuries, genetic disorders, or typical aging—can affect a person's mobility and quality of life. For many people with muscle weakness, assistive devices provide the means to regain mobility and independence. These devices range from well-established technology, such as wheelchairs, to newer technologies, such as exoskeletons and exosuits. For assistive devices to be used in everyday life, they must provide assistance across activities of daily living (ADLs in an unobtrusive manner. This article introduces the Myosuit, a soft, wearable device designed to provide continuous assistance at the hip and knee joint when working with and against gravity in ADLs. This robotic device combines active and passive elements with a closed-loop force controller designed to behave like an external muscle (exomuscle and deliver gravity compensation to the user. At 4.1 kg (4.6 kg with batteries, the Myosuit is one of the lightest untethered devices capable of delivering gravity support to the user's knee and hip joints. This article presents the design and control principles of the Myosuit. It describes the textile interface, tendon actuators, and a bi-articular, synergy-based approach for continuous assistance. The assistive controller, based on bi-articular force assistance, was tested with a single subject who performed sitting transfers, one of the most gravity-intensive ADLs. The results show that the control concept can successfully identify changes in the posture and assist hip and knee extension with up to 26% of the natural knee moment and up to 35% of the knee power. We conclude that the Myosuit's novel approach to assistance using a bi-articular architecture, in combination with the posture-based force controller, can effectively assist its users in gravity-intensive ADLs, such as sitting transfers.

  8. Mast cells in early stages of antigen-induced arthritis in rat knee joints

    NARCIS (Netherlands)

    Tiggelman, A. M.; van Noorden, C. J.

    1990-01-01

    The occurrence of mast cells has been investigated in inflamed and control knee joints of rats suffering from antigen-induced arthritis, an animal model of rheumatoid arthritis in man. Rats were immunized with methylated bovine serum albumin (mBSA) followed by an intra-articular injection of mBSA

  9. Biologic Options for Articular Cartilage Wear (Platelet-Rich Plasma, Stem Cells, Bone Marrow Aspirate Concentrate).

    Science.gov (United States)

    Kraeutler, Matthew J; Chahla, Jorge; LaPrade, Robert F; Pascual-Garrido, Cecilia

    2017-07-01

    Biological treatments for articular cartilage repair have gained in popularity in the past decade. Advantages of these therapies include minimal invasiveness, improved healing time, and faster recovery. Biological therapies for cartilage repair include platelet-rich plasma, bone marrow aspirate concentrate, and cell-based therapies. These methods have the added benefit of containing growth factors and/or stem cells that aid in recovery and regeneration. The purpose of this article is to review the current cartilage treatment options and the existing literature on outcomes, complications, and safety profile of these products for use in the knee and hip joints. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Influence of site and age on biochemical characteristics of the collagen network of equine articular cartilage.

    Science.gov (United States)

    Brama, P A; TeKoppele, J M; Bank, R A; van Weeren, P R; Barneveld, A

    1999-03-01

    To determine variations in biochemical characteristics of equine articular cartilage in relation to age and the degree of predisposition for osteochondral disease at a specific site. Articular cartilage specimens from 53 horses 4 to 30 years old. Healthy specimens were obtained from 2 locations on the proximal articular surface of the first phalanx that had different disease prevalences (site 1 at the mediodorsal margin and site 2 at the center of the medial cavity). Water, total collagen, and hydroxylysine contents and enzymatic (hydroxylysylpyridinoline [HP]) and nonenzymatic (pentosidine) crosslinking were determined at both sites. Differences between sites were analyzed by ANOVA (factors, site, and age), and age correlation was tested by Pearson's product-moment correlation analysis. Significance was set at Pcollagen, hydroxylysine contents, and enzymatic cross-linking. Nonenzymatic crosslinking was higher in older horses and was linearly related to age (r = 0.94). Water and collagen contents and HP and pentosidine crosslinks were significantly higher at site 1. Hydroxylysine content was significantly lower at site 1. Except for nonenzymatic glycation, the composition of articular cartilage collagen does not change significantly in adult horses. A significant topographic variation exists in biochemical characteristics of the articular cartilage collagen network in equine metacarpophalangeal joints. These differences may influence local biomechanical properties and, hence, susceptibility to osteochondral disease, as will greater pentosidine crosslinks in older horses that are likely to cause stiffer and more brittle cartilage.

  11. Leptin protects rat articular chondrocytes from cytotoxicity induced by TNF-α in the presence of cyclohexamide.

    Science.gov (United States)

    Lee, S W; Rho, J H; Lee, S Y; Kim, J H; Cheong, J-H; Kim, H Y; Jeong, N Y; Chung, W T; Yoo, Y H

    2015-12-01

    Although leptin appears to be an important local and systemic factor influencing cartilage homeostasis, the role of leptin in chondrocyte death is largely unknown. Tumor necrosis factor α (TNF-α) is a pro-inflammatory cytokine that plays a central role in the pathogenesis of articular diseases. This study examines whether leptin modulates TNF-α-induced articular chondrocyte death. Primary rat articular chondrocytes were isolated from knee joint cartilage slices. To induce cell death, the chondrocytes were treated with TNF-α. To examine whether leptin modulates the extent of TNF-α-mediated chondrocyte death, the cells were pretreated with leptin for 3 h before TNF-α treatment followed by viability analysis. To examine the mechanism by which leptin modulates the extent of TNF-α-mediated chondrocyte death, we utilized mitochondrial membrane potential (MMP) measurements, flow cytometry, nuclear morphology observation, co-immunoprecipitation, western blot analysis and confocal microscopy. We demonstrated that leptin suppresses TNF-α induced chondrocyte death. We further found that apoptosis partially contributes to TNF-α induced chondrocyte death while necroptosis primarily contributes to TNF-α induced chondrocyte death. In addition, we observed that leptin exerts anti-TNF-α toxicity via c-jun N-terminal kinase (JNK) in rat articular chondrocytes. Based on our findings, we suggest that the leptin present in the articular joint fluid protects articular chondrocytes against cumulative mechanical load and detrimental stresses throughout a lifetime, delaying the onset of degenerative changes in chondrocytes. We can further hypothesize that leptin protects articular chondrocytes against destructive stimuli even in the joints of osteoarthritis (OA) patients. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  12. Biomechanical and functional efficacy of knee sleeves: A literature review.

