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1
Wilding, Christopher P., Martyn Snow, and Lee Jeys. "Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901988551. http://dx.doi.org/10.1177/2309499019885510.
Анотація:
Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
2
Fahlman, Lissa, Emmeline Sangeorzan, Nimisha Chheda, and Daphne Lambright. "Older Adults without Radiographic Knee Osteoarthritis: Knee Alignment and Knee Range of Motion." Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 7 (January 2014): CMAMD.S13009. http://dx.doi.org/10.4137/cmamd.s13009.
Анотація:
This study describes knee alignment and active knee range of motion (ROM) in a community-based group of 78-year old adults (n = 143) who did not have radiographic evidence of knee osteoarthritis in either knee (KL < 2). Although knee malalignment is a risk factor for knee osteoarthritis, most women and men had either valgus or varus alignments. Notably, no men were valgus in both knees. Women with both knees valgus had significantly greater body mass index ( P > 0.001) than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.
3
Mohd Nizlan, Nasir, Fauzah Abd Ghani, and Rohaman Tasarib. "Acute Post-Traumatic Locked Knee - An Unmasking of a Rare Knee Disorder." Malaysian Journal of Medicine and Health Sciences 18, no. 5 (September 15, 2022): 215–17. http://dx.doi.org/10.47836/mjmhs.18.5.29.
Анотація:
Locked knees are commonly caused by meniscal tears, floating osteochondral bodies, ruptured anterior cruciate ligament (ACL) stump, or other mechanical origins in the knee. Some locked knees occur spontaneously, while in most cases, by a preceding knee trauma. Locked knees are rarely caused by a pathological growth in the knee. More unusually is the occurrence of locked knee caused by a pre-existing pathological entity after a traumatic event. We report a rare case of locking in the knee by a pre-existing knee condition presented only after trauma to the knee. This case emphasizes that locking in the knee can be caused by a pathology that may be asymptomatic until it is revealed by a traumatic event.
4
Ismail, Shiek Abdullah, Milena Simic, Lucy J. Salmon, Justin P. Roe, Leo A. Pinczewski, Richard Smith, and Evangelos Pappas. "Side-to-Side Differences in Varus Thrust and Knee Abduction Moment in High-Functioning Individuals With Chronic Anterior Cruciate Ligament Deficiency." American Journal of Sports Medicine 47, no. 3 (December 10, 2018): 590–97. http://dx.doi.org/10.1177/0363546518812883.
Анотація:
Background: There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament–deficient (ACLD) knees remains sparse. Purpose: To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament–intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees. Study Design: Descriptive laboratory study. Methods: Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase. Results: Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees. Conclusion: There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.
5
Amin, Raj M., Vikram Vasan, and Julius K. Oni. "Kneeling after Total Knee Arthroplasty." Journal of Knee Surgery 33, no. 02 (January 2, 2019): 138–43. http://dx.doi.org/10.1055/s-0038-1676801.
Анотація:
AbstractThe ability to kneel is one of the many patient goals after total knee arthroplasty (TKA). Few studies have addressed patients' ability to kneel after TKA as a primary outcome. Given the altered biomechanics of the knee after TKA, the various implant designs, and multiple surgical approaches, there is a need to further understand the patient's kneeling ability after TKA. We evaluated the available literature on this topic to help to guide postoperative care recommendations. Biomechanical data show that the load borne by the patellofemoral joint is elevated significantly at all flexion angles, whereas tibiofemoral articulation pressures are elevated only at 90 to 120 degrees of flexion. However, these increased pressures are rarely borne by prosthetic knees because patients often avoid kneeling after TKA. In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after TKA, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after TKA. Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after TKA. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after TKA.
6
Agarwal, A., S. Miller, W. Hadden, L. Johnston, W. Wang, G. Arnold, and RJ Abboud. "Comparison of gait kinematics in total and unicondylar knee replacement surgery." Annals of The Royal College of Surgeons of England 101, no. 6 (July 2019): 391–98. http://dx.doi.org/10.1308/rcsann.2019.0016.
Анотація:
Introduction This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. Materials and methods This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. Results The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. Conclusions The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.
7
Nagai, Kanto, Elmar Herbst, Tom Gale, Yasutaka Tashiro, James J. Irrgang, William Anderst, and Freddie H. Fu. "Patient-reported outcome measures following anterior cruciate ligament reconstruction are not related to dynamic knee extension angle." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 3, no. 1 (January 2018): 33–37. http://dx.doi.org/10.1136/jisakos-2017-000173.
Анотація:
ObjectivesControversy still exists on whether knee hyperextension affects the outcome following anterior cruciate ligament reconstruction (ACL-R). Therefore, the purpose of the present study was to determine if maximum knee extension angle of ACL-R knees and contralateral uninjured knees during walking is related to the clinical outcome following ACL-R. It was hypothesised that maximum knee extension angle would not be significantly correlated with patient-reported outcome measures (PROMs) following ACL-R.MethodsForty-two patients (age at surgery: 23±9 years, 23 male and 19 female) underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking on a treadmill while biplane radiographs were acquired at 100 Hz. Three-dimensional tibiofemoral motion was determined using a validated model-based tracking process. Tibiofemoral rotations were calculated from foot strike through early stance. The primary kinematic outcome measure was maximum knee extension angle of ACL-R and contralateral uninjured knees during walking, with positive values indicating hyperextension. The side-to-side difference (SSD) in maximum knee extension angle was calculated by subtracting the angle of the contralateral uninjured knee from that of the ACL reconstructed knee. PROMs (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Score and Marx Activity Rating Scale) were obtained at 24 months after surgery. Correlations between PROMs and maximum dynamic knee extension angle in ACL-R and contralateral knee were evaluated (P<0.05).ResultsMaximum knee extension angle during walking was 2.3±4.5° in ACL-R knees and 4.3±4.2° in contralateral uninjured knees at 24 months after surgery, indicating hyperextension during walking on average. SSD in maximum knee extension angle was −2.0±3.7°. No significant correlation was observed between maximum knee extension angle and the PROMs.ConclusionMaximum knee extension angle during walking was not significantly correlated with PROMs, suggesting that clinically, physiologic knee hyperextension can be restored after ACL-R and not adversely affect PROMs.Level of evidenceLevel III.
8
WISE, BARTON L., DAVID T. FELSON, MARGARET CLANCY, JINGBO NIU, TUHINA NEOGI, NANCY E. LANE, JEAN HIETPAS, et al. "Consistency of Knee Pain and Risk of Knee Replacement: The Multicenter Osteoarthritis Study." Journal of Rheumatology 38, no. 7 (April 15, 2011): 1390–95. http://dx.doi.org/10.3899/jrheum.100743.
Анотація:
Objective.To examine whether the consistency or persistence of knee pain, in addition to its severity, predicts incident total knee replacement (TKR).Methods.The Multicenter Osteoarthritis Study (MOST) is a longitudinal study of persons aged 50 to 79 years with symptomatic knee osteoarthritis or at high risk of disease. Subjects were queried about the presence of knee pain on most days of the previous 30 days (i.e., frequent knee pain; FKP) at 2 timepoints: a telephone screen followed by a clinic visit (median separation 4 weeks). We defined a knee as having “consistent pain” if the subject answered positively to the FKP question at both timepoints, “inconsistent pain” if FKP was positive at only one timepoint, or as “no FKP” if negative at both. We examined the association between consistent FKP and risk of TKR using multiple binomial regression with generalized estimating equations.Results.In 3026 persons (mean age 63 yrs, mean body mass index 30.4), 2979 knees (50%) had no FKP at baseline, 1279 knees (21.5%) had inconsistent FKP, and 1696 knees (28.5%) had consistent FKP. Risk of TKR over 30 months was 0.8%, 2.6%, and 8.8% for knees with no, inconsistent, and consistent FKP, respectively. Relative risks of TKR over 30 months were 1.2 (95% CI 0.6–2.3) and 2.3 (95% CI 1.2–4.4) for knees with inconsistent and consistent FKP, compared with those without FKP. This association was consistent across each level of pain severity on the Western Ontario and McMaster Universities Osteoarthritis Index.Conclusion.Consistency of frequent knee pain is associated with an increased risk of TKR independently of knee pain severity.