    Science.gov (United States)

    Mohd Sharif, Nahdatul Aishah; Goh, Siew-Li; Usman, Juliana; Wan Safwani, Wan Kamarul Zaman

    2017-11-01

    Knee sleeves are widely used for the symptomatic relief and subjective improvements of knee problems. To date, however, their biomechanical effects have not been well understood. To determine whether knee sleeves can significantly improve the biomechanical variables for knee problems. Systematic literature search was conducted on four online databases - PubMed, Web of Science, ScienceDirect and Springer Link - to find peer-reviewed and relevant scientific papers on knee sleeves published from January 2005 to January 2015. Study quality was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES). Twenty studies on knee sleeves usage identified from the search were included in the review because of their heterogeneous scope of coverage. Twelve studies found significant improvement in gait parameters (3) and functional parameters (9), while eight studies did not find any significant effects of knee sleeves usage. Most improvements were observed in: proprioception for healthy knees, gait and balance for osteoarthritic knees, and functional improvement of injured knees. This review suggests that knee sleeves can effect functional improvements to knee problems. However, further work is needed to confirm this hypothesis, due to the lack of homogeneity and rigor of existing studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Wearable Vector Electrical Bioimpedance System to Assess Knee Joint Health.

    Science.gov (United States)

    Hersek, Sinan; Toreyin, Hakan; Teague, Caitlin N; Millard-Stafford, Mindy L; Jeong, Hyeon-Ki; Bavare, Miheer M; Wolkoff, Paul; Sawka, Michael N; Inan, Omer T

    2017-10-01

    We designed and validated a portable electrical bioimpedance (EBI) system to quantify knee joint health. Five separate experiments were performed to demonstrate the: 1) ability of the EBI system to assess knee injury and recovery; 2) interday variability of knee EBI measurements; 3) sensitivity of the system to small changes in interstitial fluid volume; 4) reducing the error of EBI measurements using acceleration signals; and 5) use of the system with dry electrodes integrated to a wearable knee wrap. 1) The absolute difference in resistance ( R) and reactance (X) from the left to the right knee was able to distinguish injured and healthy knees (p knee R was 2.5 Ω and for X was 1.2 Ω. 3) Local heating/cooling resulted in a significant decrease/increase in knee R (p knee R and X measured using the wet electrodes and the designed wearable knee wrap were highly correlated ( R 2 = 0.8 and 0.9, respectively). This study demonstrates the use of wearable EBI measurements in monitoring knee joint health. The proposed wearable system has the potential for assessing knee joint health outside the clinic/lab and help guide rehabilitation.

  14. MR imaging findings in early osteoarthritis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Karachalios, Theofilos E-mail: kar@med.uth.gr; Zibis, Aristidis; Papanagiotou, Panagiotis; Karantanas, Apostolos H.; Malizos, Konstantinos N.; Roidis, Nikolaos

    2004-06-01

    Purpose: To carry out a modern diagnostic survey among patients with a clinical and radiological diagnosis of early osteoarthritis of the knee. Materials and methods:A magnetic resonance imaging survey was performed on 70 patients (82 knees) with a mean age of 59 years. (range, 40-71 years) who had chronic knee pain, clinical diagnosis of early osteoarthritis of the knee and conventional knee radiographs classified as 1 and 2 on the Kellgren-Lawrence scale. Results: A variety of different disorders was found; degenerative meniscal lesions with or without ruptures of the anterior cruciate ligament in 70.7% of the knees, osteonecrosis of the femoral and tibial condyles in 9.75%, osteophytes and degenerative articular cartilage lesions in 8.54%, transient osteoporosis in 2.44% and benign neoplasms and cysts in 6.1%. Conclusions: The existence of such a heterogenous group of disorders in these 'early osteoarthritic knees' may explain failures in treatment and it may justify a modern MRI imaging approach to proper diagnosis.

  15. The Influence of Articular Cartilage Thickness Reduction on Meniscus Biomechanics

    OpenAIRE

    ?uczkiewicz, Piotr; Daszkiewicz, Karol; Chr??cielewski, Jacek; Wojciech WITKOWSKI; Winklewski, Pawel J

    2016-01-01

    Objective Evaluation of the biomechanical interaction between meniscus and cartilage in medial compartment knee osteoarthritis. Methods The finite element method was used to simulate knee joint contact mechanics. Three knee models were created on the basis of knee geometry from the Open Knee project. We reduced the thickness of medial cartilages in the intact knee model by approximately 50% to obtain a medial knee osteoarthritis (OA) model. Two variants of medial knee OA model with congruent ...

  16. Contrast agent enhanced pQCT of articular cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Kallioniemi, A S [Department of Physics, University of Kuopio, POB 1627, 70211 Kuopio (Finland); Jurvelin, J S [Department of Physics, University of Kuopio, POB 1627, 70211 Kuopio (Finland); Nieminen, M T [Department of Diagnostic Radiology, POB 50, 90029 OYS, Oulu University Hospital, Oulu (Finland); Lammi, M J [Department of Anatomy, Institute of Biomedicine, University of Kuopio, POB 1627, 70211 Kuopio (Finland); Toeyraes, J [Department of Physics, University of Kuopio, POB 1627, 70211 Kuopio (Finland)

    2007-02-21

    degraded articular cartilage in vitro. As high resolution imaging of e.g. the knee joint is possible with pQCT, the present technique may be further developed for in vivo quantification of PG depletion in osteoarthritic cartilage. However, careful in vitro and in vivo characterization of diffusion mechanics and optimal contrast agent concentrations are needed before diagnostic applications are feasible.

  17. Change in Knee Cartilage Volume in Individuals Completing a Therapeutic Exercise Program for Knee Osteoarthritis

    Science.gov (United States)

    Woollard, Jason D.; Gil, Alexandra B.; Sparto, Patrick; Kwoh, C. Kent; Piva, Sara R.; Farrokhi, Shawn; Powers, Christopher M.; Fitzgerald, G. Kelley

    2012-01-01

    STUDY DESIGN Prospective cohort study OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis (KOA) who have completed a therapeutic exercise program. BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA, no studies have reported the volume of cartilage change, or individual factors that may impact volume of cartilage change, in those completing an exercise program for KOA. METHODS 13 individuals with KOA underwent magnetic resonance imaging (MR) to quantify cartilage volume change for the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up. Measurements of body structure and function and activity levels/limitations such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Physical Activity Scale for the Elderly (PASE) were performed prior to the therapeutic exercise program. At 6 months from baseline follow-up clinical measurements of knee strength and motion were performed. At 1-year from baseline, imaging of the knee cartilage, knee alignment, and the WOMAC and PASE questionnaires were completed. RESULTS The central region of the medial femoral condyle (cMF) had a median volume of cartilage loss of 3.8%. The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change. Individuals were dichotomized into progressors (n=6) and non-progressors (n=7) based on the standard error of measurement (SEM) of cartilage volume change for the cMF. Progressors were younger, had a larger body mass index, had a higher Kellgren-Lawrence grade in the medial compartment of the knee, and had a greater increase in knee varus alignment from baseline to 1-year follow-up. The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increase medial knee joint loading. CONCLUSION The loss of c

  18. Articular chondrocyte metabolism and osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Leipold, H.R.

    1989-01-01

    The three main objectives of this study were: (1) to determine if depletion of proteoglycans from the cartilage matrix that occurs during osteoarthritis causes a measurable increase of cartilage proteoglycan components in the synovial fluid and sera, (2) to observe what effect intracellular cAMP has on the expression of matrix components by chondrocytes, and (3) to determine if freshly isolated chondrocytes contain detectable levels of mRNA for fibronectin. Canine serum keratan sulfate and hyaluronate were measured to determine if there was an elevation of these serum glycosaminoglycans in a canine model of osteoarthritis. A single intra-articular injection of chymopapain into a shoulder joint increased serum keratan sulfate 10 fold and hyaluronate less than 2 fold in 24 hours. Keratan sulfate concentrations in synovial fluids of dogs about one year old were unrelated to the presence of spontaneous cartilage degeneration in the joints. High keratan sulfate in synovial fluids correlated with higher keratan sulfate in serum. The mean keratan sulfate concentration in sera of older dogs with osteoarthritis was 37% higher than disease-free controls, but the difference between the groups was not statistically significant. Treatment of chondrocytes with 0.5 millimolar (mM) dibutyryl cAMP (DBcAMP) caused the cells to adopt a more rounded morphology. There was no difference between the amount of proteins synthesized by cultures treated with DBcAMP and controls. The amount of fibronectin (FN) in the media of DBcAMP treated cultures detected by an ELISA was specifically reduced, and the amount of {sup 35}S-FN purified by gelatin affinity chromatography decreased. Moreover, the percentage of FN containing the extra domain. A sequence was reduced. Concomitant with the decrease in FN there was an increase in the concentration of keratan sulfate.

  19. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC).

    Science.gov (United States)

    Logerstedt, David; Arundale, Amelia; Lynch, Andrew; Snyder-Mackler, Lynn

    2015-10-06

    Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.

  20. A conceptual framework for a sports knee injury performance profile (SKIPP and return to activity criteria (RTAC

    Directory of Open Access Journals (Sweden)

    David Logerstedt

    2015-10-01

    Full Text Available ABSTRACTInjuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.

  1. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC)

    Science.gov (United States)

    Logerstedt, David; Arundale, Amelia; Lynch, Andrew; Snyder-Mackler, Lynn

    2015-01-01

    Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health. PMID:26537805

  2. Effect of Sodium Hyaluronate on Recovery after Arthroscopic Knee Surgery.

    Science.gov (United States)

    Anand, Sanjeev; Singisetti, Kiran; Srikanth, Koppa N; Bamforth, Cathy; Asumu, Theophilus; Buch, Keyur

    2016-08-01

    The aim of this study was to evaluate the effect of a single immediate postoperative instillation of 10 mL of sodium hyaluronate (Viscoseal) into the knee following arthroscopy. A single-center, prospective, randomized, controlled study was undertaken. Consenting knee arthroscopy patients were randomized into two groups following surgery: the study group received 10 mL of sodium hyaluronate intra-articularly, while the control group received an intra-articular instillation of 10 mL of Bupivacaine. Pre- and postoperative visual analogue scale scores for pain and Western Ontario and McMaster Universities (WOMAC) scores for knee function were obtained. Overall, 48 patients under the care of a single surgeon were randomized into two groups of 24. There were no statistically significant demographic differences at baseline. Three patients were lost to follow-up. There was a statistically significant difference in pain scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p hyaluronate following arthroscopic knee surgery conferred statistically significant improvements in pain and function scores compared with Bupivacaine in the short term (3-6 weeks). Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Gait variability and motor control in people with knee osteoarthritis