9
Blaisdell, Jay, and James Talmage. "Rating Knee Impairments." Guides Newsletter 23, no. 1 (January 1, 2018): 14–16. http://dx.doi.org/10.1001/amaguidesnewsletters.2018.janfeb04.
Анотація:
Abstract Workers who kneel for major portions of their workday (eg, floor and roof installers) may be prone to inflammation of the knee bursae and patellofemoral pain. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), range-of-motion (ROM) and diagnosis-based impairment (DBI) are the two possible stand-alone methods for rating knee impairment. The ROM method was widely used in previous editions of the AMA Guides, but at present DBI is the method of choice for calculating impairment. To rate knee impairment using the DBI method, the physician first chooses the appropriate diagnosis from the Knee Regional Grid in the AMA Guides, Sixth Edition. Next, the physician chooses the appropriate impairment class for the diagnosis and then selects the appropriate grade modifiers. The physician applies the net adjustment formula to determine lower extremity impairment and finally converts the final lower extremity impairment to whole person impairment. Two or more conditions often are found in the knees and require causation analysis in which the physician should choose the single causally related diagnosis that will yield the highest impairment rating. Modifiers should be chosen based on reliable findings that have not been used previously to assign either the diagnosis or impairment class. The ROM method can be used to select the physical examination grade modifier or as a stand-alone rating if the physician offers a rationale that is supported by the AMA Guides.
10
Hiranaka, Takafumi, Yuichi Hida, Takaaki Fujishiro, Tomoyuki Kamenaga, Kenichi Kikuchi, Ryo Yoshikawa, Shotaro Tachibana, and Koji Okamoto. "Approximately 30% of Functioning Anterior Cruciate Ligaments Are Sacrificed for Knee Arthroplasty." Journal of Knee Surgery 33, no. 07 (March 25, 2019): 655–58. http://dx.doi.org/10.1055/s-0039-1683928.
Анотація:
AbstractThe anterior cruciate ligament (ACL) plays an important role in knee kinematics. Unicompartmental knee arthroplasty (UKA) preserves the ACL, an advantage over total knee arthroplasty (TKA), where it is sacrificed. This study aims to evaluate how often functional ACLs are sacrificed in arthroplasty. The type of arthroplasty (TKA or UKA) and condition of the ACL were studied in a total of 1,586 knees in 1,052 patients who underwent knee arthroplasties. Of 1,586 knees, TKA was performed on 653 knees (41%) and UKA on 933 knees (59%). The ACL was functioning in 77% of all knees. Of the TKA knees, the ACL was functioning in 357 knees (55%). Of these, around 30% of the functioning ACLs were sacrificed to perform TKA. To improve postoperative patient satisfaction after knee arthroplasty, further study regarding relationship between ACL preservation and clinical outcome will be required.
11
Iriuchishima, Takanori, and Keinosuke Ryu. "A Comparison of Rollback Ratio between Bicruciate Substituting Total Knee Arthroplasty and Oxford Unicompartmental Knee Arthroplasty." Journal of Knee Surgery 31, no. 06 (July 25, 2017): 568–72. http://dx.doi.org/10.1055/s-0037-1604445.
Анотація:
AbstractThe purpose of this study was to compare the rollback ratio in bicruciate substituting (BCS) total knee arthroplasty (TKA) and bicruciate-retaining Oxford unicompartmental knee arthroplasty (UKA). In this study, 64 subjects (64 knees) undergoing BCS-TKA (Journey II: Smith and Nephew) and 50 subjects (50 knees) undergoing Oxford UKA (Zimmer-Biomet holdings, Inc., IN) were included. Approximately 6 months after surgery, and when the subjects had recovered their knee range of motion, following the Laidlow's method, lateral radiographic imaging of the knee was performed with active full knee flexion. The most posterior tibiofemoral contact point was measured for the evaluation of femoral rollback (rollback ratio). Flexion angle was also measured using the same radiograph and the correlation of rollback and flexion angle was analyzed. As a control, radiographs of the asymptomatic contralateral knees of subjects undergoing Oxford UKA were evaluated (50 knees). The rollback ratios of the BCS-TKA, Oxford UKA, and control knees were 37.9 ± 4.9, 35.7 ± 4.2, and 35.3 ± 4.8% respectively. No significant difference in rollback ratio was observed among the three groups. The flexion angles of the BCS-TKA, Oxford UKA, and control knees were 123.8 ± 8.4, 125.4 ± 7.5, and 127 ± 10.3 degrees, respectively. No significant difference in knee flexion angle was observed among the three groups. Significant correlation between rollback ratio and knee flexion angle was observed (p = 0.002; Pearson's correlation coefficient = − 0.384). BCS-TKA showed no significant difference in rollback ratio when compared with control knees and Oxford UKA knees. The BCS-TKA design is likely to reproduce native anterior cruciate ligament and posterior cruciate ligament function, and native knee rollback.
12
HARMAN, MELINDA K., SCOTT A. BANKS, BENJAMIN J. FREGLY, W. GREGORY SAWYER, and W. ANDREW HODGE. "BIOMECHANICAL MECHANISMS FOR DAMAGE: RETRIEVAL ANALYSIS AND COMPUTATIONAL WEAR PREDICTIONS IN TOTAL KNEE REPLACEMENTS." Journal of Mechanics in Medicine and Biology 05, no. 03 (September 2005): 469–75. http://dx.doi.org/10.1142/s0219519405001588.
Анотація:
Damage patterns on the articular surface of the proximal tibia, including cartilage degeneration in osteoarthritic knees and damage of polyethylene knee prostheses after total knee replacement, provide information related to knee joint biomechanics and damage mechanisms at the articular surface. This study reports articular damage patterns and knee kinematics assessed in the knees of older subjects, before and after total knee replacement. The damage patterns are used to evaluate computational dynamic contact and tribological models that predict polyethylene damage in a patient-specific total knee replacement model.
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C, Kavinaya, and Ashuthoshkumar L. "Various Knee Model Measurement Techniques to Find the Knee Geometries." International Journal of Pharmacy and Biomedical Engineering 3, no. 3 (December 25, 2016): 4–6. http://dx.doi.org/10.14445/23942576/ijpbe-v3i3p102.
Анотація:
Computation of knee modeling is a subject-specific techniquethatdefining the zero-load measurements of the cruciate and indemnity ligaments.The dynamic knee simulator was used to test the three carcass knees. The carcass knees also experiencedphysicalsachet of motion testing to discovery their inactivesort of motion in order to regulate the zero-load measurements for everymuscle bundle. Compotation multibody knee representations were shaped for each knee and classical kinematics were likened to investigational kinematics for a replicated walk series. Simple-minded non-linear mechanisminhibition elements were used to characterize cruciate and deposited particles in musclepackages in the knee representations. This learningoriginate that knee kinematics was enormously sensitive to changing of the zero-load measurement. The domino effects also recommendoptimum methods for describing each of the muscle bundle zero-load measurements, irrespective of the subject. These consequencesvalidate the significance ofthe zero-load length when modeling the knee united and verify that physicalcloak of motion dimensions can be usedto determine the passive range of motion of the knee joint. It is also supposed that the method defined here forresponsible zero-load measurement can be used for in vitro or in vivo subject-specific computational models.
14
Thilak, Jai, Srivatsa Nagaraja Rao, Vipin Mohan, and Balu C. Babu. "Image-based robot assisted bicompartmental knee arthroplasty versus total knee arthroplasty." SICOT-J 8 (2022): 48. http://dx.doi.org/10.1051/sicotj/2022048.