    DEFF Research Database (Denmark)

    Alkjaer, Tine; Raffalt, Peter C; Dalsgaard, Helle

    2015-01-01

    stereotypic pattern in people with knee OA compared with healthy age-matched subjects. To assess the gait variability the temporal structure of the ankle and knee joint kinematics was quantified by the largest Lyapunov exponent and the stride time fluctuations were quantified by sample entropy and detrended...

  4. Isotonic quadriceps-hamstring strength ratios of patients with knee ...

    African Journals Online (AJOL)

    (Q/H) ratios of patients with knee osteoarthritis (OA) and apparently healthy control subjects. The relationships between Q/H ratio and each of height, total body weight, age and Quetelet index of both groups were also investigated. Participants in the study were twenty patients with knee OA (13 females and 7 males) and 20 ...

  5. Imaging of the cervical articular pillar

    Energy Technology Data Exchange (ETDEWEB)

    Yeomans, E. [Orange Base Hospital, Orange, NSW (Australia)

    1998-12-01

    The cervical articular pillar, due to the complex anatomical structure of the cervical spine, is not well demonstrated in routine plain radiographic views. Dedicated views have been devised to demonstrate the pillar, yet their performance has abated considerably since the inception of Computed Tomography (CT) in the 1970`s. It is the consideration that CT does not image the articular pillar with a 10 per cent accuracy that poses the question: Is there still a need for plain radiography of the cervical articular pillar? This paper studies the anatomy, plain radiography, and incidence of injury to the cervical articular pillar. It discusses (with reference to current and historic literature) the efficacy of current imaging protocols in depicting this injury. It deals with plain radiography, CT, complex tomography, and Magnetic Resonance Imaging (MRI) of the cervical spine to conclude there may still be a position in current imaging protocols for plain radiography of the cervical articular pillar. Copyright (1998) Australian Institute of Radiography 43 refs., 5 figs.

  6. Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters

    Directory of Open Access Journals (Sweden)

    Rita Nely Vilar Furtado

    Full Text Available Abstract Objectives: To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. Methods: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0–10 cm (VAS for rest pain (VASR; VAS for movement pain (VASM; VAS for joint swelling (VASSw; flexion (FlexG and extension (ExtG. Results: 289 patients (635 joints were studied. VASSw (p < 0.001 and VASR (0.001 < p < 0.016 improved from T0 to T4, T12 and T24 for all joints. VASM improved from T0 to T4 (p < 0.021 for all joints; T0 to T12 (p < 0.023 for MCF and knee; T0 to T24 (p < 0.019 only for MCF and knee. FlexG improved from T0 to T4 (p < 0.001 for all joints; T0 to T12 (p < 0.001 and T0 to T24 (p < 0.02 only for MCF and knee. ExtG improved from T0 to T4 (p < 0.001 for all joints except for elbow; T0 to T12 (p = 0.003 for wrist, metacarpophalangeal and knee; and T0 to T24 (p = 0.014 for MCF and knee. Conclusion: VASSw responded better at short and medium term after IAI with triamcinolone hexacetonide in our sample of RA patients.

  7. Effect of Fatigue on Knee Kinematics During Countermovement Jumps in Female Students of Physical Education With Valgus Knee Deformity

    Directory of Open Access Journals (Sweden)

    Najmeh Sharifi

    2016-06-01

    Discussion: According to the results, the effects of fatigue on the kinematic variables in patients with valgus knee deformity are greater than on the healthy people. This could have been caused by the changes in the lower extremities and muscle length in patients with valgus knee deformity.

  8. Prediction of Wear in Crosslinked Polyethylene Unicompartmental Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan Netter

    2015-05-01

    Full Text Available Wear-related complications remain a major issue after unicompartmental arthroplasty. We used a computational model to predict knee wear generated in vitro under diverse conditions. Inverse finite element analysis of 2 different total knee arthroplasty designs was used to determine wear factors of standard and highly crosslinked polyethylene by matching predicted wear rates to measured wear rates. The computed wear factor was used to predict wear in unicompartmental components. The articular surface design and kinematic conditions of the unicompartmental and tricompartmental designs were different. Predicted wear rate (1.77 mg/million cycles was very close to experimental wear rate (1.84 mg/million cycles after testing in an AMTI knee wear simulator. Finite element analysis can predict experimental wear and may reduce the cost and time of preclinical testing.

  9. Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes.

    Science.gov (United States)

    Smith, Matthew V; Nepple, Jeffrey J; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. In elite football players undergoing knee magnetic resonance imaging at the National Football League's Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. Retrospective cohort. Level 4. A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery-including ACL reconstruction, meniscal procedures, and articular cartilage surgery-and position were recorded for each athlete. BMI was calculated based on height and weight. There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P 30 kg/m 2 was also associated with a higher risk of OA ( P = 0.007) but player position was not associated with knee OA. Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes. Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible.

  10. Power at hip, knee and ankle joints are compromised in women with mild and moderate knee osteoarthritis.

    Science.gov (United States)

    Resende, Renan Alves; Fonseca, Sérgio Teixeira; Silva, Paula Lanna; Magalhães, Claudio Marcos Bedran; Kirkwood, Renata Noce

    2012-12-01

    Analyses of the biomechanical characteristics of gait of women with mild and moderate knee osteoarthritis may identify parameters that could be targeted by physical therapy interventions. Therefore, the purpose of the present study was to compare the joint power profiles during gait between a group of elderly women with mild and moderate levels of knee osteoarthritis and a group of age-matched asymptomatic women. Thirty-nine women diagnosed with osteoarthritis at the medial compartment of the knee and 39 healthy women with no diagnosis of knee osteoarthritis participated in the study. Joint power profiles of the hip, knee and ankle joints in the sagittal plane during gait were performed using video and force data obtained using Qualisys ProReflex System synchronized with two force plates. Principal component analysis was applied to extract features from the joint power waveforms characterizing their main modes of temporal variation. The extracted features were compared between groups. Women with knee osteoarthritis absorbed and generated less energy at the hip and ankle joints, and absorbed less energy at the knee when compared to the asymptomatic group. The observed power pattern in women with knee osteoarthritis may be related to their reduced gait speed, a suboptimal strategy possibly used to reduce reaction forces at the knee. Clinical studies should investigate whether interventions designed to improve muscular resources, as a means to control the flow of forces at the knee, would optimize power patterns and gait performance in women with knee osteoarthritis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Intra-articular enzyme replacement therapy with rhIDUA is safe, well-tolerated, and reduces articular GAG storage in the canine model of mucopolysaccharidosis type I.

    Science.gov (United States)

    Wang, Raymond Y; Aminian, Afshin; McEntee, Michael F; Kan, Shih-Hsin; Simonaro, Calogera M; Lamanna, William C; Lawrence, Roger; Ellinwood, N Matthew; Guerra, Catalina; Le, Steven Q; Dickson, Patricia I; Esko, Jeffrey D

    2014-08-01

    Treatment with intravenous enzyme replacement therapy and hematopoietic stem cell transplantation for mucopolysaccharidosis (MPS) type I does not address joint disease, resulting in persistent orthopedic complications and impaired quality of life. A proof-of-concept study was conducted to determine the safety, tolerability, and efficacy of intra-articular recombinant human iduronidase (IA-rhIDUA) enzyme replacement therapy in the canine MPS I model. Four MPS I dogs underwent monthly rhIDUA injections (0.58 mg/joint) into the right elbow and knee for 6 months. Contralateral elbows and knees concurrently received normal saline. No intravenous rhIDUA therapy was administered. Monthly blood counts, chemistries, anti-rhIDUA antibody titers, and synovial fluid cell counts were measured. Lysosomal storage of synoviocytes and chondrocytes, synovial macrophages and plasma cells were scored at baseline and 1 month following the final injection. All injections were well-tolerated without adverse reactions. One animal required prednisone for spinal cord compression. There were no clinically significant abnormalities in blood counts or chemistries. Circulating anti-rhIDUA antibody titers gradually increased in all dogs except the prednisone-treated dog; plasma cells, which were absent in all baseline synovial specimens, were predominantly found in synovium of rhIDUA-treated joints at study-end. Lysosomal storage in synoviocytes and chondrocytes following 6 months of IA-rhIDUA demonstrated significant reduction compared to tissues at baseline, and saline-treated tissues at study-end. Mean joint synovial GAG levels in IA-rhIDUA joints were 8.62 ± 5.86 μg/mg dry weight and 21.6 ± 10.4 μg/mg dry weight in control joints (60% reduction). Cartilage heparan sulfate was also reduced in the IA-rhIDUA joints (113 ± 39.5 ng/g wet weight) compared to saline-treated joints (142 ± 56.4 ng/g wet weight). Synovial macrophage infiltration, which was present in all joints at baseline, was

  12. Ankylosing spondylitis presenting as juxta-articular masses in females

    Energy Technology Data Exchange (ETDEWEB)

    Lindsley, H.B.; De Smet, A.A.; Neff, J.R.

    1987-02-01

    Juxta-articular inflammatory masses, sternomanubrial or sternoclavicular, were noted in two women who were subsequently found to have ankylosing spondylitis. The differential diagnosis of juxta-articular masses should include systemic rheumatic disorders as well as tumor or infection.

  13. Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity.

    Science.gov (United States)

    Moro-oka, Taka-aki; Shiraishi, Hirokazu; Iwamoto, Yukihide; Banks, Scott A

    2010-03-01

    It is unknown how intra-operative soft-tissue balance affects post-operative knee kinematics during different functional tasks. In order to clarify this relationship, the intra-operative varus-valgus balance and post-operative knee kinematics were compared for 17 patients who underwent total knee arthroplasty using a modified gap technique. The intra-operative balance was recorded with a tensor device, and in vivo knee kinematics of lunging, kneeling and non-weight-bearing knee extension were analyzed with 3D-to-2D model registration techniques. Femoral condylar separation from the tibial articular surface also was investigated. The post-operative varus-valgus angle in 90 degrees kneeling had a strong relationship with the intra-operative varus-valgus angle, while there was a weak relationship for the non-weight-bearing motion at 0 degrees and 90 degrees flexion. Articular surface separation was an uncommon observation, seen in 2.2% of images during non-weight-bearing motion and in none of the lunging or kneeling images. The modified gap technique appears effective providing stable knee arthroplasty kinematics during in vivo activities with minimal articular separation in non-weight-bearing motion.

  14. Association between MRI-defined osteoarthritis, pain, function and strength 3-10 years following knee joint injury in youth sport.