Анотація:
Objective: To evaluate the short-term clinical outcomes of image-based robot-assisted bicruciate retaining bicompartmental knee arthroplasty and compare it to robot-assisted total knee arthroplasty in the Indian population. Methods: Between December 2018 and November 2019, five patients (six knees) underwent robot-assisted bicompartmental knee arthroplasty (BCKA). These patients were demographically matched with five patients (six knees) who underwent robot-assisted total knee arthroplasty (TKA) during the same period. Clinical outcomes of these twelve knees were assessed in the form of knee society score (KSS) score, Oxford knee score (OKS), and forgotten joint score (FJS) after a minimum follow-up period of 25 months. The data between the two cohorts were compared and analyzed. Results: Scores obtained from both cohorts were subjected to statistical analysis. SPSS software was utilized and the Mann Whitney U-test was utilized to compare the two groups. There was no statistically significant difference found between the two groups in terms of functional outcome. Conclusion: Image-based robot-assisted BCKA is a bone stock preserving and more physiological procedure which can be a promising alternative to patients presenting with isolated arthritis of only two compartments of the knee. Although long-term, larger trials are warranted to establish it as an alternative, our pilot study shows an equally favorable outcome as TKA, making it an exciting new avenue in the field of arthroplasty.
15
Hollman, John H., Robert H. Deusinger, Linda R. Van Dillen, and Matthew J. Matava. "Knee Joint Movements in Subjects Without Knee Pathology and Subjects With Injured Anterior Cruciate Ligaments." Physical Therapy 82, no. 10 (October 1, 2002): 960–72. http://dx.doi.org/10.1093/ptj/82.10.960.
Анотація:
Abstract Background and Purpose. Although weight-bearing (WB) exercise and increased hamstring muscle activity may contribute to knee joint stability in knees with an injured anterior cruciate ligament (ACL), the relationship among ACL integrity, muscle activity, and joint surface motion is not fully understood. The purpose of this study was to investigate whether knee joint rolling and gliding movements and electromyographic (EMG) activity differed between subjects with injured ACLs and subjects without knee pathology. Subjects. Fifteen subjects with injured ACLs (9 men and 6 women; mean age=26 years, SD=7, range=18–36) and 15 age- and sex-matched subjects without knee pathology (9 men and 6 women; mean age=25 years, SD=6, range=18–36) participated in the study. Methods. Sagittal-plane knee joint rolling and gliding movements and lower-extremity EMG activity were measured during non-weight-bearing (NWB) and WB movements. Mixed-model analyses of variance were conducted to analyze rolling and gliding and EMG data. Results. During NWB knee extension, greater joint surface gliding occurred in knees with injured ACLs at full knee extension. During WB knee extension, greater gliding occurred in knees with injured ACLs throughout the range of motion tested. No differences in EMG activity occurred between groups. Discussion and Conclusion. The results suggest that, in the absence of increased hamstring muscle activity, anterior tibial displacement is not reduced in knees with injured ACLs during WB movement.
16
Kijima, Hiroaki, Naohisa Miyakoshi, Yuji Kasukawa, Yoshinori Ishikawa, Hayato Kinoshita, Kentaro Ohuchi, Masazumi Suzuki, et al. "Cut-Off Value of Medial Meniscal Extrusion for Knee Pain." Advances in Orthopedics 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/6793026.
Анотація:
Purpose. Medial meniscal extrusion (MME) has attracted attention as an index of knee pain in conjunction with clinical symptoms that could be more useful than the diagnosis of knee osteoarthritis on X-ray. However, the size of MME that would cause knee pain has not been clarified. The aim of the present study was to investigate the cut-off value of MME for knee pain. Methods. A total of 318 knees were evaluated. The presence of current or past knee pain was confirmed by interview. Next, MME was measured using vertical sonographic images of the medial joint spaces during weightbearing. Results. Overall, 71 knees were painful (P-group), and 247 knees were not (N-group). MME was 5.9 ± 1.8 mm in the P-group and 2.9 ± 1.5 mm in the N-group (P<0.0001). Analysis of the receiver operating characteristic curve showed that the cut-off value of MME for knee pain was 4.3 mm, with sensitivity of 0.8451 and specificity of 0.8502. In addition, 64% of knees without pain cases at the time of examination whose MME exceeded this cut-off value had past knee pain. Conclusions. The sensitivity and specificity of MME for knee pain were very high with a cut-off value of 4.3 mm.
17
White, Leigh, Nicholas Hartnell, Melissa Hennessy, and Judy Mullan. "The Impact of an Intact Infrapatellar Fat Pad on Outcomes after Total Knee Arthroplasty." Advances in Orthopedic Surgery 2015 (November 16, 2015): 1–6. http://dx.doi.org/10.1155/2015/817906.
Анотація:
Background. The infrapatellar fat pad (IPFP) is currently resected in approximately 88% of Total Knee Arthroplasties (TKAs). We hypothesised that an intact IPFP would improve outcomes after TKA. Methods. Patients with an intact IPFP participated in this cross-sectional study by completing two surveys, at 6 and 12 months after TKA. Both surveys included questions regarding kneeling, with the Oxford Knee Score also included at 12 months. Results. Sixty patients participated in this study. At 6 and 12 months, a similar number of patients were able to kneel, 40 (66.7%) and 43 (71.7%), respectively. Fifteen (25.0%) patients were unable to kneel due to knee pain at 6 months; of these, nine (15%) were unable to kneel at 12 months. Moreover, at 12 months, 90.0% of the patients reported minimal or no knee pain. There was no correlation between the inability to kneel and knee pain (p=0.13). There was a significant correlation between the inability to kneel and reduced overall standardised knee function scores (p=0.02). Conclusions. This was the first study to demonstrate improved kneeling and descending of stairs after TKA with IPFP preservation. These results in the context of current literature show that IPFP preservation reduces the incidence of knee pain 12 months after TKA.
18
Anand, TS, and S. Sujatha. "A method for performance comparison of polycentric knees and its application to the design of a knee for developing countries." Prosthetics and Orthotics International 41, no. 4 (July 18, 2016): 402–11. http://dx.doi.org/10.1177/0309364616652017.
Анотація:
Background:Polycentric knees for transfemoral prostheses have a variety of geometries, but a survey of literature shows that there are few ways of comparing their performance.Objectives:Our objective was to present a method for performance comparison of polycentric knee geometries and design a new geometry.Study design:In this work, we define parameters to compare various commercially available prosthetic knees in terms of their stability, toe clearance, maximum flexion, and so on and optimize the parameters to obtain a new knee design.Methods:We use the defined parameters and optimization to design a new knee geometry that provides the greater stability and toe clearance necessary to navigate uneven terrain which is typically encountered in developing countries.Results:Several commercial knees were compared based on the defined parameters to determine their suitability for uneven terrain. A new knee was designed based on optimization of these parameters. Preliminary user testing indicates that the new knee is very stable and easy to use.Conclusion:The methodology can be used for better knee selection and design of more customized knee geometries.Clinical relevanceThe method provides a tool to aid in the selection and design of polycentric knees for transfemoral prostheses.
19
Fosco, M., M. Filanti, L. Amendola, L. M. Savarino, and D. Tigani. "Total knee arthroplasty in stiff knee compared with flexible knees." MUSCULOSKELETAL SURGERY 95, no. 1 (March 9, 2011): 7–12. http://dx.doi.org/10.1007/s12306-011-0099-6.
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Reddy, K. Vijaya Bhaskar, N. Brahma Chary, and Birru Sumanth. "A study on functional outcome of posterior cruciate ligament substituted total knee arthroplasty." International Journal of Research in Orthopaedics 7, no. 6 (October 26, 2021): 1161. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20214182.