    Science.gov (United States)

    Whittaker, Jackie L; Toomey, Clodagh M; Woodhouse, Linda J; Jaremko, Jacob L; Nettel-Aguirre, Alberto; Emery, Carolyn A

    2017-10-10

    Youth and young adults who participate in sport have an increased risk of knee injury and subsequent osteoarthritis. Improved understanding of the relationship between structural and clinical outcomes postinjury could inform targeted osteoarthritis prevention interventions. This secondary analysis examines the association between MRI-defined osteoarthritis and self-reported and functional outcomes, 3-10 years following youth sport-related knee injury in comparison to healthy controls. Participants included a subsample (n=146) of the Alberta Youth Prevention of Early Osteoarthritis cohort: specifically, 73 individuals with 3-10 years history of sport-related intra-articular knee injury and 73 age-matched, sex-matched and sport-matched controls with completed MRI studies. Outcomes included: MRI-defined osteoarthritis, radiographic osteoarthritis, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain, knee extensor/flexor strength, triple-hop and Y-balance test. Descriptive statistics and univariate logistic regression were used to compare those with and without MRI-defined osteoarthritis. Associations between MRI-defined osteoarthritis and each outcome were assessed using multivariable linear regression considering the influence of injury history, sex, body mass index and time since injury. Participant median age was 23 years (range 15-27), and 63% were female. MRI-defined osteoarthritis varied by injury history, injury type and surgical history and was not isolated to participants with ACL and/or meniscal injuries. Those with a previous knee injury had 10-fold (95% CI 2.3 to 42.8) greater odds of MRI-defined osteoarthritis than uninjured participants. MRI-defined osteoarthritis was independently significantly associated with quality of life, but not symptoms, strength or function. MRI-detected structural changes 3-10 years following youth sport-related knee injury may not dictate clinical symptomatology, strength or function

  15. The effects of a strength and neuromuscular exercise programme for the lower extremity on knee load, pain and function in obese children and adolescents: study protocol for a randomised controlled trial

    OpenAIRE

    Horsak, Brian; Artner, David; Baca, Arnold; Pobatschnig, Barbara; Greber-Platzer, Susanne; Nehrer, Stefan; Wondrasch, Barbara

    2015-01-01

    Background Childhood obesity is one of the most critical and accelerating health challenges throughout the world. It is a major risk factor for developing varus/valgus misalignments of the knee joint. The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage. A training programme, which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading...

  16. Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella.

    Science.gov (United States)

    Metsna, Vahur; Vorobjov, Sigrid; Lepik, Katrin; Märtson, Aare

    2014-08-01

    Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6-20) and that of patients with AKP was 15 (6-20) (p = 0.04). Patients with OARSI scores of 13-24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0-2.3) than patients with OARSI scores of 0-12. The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.

  17. Knee extension and stiffness in osteoarthritic and normal knees: a videofluoroscopic analysis of the effect of a single session of manual therapy.

    Science.gov (United States)

    Taylor, Alden L; Wilken, Jason M; Deyle, Gail D; Gill, Norman W

    2014-04-01

    Descriptive biomechanical study using an experimental repeated-measures design. To quantify the response of participants with and without knee osteoarthritis (OA) to a single session of manual physical therapy. The intervention consisted primarily of joint mobilization techniques, supplemented by exercises, aiming to improve knee extension. While manual therapy benefits patients with knee OA, there is limited research quantifying the effects of a manual therapy treatment session on either motion or stiffness of osteoarthritic and normal knees. Methods The study included 5 participants with knee OA and 5 age-, gender-, and body mass index-matched healthy volunteers. Knee extension motion and stiffness were measured with videofluoroscopy before and after a 30-minute manual therapy treatment session. Analysis of variance and intraclass correlation coefficients were used to analyze the data. Participants with knee OA had restricted knee extension range of motion at baseline, in contrast to the participants with normal knees, who had full knee extension. After the therapy session, there was a significant increase in knee motion in participants with knee OA (P = .004) but not in those with normal knees (P = .201). For stiffness data, there was no main effect for time (P = .903) or load (P = .274), but there was a main effect of group (P = .012), with the participants with healthy knees having greater stiffness than those with knee OA. Reliability, using intraclass correlation coefficient model 3,3, for knee angle measurements between imaging sessions for all loading conditions was 0.99. Reliability (intraclass correlation coefficient model 3,1) for intraimage measurements was 0.97. End-range knee extension stiffness was greater in the participants with normal knees than those with knee OA. The combination of lesser stiffness and lack of motion in those with knee OA, which may indicate the potential for improvement, may explain why increased knee extension angle was

  18. Effects of intra-articular injection of mesenchymal stem cells associated with platelet-rich plasma in a rabbit model of osteoarthritis.

    Science.gov (United States)

    Hermeto, L C; DeRossi, R; Oliveira, R J; Pesarini, J R; Antoniolli-Silva, A C M B; Jardim, P H A; Santana, A E; Deffune, E; Rinaldi, J C; Justulin, L A

    2016-09-02

    The current study aims to evaluate the macroscopic and histological effects of autologous mesenchymal stem cells (MSC) and platelet-rich plasma on knee articular cartilage regeneration in an experimental model of osteoarthritis. Twenty-four rabbits were randomly divided into four groups: control group, platelet-rich plasma group, autologous MSC undifferentiated group, and autologous MSC differentiated into chondrocyte group. Collagenase solution was used to induce osteoarthritis, and treatments were applied to each group at 6 weeks following osteoarthritis induction. After 60 days of therapy, the animals were euthanized and the articular surfaces were subjected to macroscopic and histological evaluations. The adipogenic, chondrogenic, and osteogenic differentiation potentials of MSCs were evaluated. Macroscopic and histological examinations revealed improved tissue repair in the MSC-treated groups. However, no difference was found between MSC-differentiated and undifferentiated chondrocytes. We found that MSCs derived from adipose tissue and platelet-rich plasma were associated with beneficial effects in articular cartilage regeneration during experimental osteoarthritis.

  19. Monitoring of the degradation in the rat's articular cartilage inducing osteoarthritis using common-path Fourier-domain optical coherence tomography

    Science.gov (United States)

    Shin, D. H.; Park, S. H.; Kim, B. Y.; Lee, M. Y.; Baik, H. K.; Seo, J. H.; Kang, J. U.; Song, C. G.

    2013-03-01

    The objective of this experiment is to evaluate the utility and limitations of optical coherence tomography (OCT) for real-time, high-resolution structural analysis. We monitored the degradation of the rat's articular cartilage inducing osteoarthritis (OA) and the change of the rat's articular cartilage recovery by treatment medication, using our developed common-path Fourier-domain (CP-FD) OCT. Also, we have done a comparative analysis the rat's articular cartilage and OA grade. To observe the progression of OA, we induced OA by injecting the monosodium iodoacetate (MIA) into the right knee joint. After the injection of MIA, we sacrificed the rats at intervals of 3 days and obtained OCT and histological images. OCT and histological images showed the OA progress of similar pattern. These results illustrated the potential for non-invasive diagnosis about the grade of OA using CP-FD OCT.

  20. Intracapsular and para-articular chondroma adjacent to large joints: report of three cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez-Lois, C.; Garcia-de-la-Torre, J.P.; SantosBriz-Terron, A.; Martinez-Tello, F.J. [Dept. of Pathology, University Hospital ' ' Doce de Octubre' ' , Madrid (Spain); Vila, J. [Dept. of Orthopedics and Traumatology, University Hospital ' ' Doce de Octubre' ' , Madrid (Spain); Manrique-Chico, J. [Dept. of Radiology, University Hospital ' ' Doce de Octubre' ' , Madrid (Spain)

    2001-12-01

    Para-articular chondroma is a rare tumor that has been reported in only 30 cases adjacent to large joints in the Anglo-Saxon literature. We report three new cases of this entity, describe its clinical, radiological and pathological features, and review the previous literature. Para-articular chondromas have an insidious clinical presentation and on radiographs show a large soft tissue mass with variable ossification. They appear as a lobulated mass of hyaline cartilage with variable endochondral ossification in the central area. These rare benign tumors arise from the capsule or the para-articular connective tissue of a large joint (mainly the knee), which suffers cartilaginous metaplasia and subsequent ossification. Cases 1 and 2 of this presentation fit all the features described previously. Case 3 has identical clinical features but differs from the former two cases in its microscopic appearance, being composed almost entirely of fibrocartilage and myxoid areas within the fibroadipose tissue of the joint instead of mature trabecular bone surrounded by hyaline cartilage. To the best of our knowledge this is the first description of this histological variant of para-articular chondroma. (orig.)

  1. Improved Chondrotoxic Profile of Liposomal Bupivacaine Compared With Standard Bupivacaine After Intra-articular Infiltration in a Porcine Model.

    Science.gov (United States)

    Shaw, K Aaron; Moreland, Colleen; Jacobs, Jeremy; Hire, Justin M; Topolski, Richard; Hoyt, Nathan; Parada, Stephen A; Cameron, Craig D

    2017-10-01

    Increasingly, liposomal bupivacaine is being used with multimodal pain management strategies. In vitro investigations have shown decreased chondrotoxicity profiles for liposomal bupivacaine; however, there is no evidence regarding its in vivo effects. Hypothesis/Purpose: This study sought to investigate the in vivo chondrotoxicity of liposomal bupivacaine, hypothesizing that there would be increased chondrocyte viability after exposure to liposomal bupivacaine when compared with standard bupivacaine. Controlled laboratory study. Eight juvenile, female Yorkshire cross piglets underwent a lateral stifle joint injection with either 1.3% liposomal bupivacaine or 0.5% bupivacaine. Injections were performed on one joint per animal with no injection to the contralateral knee, which served as the control. Chondrocyte viability was assessed 1 week after injection with a live-dead staining protocol and histologic examination. Significant chondrocyte death was seen with the live-dead staining in the bupivacaine group (33% nonviable cells) in comparison with liposomal bupivacaine (6.2%) and control (5.8%) groups ( P model. Although bupivacaine demonstrated decreased chondrocyte viability on a cellular level, histologically there were no changes. This study highlights the dichotomy between fluorescent staining and histologic appearance of articular chondrocytes in short-term analyses of viability. This study supports the peri-articular application of liposomal bupivacaine in the setting of preserved articular cartilage. A single injection of standard bupivacaine did not produce histologic changes in the articular cartilage.