Анотація:
<p class="abstract"><strong>Background: </strong>Total knee replacement surgery is considered as a treatment of choice in patients with advanced arthritis, especially in patients where conservative treatment has been failed. Total knee replacement gives good pain relief, functional improvement of knee and correction of deformity.</p><p class="abstract"><strong>Methods:</strong> This is study of 39 patients following total knee arthroplasty, who were operated between August 2017 and March 2020 at MNR Medical College and Hospital, Sangareddy. They were followed up for a minimum period of 1 year and evaluated using oxford knee scoring system. Oxford knee score is designed specifically for measuring outcomes in knee arthroplasty. There were 14 right knees, 10 left knees, 15 bilateral knees.</p><p class="abstract"><strong>Results: </strong>There was a significant functional improvement of knee in patients and we had achieved excellent results, out of 39 patients and 4 patients had post op suprapatellar fullness, which was relieved with medications for 3 weeks and 2 patients (2 knees) without no signs of immediate post-operative period, developed infection after 6 months followed which underwent staged revision total knee replacement. The outcome categories based on oxford knee scoring system: excellent (40-48), good (30-39), fair (20-29) and poor (0-19).</p><p class="abstract"><strong>Conclusions: </strong>It is difficult to balance the knee with retention of posterior cruciate ligament, whereas posterior cruciate ligament substituting total knee replacement gives reproducible and good results, hence it is the preferred mode of management.</p>
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Hildebrand, Kevin A., Michael Holmberg, and Nigel Shrive. "A New Method to Measure Post-Traumatic Joint Contractures in the Rabbit Knee." Journal of Biomechanical Engineering 125, no. 6 (December 1, 2003): 887–92. http://dx.doi.org/10.1115/1.1634285.
Анотація:
A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9deg±1.5degmean±sd with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6deg±7.1deg, and of the four right knees (tested 26 times) was 12.0deg±10.9deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint extension (flexion contracture) was demonstrated for the experimental knees using the new methodology where the maximum extension was 35deg±9deg, compared to the unoperated knee maximum extension of 11deg±7deg, 10 or 12 weeks after the immobilization was discontinued. The custom gripping device coupled to a materials testing machine will serve as a measurement test for future studies characterizing a rabbit knee model of post-traumatic joint contractures.
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Norouzi, Sadegh, Fateme Esfandiarpour, Ali Shakourirad, Reza Salehi, Mohammad Akbar, and Farzam Farahmand. "Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics." BioMed Research International 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/248525.
Анотація:
A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.
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Heinrichs, Christian H., Dominik Knierzinger, Hannes Stofferin, and Werner Schmoelz. "Validation of a novel biomechanical test bench for the knee joint with six degrees of freedom." Biomedical Engineering / Biomedizinische Technik 63, no. 6 (November 27, 2018): 709–17. http://dx.doi.org/10.1515/bmt-2016-0255.
Анотація:
AbstractA novel biomechanical test bench has been developed for in-vitro evaluation of the knee joint. The test bench allows the kinematics of the knee joint to be studied in all six degrees of freedom. Flexion-extension knee movements are induced by quadriceps and hamstring muscle forces simulated by five pneumatic cylinders. The kinematics of the knee and the actively applied muscle forces are measured simultaneously. The aim of this study was to validate the sensitivity and reproducibility of this novel test bench. Four fresh frozen human knees were tested three times, each with seven flexion-extension cycles between 5° and 60°. After the native knees had been tested, the posterior cruciate ligament and then the lateral collateral ligament were dissected. The injured knees were tested in identical conditions [3×(7×5°–60°)] in order to evaluate whether the test bench is capable of detecting differences in knee kinematics between a native state and an injured one. With regard to reproducibility, the novel test bench showed almost perfect agreement for each specimen and for all states and flexion angles. In comparison with the native knees, the injured knees showed significant differences in knee kinematics. This validated novel test bench will make it possible to investigate various knee pathologies, as well as current and newly developed treatment options.
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Nielsen, Emil Toft, Kasper Stentz-Olesen, Sepp de Raedt, Peter Bo Jørgensen, Ole Gade Sørensen, Bart Kaptein, Michael Skipper Andersen, and Maiken Stilling. "Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis." Orthopaedic Journal of Sports Medicine 6, no. 8 (August 1, 2018): 232596711878969. http://dx.doi.org/10.1177/2325967118789699.
Анотація:
Background: An anterior cruciate ligament (ACL) rupture often occurs during rotational trauma to the knee and may be associated with damage to extracapsular knee rotation–stabilizing structures such as the anterolateral ligament (ALL). Purpose: To investigate ex vivo knee laxity in 6 degrees of freedom with and without ALL reconstruction as a supplement to ACL reconstruction. Study Design: Controlled laboratory study. Methods: Cadaveric knees (N = 8) were analyzed using dynamic radiostereometry during a controlled pivotlike dynamic movement simulated by motorized knee flexion (0° to 60°) with 4-N·m internal rotation torque. We tested the cadaveric specimens in 5 successive ligament situations: intact, ACL lesion, ACL + ALL lesion, ACL reconstruction, and ACL + ALL reconstruction. Anatomic single-bundle reconstruction methods were used for both the ACL and the ALL, with a bone-tendon quadriceps autograft and gracilis tendon autograft, respectively. Three-dimensional kinematics and articular surface interactions were used to determine knee laxity. Results: For the entire knee flexion motion, an ACL + ALL lesion increased the mean knee laxity ( P < .005) for internal rotation (2.54°), anterior translation (1.68 mm), and varus rotation (0.53°). Augmented ALL reconstruction reduced knee laxity for anterior translation ( P = .003) and varus rotation ( P = .047) compared with ACL + ALL–deficient knees. Knees with ACL + ALL lesions had more internal rotation ( P < .001) and anterior translation ( P < .045) at knee flexion angles below 40° and 30°, respectively, compared with healthy knees. Combined ACL + ALL reconstruction did not completely restore native kinematics/laxity at flexion angles below 10° for anterior translation and below 20° for internal rotation ( P < .035). ACL + ALL reconstruction was not found to overconstrain the knee joint. Conclusion: Augmented ALL reconstruction with ACL reconstruction in a cadaveric setting reduces internal rotation, varus rotation, and anterior translation knee laxity similar to knee kinematics with intact ligaments, except at knee flexion angles between 0° and 20°. Clinical Relevance: Patients with ACL injuries can potentially achieve better results with augmented ALL reconstruction along with ACL reconstruction than with stand-alone ACL reconstruction. Furthermore, dynamic radiostereometry provides the opportunity to examine clinical patients and compare the recontructed knee with the contralateral knee in 6 degrees of freedom.
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McAuliffe, MJ, G. Garg, JA Roe, A. Vakili, SL Whitehouse, and RW Crawford. "How balanced is the knee when we start a total knee replacement?" Orthopaedic Journal of Sports Medicine 5, no. 5_suppl5 (May 1, 2017): 2325967117S0016. http://dx.doi.org/10.1177/2325967117s00162.
Анотація:
Objectives: Optimal coronal plane alignment for total knee arthroplasty (TKA) remains controversial. Understanding the pre-operative soft tissue status is important for optimizing the soft tissue envelope during TKA. The purpose of this study was to define the corrected, neutral (“pre-disease”) HKAA of end stage osteoarthritic knees prior to TKA and from this point measure the medial and lateral laxity of varus and valgus knees in maximum extension, 20 and 90° of flexion prior to TKA. Methods: We conducted an observational cohort study. During surgery, the lower limb was manipulated using computer navigation, prior to surgical releases, whilst observing the joint to ensure congruence to allow the limb weight-bearing axis to pass through the knee center in maximum extension, 20° and 90° of flexion. Coronal plane laxity was measured as medial and lateral displacement from this point and compared to published values for healthy subjects. Results: The corrected, neutral HKAA in 89 knees in maximum extension prior to TKA was -1.22° +/- 1.4°. The corrected HKAA in maximum extension was within +/- 3° of 0° in 91.0% of patients. 12.8% (10/78) of varus knees displayed a medial contracture. Of these 10 knees, five also displayed abnormal lateral laxity. In maximum extension, 19.2% (15/78) of knees had abnormally increased lateral laxity. 10 of these 15 knees did not have a medial contracture. The remaining 5 knees with increased lateral laxity or 6.4% (5/78) displayed a medial contracture. Lateral laxity increased significantly with increasing varus deformity. Medial laxity did not significantly decrease when comparing varus deformity of 5 -10° versus >10°. 29 Valgus knees were examined. In maximum extension and 20° of flexion 27.6% of subjects (8/29) and 6.9% (2/29) of subjects respectively had a lateral contracture. On the medial side abnormally increased laxity was seen in 40.7% (11/27) in maximum extension; 75% (21/28) in 20° and 0% in 90° of flexion. On the lateral side abnormally increased laxity was seen in 3.7% (1/27) in maximum extension; 3.6% (1/27) in 20° of flexion and 72.4% in 90° of flexion. Conclusion: Varus and valgus knees did not record a corrected, neutral HKAA at the opposite end of the 0 +/-3° range. Optimal TKA alignment might be better and more specifically defined by the corrected neutral axis of each knee. The majority of varus knees with deformity of up to 15° have neither a medial contracture nor abnormal lateral laxity when referenced to the neutral axis of the knee. Lateral laxity is a more consistent feature of the varus knee. In the valgus OA knee a lateral contracture is not present in most patients and typically only present in maximum extension. The pattern then reverses to an abnormal increase in lateral laxity in flexion for many subjects. The pattern on the medial side is for maximum soft tissue disturbance in 20° of flexion before normalising in 90° of flexion. These findings demonstrate potentially problematic scenarios for balancing the valgus OA knee. The patterns of contracture and laxity found are variable and correlate poorly to deformity.
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Freitas, Priscilla Da Silva, Caroline Cabral Robinson, Rodrigo Py Gonçalves Barreto, Milton Antonio Zaro, Luis Henrique Telles Da Rosa, and Marcelo Faria Silva. "Infrared thermography in adolescents with Osgood-Schlatter Disease." ConScientiae Saúde 12, no. 4 (January 28, 2014): 513–18. http://dx.doi.org/10.5585/conssaude.v12n4.4319.
Анотація:
Introduction: Thermography has been used to monitor musculoskeletal disorders, but no study has assessed thermal patterns of anterior tibial tuberosity inflammation that occurs in Osgood-Schlatter Disease (OSD). Objective: To investigate the patterns of knee temperature in adolescents with and without OSD. Methods: Twenty adolescents were separated into two groups: one comprising individuals with OSD and a control in which none had OSD. An infrared image of the knees was recorded after 15 minutes of acclimatization in a temperature-controlled environment, and the maximum absolute knee temperature and the temperature difference (T) between knees were obtained. Results: The maximum knee temperature in the OSD group was significantly higher (p = 0.008) than the highest recorded knee temperature in the control group. The T between knees was significantly higher (p = 0.007) in the OSD group than in the control group. Conclusion: Adolescents with OSD present knee thermal asymmetry and hyper-radiant patterns in the affected knee, these alterations are prominent enough to be detected thermographically through infrared imaging.
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Driban, Jeffrey B., Grace H. Lo, Charles B. Eaton, Lori Lyn Price, Bing Lu, and Timothy E. McAlindon. "Knee Pain and a Prior Injury Are Associated with Increased Risk of a New Knee Injury: Data from the Osteoarthritis Initiative." Journal of Rheumatology 42, no. 8 (June 1, 2015): 1463–69. http://dx.doi.org/10.3899/jrheum.150016.
Анотація:
Objective.We explored whether knee pain or a history of knee injury were associated with a knee injury in the following 12 months.Methods.We conducted longitudinal knee-based analyses among knees in the Osteoarthritis Initiative. We included both knees of all participants who had at least 1 followup visit with complete data. Our first sets of exposures were knee pain (chronic knee symptoms and severity) at baseline, 12-month, 24-month, and 36-month visits. Another exposure was a history of injury that we defined as a self-reported injury at any time prior to baseline, 12-month, 24-month, or 36-month visit. The outcome was self-reported knee injury during the past year at 12-month, 24-month, 36-month, and 48-month visits. We evaluated the association between ipsilateral and contralateral knee pain or history of injury and a new knee injury within 12 months of the exposure using generalized linear mixed model for repeated binary outcomes.Results.A knee with reported chronic knee symptoms or ipsilateral or contralateral history of an injury was more likely to experience a new knee injury in the following 12 months than a knee without chronic knee symptoms (OR 1.84, 95% CI 1.57–2.16) or prior injury (prior ipsilateral knee injury: OR 1.81, 95% CI 1.56–2.09. Prior contralateral knee injury: OR 1.43, 95% CI 1.23–1.66).Conclusion.Knee pain and a history of injury are associated with new knee injuries. It may be beneficial for individuals with knee pain or a history of injury to participate in injury prevention programs.
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Miller, S., A. Agarwal, WB Haddon, L. Johnston, G. Arnold, W. Wang, and RJ Abboud. "Comparison of gait kinetics in total and unicondylar knee replacement surgery." Annals of The Royal College of Surgeons of England 100, no. 4 (April 2018): 267–74. http://dx.doi.org/10.1308/rcsann.2017.0226.
Анотація:
Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.
29
Kijima, Hiroaki, Shin Yamada, Koji Nozaka, Hidetomo Saito, and Yoichi Shimada. "Relationship between Pain and Medial Meniscal Extrusion in Knee Osteoarthritis." Advances in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/210972.
Анотація:
Purpose. In knee osteoarthritis, the degree of pain varies despite similar imaging findings. If there were quantitative findings related to the pain of knee osteoarthritis, it could be used for diagnosis or screening. The medial meniscal extrusion was investigated as a candidate quantitative finding related to the pain of knee osteoarthritis.Methods. Seventy-six knees of 38 patients (mean age, 73 years) who received intra-articular injections of hyaluronic acid into unilateral knees at the time of diagnosis of knee arthritis were investigated. Cartilage thickness of the femoral medial condyle and medial meniscal extrusion of bilateral knees were measured by ultrasonography. Thirty-eight knees that had hyaluronic acid injections were compared with 38 other side knees from the same patients as the control group.Results. The average cartilage thicknesses of the knees with pain that received intra-articular injections and the knees without pain that received no injections were 1.02 and 1.05 mm, respectively (P=0.6394). On the other hand, the average medial meniscal extrusions of the knees with and without pain were 7.58 and 5.88 mm, respectively (P=0.0005); pain was associated with greater medial meniscal extrusions.Conclusion. Medial meniscal extrusion is a quantitative finding related to the pain of knee osteoarthritis.
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Vo, Minh Tu, Ambrish Singh, Tao Meng, Jasveen Kaur, Alison Venn, Flavia Cicuttini, Lyn March, et al. "Prevalence and Clinical Significance of Residual or Reconverted Red Bone Marrow on Knee MRI." Diagnostics 11, no. 9 (August 25, 2021): 1531. http://dx.doi.org/10.3390/diagnostics11091531.
Анотація:
Background: Residual/reconverted red bone marrow (RBM) in adult knees is occasionally observed on routine knee magnetic resonance imaging (MRI). We aimed to identify its prevalence, distribution, and associations with lifestyle factors, knee structural abnormalities, and knee symptoms in young adults. Methods: Participants (n = 327; aged = 31–41 years) were selected from the Childhood Determinants of Adult Health (CDAH) knee study. They underwent T1-weighted and proton-density-weighted fat-suppressed MRI scans of knees. Residual/reconverted RBM in distal femur and proximal tibia were graded semi-quantitatively (grades: 0–3) based on the percentage area occupied. Knee structural abnormalities were graded semi-quantitatively using previously published MRI scoring systems. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale during CDAH knee study (year: 2008–2010) and at 6–9-year follow-up during the CDAH-3 study (year: 2014–2019). Associations between definite RBM (grade ≥ 2) and lifestyle factors, knee symptoms, and structural abnormalities were described using log-binomial regressions. Results: Definite RBM was seen in females only, in 29 out of 154 cases (18.8%), with femoral involvement preceding tibial involvement. Definite RBM was associated with increased BMI (PR = 1.09/kg/m2; 95% CI: 1.03, 1.16), overweight status (PR = 2.19; 95% CI: 1.07, 4.51), and WOMAC knee pain (PR = 1.75; 95% CI: 1.11, 2.74) in cross-section analysis. However, there was no association between RBM and knee-pain after seven years (PR = 1.15; 95% CI: 0.66, 2.00). There were no associations between RBM and knee structural abnormalities. Conclusion: Presence of definite RBM in young adult knees was observed in females only. Definite RBM was associated with overweight measures, and the modest association with knee pain may not be causally related.