  2. Comparison between Chondrogenic Markers of Differentiated Chondrocytes from Adipose Derived Stem Cells and Articular Chondrocytes In Vitro

    Directory of Open Access Journals (Sweden)

    Mohmmad Mardani

    2013-06-01

    Full Text Available   Objective(s: Osteoarthritis is one of the most common diseases in middle-aged population in the world. Cartilage tissue engineering (TE has been presented as an effort to introduce the best combination of cells, biomaterial scaffolds and stimulating growth factors to produce a cartilage tissue similar to the natural articular cartilage. In this study, the chondrogenic potential of adipose derived stem cells (ADSCs was compared with natural articular chondrocytes cultured in alginate scaffold.   Materials and Methods: Human ADSCs were obtained from subcutaneous adipose tissue and human articular chondrocytes from non-weight bearing areas of knee joints. Cells were seeded in 1.5% alginate and cultured in chondrogenic media for three weeks with and without TGFβ3. The genes expression of types II and X collagens was assessed by Real Time PCR and the amount of aggrecan (AGC and type I collagen measured by ELISA and the content of glycosaminoglycan evaluated by GAG assay. Results: Our findings showed that type II collagen, GAG and AGC were expressed, in differentiated ADSCs. Meanwhile, they produced a lesser amount of types II and X collagens but more AGC, GAG and type I collagen in comparison with natural chondrocytes (NCs. Conclusion: Further attempt should be carried out to optimize achieving type II collagen in DCs, as much as, natural articular chondrocytes and decline of the production of type I collagen in order to provide efficient hyaline cartilage after chondrogenic induction, prior to the usage of harvested tissues in clinical trials.

  3. Body weight independently affects articular cartilage catabolism.

    Science.gov (United States)

    Denning, W Matt; Winward, Jason G; Pardo, Michael Becker; Hopkins, J Ty; Seeley, Matthew K

    2015-06-01

    Although obesity is associated with osteoarthritis, it is unclear whether body weight (BW) independently affects articular cartilage catabolism (i.e., independent from physiological factors that also accompany obesity). The primary purpose of this study was to evaluate the independent effect of BW on articular cartilage catabolism associated with walking. A secondary purpose was to determine how decreased BW influenced cardiovascular response due to walking. Twelve able-bodied subjects walked for 30 minutes on a lower-body positive pressure treadmill during three sessions: control (unadjusted BW), +40%BW, and -40%BW. Serum cartilage oligomeric matrix protein (COMP) was measured immediately before (baseline) and after, and 15 and 30 minutes after the walk. Heart rate (HR) and rate of perceived exertion (RPE) were measured every three minutes during the walk. Relative to baseline, average serum COMP concentration was 13% and 5% greater immediately after and 15 minutes after the walk. Immediately after the walk, serum COMP concentration was 14% greater for the +40%BW session than for the -40%BW session. HR and RPE were greater for the +40%BW session than for the other two sessions, but did not differ between the control and -40%BW sessions. BW independently influences acute articular cartilage catabolism and cardiovascular response due to walking: as BW increases, so does acute articular cartilage catabolism and cardiovascular response. These results indicate that lower-body positive pressure walking may benefit certain individuals by reducing acute articular cartilage catabolism, due to walking, while maintaining cardiovascular response. Key pointsWalking for 30 minutes with adjustments in body weight (normal body weight, +40% and -40% body weight) significantly influences articular cartilage catabolism, measured via serum COMP concentration.Compared to baseline levels, walking with +40% body weight and normal body weight both elicited significant increases in

  4. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  5. Knee arthroscopy - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100117.htm Knee arthroscopy - series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The knee is a complex joint made up of the ...

  6. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  7. Knee braces - unloading

    Science.gov (United States)

    ... most people talk about the arthritis in their knees, they are referring to a type of arthritis ... is caused by wear and tear inside your knee joints. Cartilage, the firm, rubbery tissue that cushions ...

  8. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  9. Long-term results of rib perichondrial grafts for repair of cartilage defects in the human knee

    NARCIS (Netherlands)

    Bouwmeester, SJM; Beckers, JMH; Kuijer, R; van der Linden, AJ; Bulstra, SK

    1997-01-01

    Eighty-eight patients with articular cartilage defects in the knee were treated by perichondrial arthroplasty between 1986 and 1992. An autogenous strip of costal perichondrium was fixed in place with fibrin glue, followed by immobilisation, continuous passive motion, and partial weightbearing. The

  10. Retrospective Evaluation Of MRI Findings Of Knee Joint In 255 Patients

    Directory of Open Access Journals (Sweden)

    Ahmet Mete

    2003-03-01

    Full Text Available Retrospective evaluation of knee MRI obtained from 255 cases and to demonstrate most common knee joint pathologies in our region.In our study knee joints of 255 cases who admitted to different clinics of our hospital with various complains of knee between October 1996 and December 1998 were examined in wide spectrum with MRI. Via 1.0 Tesla MRI device and special knee coil in sagittal, coronal and axial plains MRI images were obtained. The number of male and female patients were 173 and 82 and their ages were ranged between 14 and 70, and the mean age was 3413.The most common knee pathologies were intra-articular fluid (%58.04, medial (%46,66 and lateral (%12.55 meniscal injuries, anterior cruciate ligament injury (%17.25 and osteoarthritis (%14.9. The other important lesions were degeneration of medial and lateral meniscus, Baker’s cyst, bursitis, posterior cruciate ligament injury , medial and lateral collateral ligament injuries, synovial hypertrophy, chondromalasia of patella, and contusion.In our images of knee the most common lesions were injuries of meniscus and ligament. Because of being noninvasive technique for knee joint pathologies, capacity of multiplanar imaging, high contrast resolution and chance of detailed anatomic evaluation MR imaging was found to be most appropriate imaging technique for knee joint pathologies.

  11. MRI based knee cartilage assessment

    Science.gov (United States)

    Kroon, Dirk-Jan; Kowalski, Przemyslaw; Tekieli, Wojciech; Reeuwijk, Els; Saris, Daniel; Slump, Cornelis H.

    2012-03-01

    Osteoarthritis is one of the leading causes of pain and disability worldwide and a major health problem in developed countries due to the gradually aging population. Though the symptoms are easily recognized and described by a patient, it is difficult to assess the level of damage or loss of a