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JONES, RICHARD K., GRAHAM J. CHAPMAN, ANDREW H. FINDLOW, LAURA FORSYTHE, MATTHEW J. PARKES, JAWAD SULTAN, and DAVID T. FELSON. "A New Approach to Prevention of Knee Osteoarthritis: Reducing Medial Load in the Contralateral Knee." Journal of Rheumatology 40, no. 3 (January 15, 2013): 309–15. http://dx.doi.org/10.3899/jrheum.120589.
Анотація:
Objective.Few if any prevention strategies are available for knee osteoarthritis (OA). In those with symptomatic medial OA, the contralateral knee may be at high risk of disease, and a reduction in medial loading in that knee might prevent disease or its progression there. Our aim was to determine how often persons with medial OA on 1 side had either concurrent or later medial OA on the contralateral side, and whether an intervention known to reduce medial loading in affected knees with medial OA might reduce medial loading in the contralateral knee. Lateral wedge insoles reduce loading across an affected medial knee but their effect on the contralateral knee is unknown.Methods.To determine the proportion of persons with medial knee OA who had concurrent medial contralateral OA or developed contralateral medial OA later, we examined knee radiographs from the longitudinal Framingham Osteoarthritis Study. Then, to examine an approach to reducing medial load in the contralateral knee, 51 people from a separate study with painful medial tibiofemoral OA underwent gait analysis wearing bilateral controlled shoes with no insoles, and then with 2 types of wedge insoles laterally posted by 5°. Primary outcome was the external knee adduction moment (EKAM) in the contralateral knee. Nonparametric CI were constructed around the median differences in percentage change in the affected and contralateral sides.Results.Of Framingham subjects with medial radiograph knee OA, 137/152 (90%) either had concurrent contralateral medial OA or developed it within 10 years. Of those with medial symptomatic knee OA, 43/67 (64%) had or developed the same disease state in the contralateral knee. Compared to a control shoe, medial loading was reduced substantially on both the affected (median percentage EKAM change −4.84%; 95% CI −11.33% to −0.65%) and contralateral sides (median percentage EKAM change −9.34%; 95% CI −10.57% to −6.45%).Conclusion.In persons with medial OA, the contralateral knee is also at high risk of medial OA. Bilateral reduction in medial loading in knees by use of strategies such as lateral wedge insoles might not only reduce medial load in affected knees but prevent knee OA or its progression on the contralateral side.
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Harter, Rod A., Louis R. Osternig, and Kenneth M. Singer. "Knee Joint Proprioception Following Anterior Cruciate Ligament Reconstruction." Journal of Sport Rehabilitation 1, no. 2 (May 1992): 103–10. http://dx.doi.org/10.1123/jsr.1.2.103.
Анотація:
This study evaluated knee joint position sense in the ACL-reconstructed and contralateral normal knees of 48 male and female subjects (M age 27.6 ± 6.9 yrs). Subjects were blindfolded and tested on their ability to actively reproduce five passively placed knee positions at 5° intervals between 35 and 15° of knee flexion. Mean algebraic target angle error and mean absolute error values were measured in degrees. The grand mean absolute error for the postsurgical knees at all positions was 5.4 ± 3.2°, compared with 5.2 ± 2.7° for the normal contralateral knees. There were no significant differences in knee joint position sense between the postsurgical and normal contralateral limbs at any of the five positions tested. Pivot shift, anterolateral rotatory instability, and Lachman test results were poorly correlated with knee joint position sense. The results suggest that if knee joint position sense was indeed disrupted by ACL injury and reconstructive surgery, related sensory mechanisms compensated for any proprioceptive loss prior to the minimum 2-yr postsurgical follow-up period employed in our study.
33
Artul, Suheil, Fadi Khazin, Jeries Hakim, and George Habib. "Ultrasonographic Findings in a Large Series of Patients with Knee Pain." Journal of Clinical Imaging Science 4 (August 30, 2014): 45. http://dx.doi.org/10.4103/2156-7514.139735.
Анотація:
Background: Musculoskeletal ultrasound (MSKUS) is becoming more and more popular in the evaluation of different musculoskeletal abnormalities. The aim of this retrospective study was to document the prevalence and spectrum of MSKUS findings at the painful knee. Materials and Methods: All the studies of MSKUS that were performed for the evaluation of knee pain during the previous 2 years at the Department of Radiology in Nazareth hospital were reviewed. Demographic and clinical parameters including age, gender, side, and MSKUS findings were documented. Results: Two hundred and seventy-six patients were included in the review. In 21 of them, both knees were evaluated at the same setting (total number of knees evaluated was 297). One hundred and forty-four knees were of the left side. Thirty-three pathologies were identified. 34% of the studies were negative. The most common MSKUS findings were medial meniscal tear (MMT) (20%), Baker's cyst (BC) (16%), and osteoarthritis (OA) (11%). Only one knee of all the knees evaluated in our study showed synovitis. Fifty-three knees (18% of all the knees evaluated) had more than one imaging finding, mosty two and while some had three findings. The most common combination of findings was MMT and BC (8 knees), MMT with OA (8 knees), and MMT with fluid (6 knee). In 67% of the patients who had simultaneous bilateral knee evaluation, at least one knee had no abnormal findings and in 43%, both knees were negative. Conclusions: MSKUS has the potential for revealing huge spectrum of abnormalities. In nearly 90% of the positive studies, degenerative/mechanical abnormalities were reported, with MMT, BC, and osteoarthritic changes being the most common.
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WANG, SHANGCHENG, ZHIHONG LIU, JIANMING FENG, LIANFU DENG, and NAIQUAN NIGEL ZHENG. "COMPARING TRANSVERSE PLANE BIOMECHANICS BETWEEN FIXED- AND MOBILE-BEARING TOTAL KNEE ARTHROPLASTY DURING LEVEL WALKING, STAIR NEGOTIATION AND PIVOTING." Journal of Mechanics in Medicine and Biology 19, no. 05 (August 2019): 1950028. http://dx.doi.org/10.1142/s0219519419500283.
Анотація:
Compared with fixed-bearing (FB) total knee arthroplasty (TKA), mobile-bearing (MB) TKA may promote knee rotation and reduce rotational load at bone–implant interface. Unfortunately, this hypothesis has not been examined with neither knee rotation during stance of pivoting nor knee rotational moment during activities other than level walking. This study used 3D motion analysis to obtain the rotation of tibia relative to the femur and knee rotation moment during stance phase of level walking, stair ascent/descent, step and spin turn for 17 FB, 20[Formula: see text]MB and 28 healthy knees. Statistical comparisons revealed that transverse plane biomechanics was similar between MB and FB knees. Compared with healthy knees ([Formula: see text]), both FB ([Formula: see text]) and MB knees ([Formula: see text]) reduced internal rotation during step turn at early stance. During spin turn, FB knees ([Formula: see text] vs. [Formula: see text]) reduced internal rotation at late stance, whereas MB knees ([Formula: see text] versus [Formula: see text]) reduced external rotation at early stance. MB knees (0.064% and 0.126% body weight [Formula: see text] height) had lower peak external rotation moments during early stance phase of both level walking and spin turn than healthy knees (0.108% and 0.238% body weight [Formula: see text] height). Using FB for TKA surgery without bias and step-turn strategy for pivoting were recommended.
35
Chillakuru, Cherith Reddy, N. Jambu, and Akshay Deepak. "A comparison of the proprioception of osteoarthritic knees and post total knee arthroplasty." International Journal of Research in Orthopaedics 3, no. 4 (June 23, 2017): 781. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20172525.
Анотація:
<p class="abstract"><strong>Background:</strong> Proprioception of the knee joint is an important factor for establishing balance, and smooth walking. The effect of arthroplasty on proprioception can be a determinant of post-operative function and subjective feeling of the arthroplasty. We wished to check the status of osteoarthritic knees and how their proprioceptive function is, in comparison to knees post total knee replacement.</p><p class="abstract"><strong>Methods:</strong> We compared 80 unilateral knee replacement patients with their osteoarthritic counterpart in the opposite knee. There was 50% Cruciate Retaining (n =40), Posterior Stabilized 50% (n =40). We assessed the proprioception using threshold to detection of passive motion and conscious awareness of passive joint position.<strong></strong></p><p class="abstract"><strong>Results:</strong> 73.8% (n =59) of patients experienced a better joint position sense, 21% (n =17) had decreased joint position sense and 5% (n =4) had the same, when compared to the contralateral osteoarthritic knee. The mean of threshold to detection of passive motion was 2.16+0.68 for the replaced knees versus 2.72±0.61 for the contralateral osteoarthritic knee.</p><p class="abstract"><strong>Conclusions:</strong> The proprioception of the knees that were replaced with arthroplasties had a better proprioceptive function then the osteoarthritic knees. This further solidifies the reasons to replace the dysfunctional osteoarthritic knee. </p>
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Pearle, Andrew D., Daniel J. Solomon, Tony Wanich, Alexandre Moreau-Gaudry, Carinne C. Granchi, Thomas L. Wickiewicz, and Russell F. Warren. "Reliability of Navigated Knee Stability Examination." American Journal of Sports Medicine 35, no. 8 (August 2007): 1315–20. http://dx.doi.org/10.1177/0363546507300821.
Анотація:
Background Clinical examination remains empirical and may be confusing in the setting of rotatory knee instabilities. Computerized navigation systems provide the ability to visualize and quantify coupled knee motions during knee stability examination. Hypothesis An image-free navigation system can reliably register and collect multiplanar knee kinematics during knee stability examination. Study Design Controlled laboratory study. Methods Coupled knee motions were determined by a robotic/UFS testing system and by an image-free navigation system in 6 cadaveric knees that were subjected to (1) isolated varus stress and (2) combined varus and external rotation force at 0°, 30°, and 60°. This protocol was performed in intact knees and after complete sectioning of the posterolateral corner (lateral collateral ligament, popliteus tendon, and popliteofibular ligament). The correlation between data from the surgical navigation system and the robotic positional sensor was assessed using the intraclass correlation coefficient. The 3-dimensional motion paths of the intact and sectioned knees were assessed qualitatively using the navigation display system. Results Intraclass correlation coefficients between the robotic sensor and the navigation system for varus and external rotation at 0°, 30°, and 60° were all statistically significant at P < .01. The overall intraclass correlation coefficient for all tests was 0.9976 (P < .0001). Real-time visualization of the coupled motions was possible with the navigation system. Post hoc analysis of the knee motion paths during loading distinguished distinct rotatory patterns. Conclusion Surgical navigation is a precise intraoperative tool to quantify knee stability examination and may help delineate pathologic multiplanar or coupled knee motions, particularly in the setting of complex rotatory instability patterns. Repeatability of load application during clinical stability testing remains problematic. Clinical Relevance Surgical navigation may refine the diagnostic evaluation of knee instability.
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Ebied, Ayman, Ahmed Zayda, Sameh Marei, and Hany Elsayed. "Medium term results of total knee arthroplasty as a primary treatment for knee fractures." SICOT-J 4 (2018): 6. http://dx.doi.org/10.1051/sicotj/2017060.
Анотація:
Introduction: Successful treatment of knee comminuted periarticular fractures associated with osteoporosis and pre-existing arthritis is a challenging task. Methods: This is a prospective study on 27 patients who had comminuted intra and periarticular knee fractures and pre-existing arthritis. Fractures were classified according to Muller's AO classification. Primary knee arthroplasty was performed ± internal fixation following 4 weeks of splinting. A stem was added to the tibial tray and Legacy Constrained Condylar Knee (LCCK) or Rotating Hinge (RH) prosthesis were used depending on the level of ligament damage and bone defects. The Knee Society Score (KSS) and radiological evaluation were performed at 3, 6 and 12 months then annually thereafter. Results: The average age of this group of patients was 63 years (range 59–74). Sixteen knees received primary femoral component and Posterior Stabilized insert, while 8 had LCCK. RH implants were chosen in 2 and distal femoral replacement was necessary in one knee. Twenty five patients were available for the final review at an average 6 years in whom the KSS was 80 (range 75–89) points. All patients achieved full knee extension and average knee flexion of 110° (range 90–135°). One knee needed re-admission for early Debridement Antibiotic Irrigation and Retention (DAIR) but none of the knees was revised or awaiting revision. Conclusion: Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent.
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Gupta, S., E. Wakelin, S. Putman, and C. Plaskos. "VARIATION IN PREOPERATIVE KNEE BALANCE AS A FUNCTION OF HIP-KNEE-ANKLE ANGLE AND JOINT LINE OBLIQUITY IN TOTAL KNEE ARTHROPLASTY." Orthopaedic Proceedings 105-B, SUPP_3 (February 2023): 71. http://dx.doi.org/10.1302/1358-992x.2023.3.071.
Анотація:
The Coronal Plane Alignment of the Knee (CPAK) is a recent method for classifying knees using the hip-knee-ankle angle and joint line obliquity to assist surgeons in selection of an optimal alignment philosophy in total knee arthroplasty (TKA)1. It is unclear, however, how CPAK classification impacts pre-operative joint balance. Our objective was to characterise joint balance differences between CPAK categories.A retrospective review of TKA's using the OMNIBotics platform and BalanceBot (Corin, UK) using a tibia first workflow was performed. Lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were landmarked intra-operatively and corrected for wear. Joint gaps were measured under a load of 70–90N after the tibial resection. Resection thicknesses were validated to recreate the pre-tibial resection joint balance.Knees were subdivided into 9 categories as described by MacDessi et al.1 Differences in balance at 10°, 40° and 90° were determined using a one-way 2-tailed ANOVA test with a critical p-value of 0.05.1124 knees satisfied inclusion criteria. The highest proportion of knees (60.7%) are CPAK I with a varus aHKA and Distal Apex JLO, 79.8% report a Distal Apex JLO and 69.3% report a varus aHKA. Greater medial gaps are observed in varus (I, IV, VII) compared to neutral (II, V, VIII) and valgus knees (III, VI, IX) (p<0.05 in all cases) as well as in the Distal Apex (I, II, III) compared to Neutral groups (IV, V, VI) (p<0.05 in all cases). Comparisons could not be made with the Proximal Apex groups due to low frequency (≤2.5%).Significant differences in joint balance were observed between and within CPAK groups. Although both hip-knee-ankle angle and joint line orientation are associated with joint balance, boney anatomy alone is not sufficient to fully characterize the knee.
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Hsieh, Shang-Lin, Tsung-Li Lin, Chih-Hung Hung, Yi-Chin Fong, Hsien-Te Chen, and Chun-Hao Tsai. "Clinical and Radiographic Outcomes of Inversed Restricted Kinematic Alignment Total Knee Arthroplasty by Asia Specific (Huang’s) Phenotypes, a Prospective Pilot Study." Journal of Clinical Medicine 12, no. 6 (March 8, 2023): 2110. http://dx.doi.org/10.3390/jcm12062110.
Анотація:
Inverse restricted kinematic alignment (irKA) was modified from restricted kinematic alignment for total knee arthroplasty (TKA). This prospective single-center study aimed to evaluate the outcomes of irKA-TKA on all knee subtypes classified by Asia specific (Huang’s) phenotypes. A total of 96 knees that underwent irKA-TKA at one hospital between January 2018 and June 2020 were included, with 15 knees classified in Type 1, nine in Type 2, 15 in Type 3, 47 in Type 4, and 10 in Type 5 by Huang’s phenotypes. Outcomes were knee alignment measures and patient-reported satisfaction evaluated by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and traditional Chinese version of the Forgotten Joint Score-12 (FJS-12). Follow-up was one year. Type 4 knee was most significantly corrected in all angles by irKA-TKA, followed by Type 2 and 3 knees. Type 5 and 1 knee were only significantly corrected in some angles. The correlation between FJS-12 and WOMAC was good at 6 months (Pearson correlation coefficient (r) = 0.74) and moderate at 6 weeks, 3 months, and 12 months during follow-up (r = 0.37~0.47). FJS-12 and WOMAC displayed comparable hip–knee–ankle angle cut-off value (4.71° vs. 6.20°), sensitivity (70.49% vs. 67.19%), specificity (84.00% vs. 85.71%), and Youden index (54.49% vs. 52.90%) in prediction of good prognosis. In conclusion, irKA-TKA corrects knee alignment in all knee types with increasing satisfaction for one-year follow-up. Knees with presurgical varus deformity are most recommended for irKA-TKA. Both presurgical scores of the traditional Chinese version of FJS-12 and WOMAC predict the prognosis of irKA-TKA.
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Ironside, Christopher, Simon Coffey, Guy Eslick, and Rami Sorial. "Functional Outcomes of Revision Total Knee Arthroplasty Following Failed Unicompartmental Knee Arthroplasty." Reconstructive Review 4, no. 4 (January 12, 2015): 22–26. http://dx.doi.org/10.15438/rr.4.4.83.
Анотація:
Introduction: Unicompartmental knee arthroplasty (UKA) can be used to treat medial compartment osteoarthritis of the knee. Some of these knees will eventually fail, and need to be revised. There is controversy about using UKA in younger patients as a definitive procedure or as a means to delay total knee arthroplasty (TKA) because the outcomes of subsequent revision surgery may be inferior to a primary TKA. Methods: We retrospectively reviewed a series of 46 revision TKA patients following failed UKA (UKA revisions) using functional outcomes questionnaires and compared the results with a cohort of age and gender matched primary TKA patients. Our hypothesis was that UKA revision surgery would be inferior to primary TKA surgery. Results: Data was collected on 33 knees after a mean follow-up period of five years. There was no significant difference in the Oxford Knee Score (33.7 vs 37.1, p = 0.09) or the Western Ontario and MacMasters Universities Arthritis Index (WOMAC) (24.8 vs. 19.1, p = 0.22). A subgroup analysis demonstrated that UKAs, which fail early, are more likely to produce an inferior outcome following revision surgery than those that survive more than five years. Discussion: We conclude that UKA can be used effectively in appropriately selected patients, as the functional outcome of their subsequent revision to TKA is not significantly inferior to a primary TKA.Keywords: unicompartmental knee arthroplasty, revision knee arthroplasty
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Tomite, Takenori, Hidetomo Saito, Toshiaki Aizawa, Hiroaki Kijima, Naohisa Miyakoshi, and Yoichi Shimada. "Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer." Case Reports in Orthopedics 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/6875821.
Анотація:
One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in thex-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning.
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Wang, Jianping, Kun Tao, Huanyi Li, and Chengtao Wang. "Modelling and Analysis on Biomechanical Dynamic Characteristics of Knee Flexion Movement under Squatting." Scientific World Journal 2014 (2014): 1–14. http://dx.doi.org/10.1155/2014/321080.
Анотація:
The model of three-dimensional (3D) geometric knee was built, which included femoral-tibial, patellofemoral articulations and the bone and soft tissues. Dynamic finite element (FE) model of knee was developed to simulate both the kinematics and the internal stresses during knee flexion. The biomechanical experimental system of knee was built to simulate knee squatting using cadaver knees. The flexion motion and dynamic contact characteristics of knee were analyzed, and verified by comparing with the data from in vitro experiment. The results showed that the established dynamic FE models of knee are capable of predicting kinematics and the contact stresses during flexion, and could be an efficient tool for the analysis of total knee replacement (TKR) and knee prosthesis design.
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S, Rajesh, Supreeth D R, and Hemant K. Kalyan. "Total Knee Arthroplasty in Bilateral Severe Fixed Flexion Deformity: A Case Report." Journal of Karnataka Orthopaedic Association 10, no. 1 (2022): 22–25. http://dx.doi.org/10.13107/jkoa.2022.v10i01.047.
Анотація:
Background: Severe bilateral Fixed flexion deformity of the knees resulting from irreversible joint damage is a disabling complication of long-standing rheumatoid arthritis, associated with loss of ambulatory ability. While Total knee Arthroplasty is an effective treatment for such patients, it poses significant intra-operative technical demands and challenges with post-operative rehabilitation. Method: We report a case of Severe Fixed flexion deformity of both knees in a 46-year-old male with long-standing rheumatoid arthritis, non-ambulatory since 5 years, treated by sequential total knee arthroplasty. Results: Treating Severe bilateral Fixed flexion deformities in a non-ambulatory patient by sequential total knee Arthroplasty using standard implants yielded complete deformity correction and pain-free restoration of active range of motion in both knees with stable independent ambulation and complete restoration of lower limb function within 3 months of surgery. Conclusion: Our case is particularly remarkable for complete restoration of stable, pain-free restoration of ambulation within 3months in a patient with severe bilateral knee fixed flexion deformities who had been non-ambulatory for 5 years preceding his bilateral sequential total knee arthroplasty. Keywords: Fixed flexion deformity, Total knee arthroplasty, Common peroneal nerve, Rheumatoid arthritis.
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Nassif, Jeffrey M., and William S. Pietrzak. "Clinical Outcomes in Men and Women following Total Knee Arthroplasty with a High-Flex Knee: No Clinical Effect of Gender." Scientific World Journal 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/285919.
Анотація:
While it is generally recognized that anatomical differences exist between the male and female knee, the literature generally refutes the clinical need for gender-specific total knee prostheses. It has been found that standard, unisex knees perform as well, or better, in women than men. Recently, high-flex knees have become available that mechanically accommodate increased flexion yet no studies have directly compared the outcomes of these devices in men and women to see if gender-based differences exist. We retrospectively compared the performance of the high-flex Vanguard knee (Biomet, Warsaw, IN) in 716 male and 1,069 female knees. Kaplan-Meier survivorship was 98.5% at 5.6–5.7 years for both genders. After 2 years, mean improvements in Knee Society Knee and Function scores for men and women (50.9 versus 46.3; 26.5 versus 23.1) and corresponding SF-12 Mental and Physical scores (0.2 versus 2.2; 13.7 versus 12.2) were similar with differences not clinically relevant. Postoperative motion gains as a function of preoperative motion level were virtually identical in men and women. This further confirms the suitability of unisex total knee prostheses for both men and women.
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Huang, Chun-Hsiung, Cheng-Kung Cheng, Jiann-Jong Liau, and Ye-Ming Lee. "MORPHOMETRICAL COMPARISON BETWEEN THE RESECTED SURFACES IN OSTEOARTHRITIC KNEES AND POROUS-COATED ANATOMIC KNEE PROSTHESIS." Journal of Musculoskeletal Research 04, no. 01 (March 2000): 39–46. http://dx.doi.org/10.1142/s0218957700000069.
Анотація:
In total knee replacement, a good match of the prosthesis to bone is very important. Most knees that require total knee replacement are deformed. However, most of the design parameters of knee prosthesis were based on the normal knee. In this series, the dimensions of the resected surfaces in 77 osteoarthritic knees were measured intraoperatively and compared with the corresponding surfaces of the porous-coated anatomic (PCA) (Howmedica, Rutherford, NJ, USA) knee prosthesis. The results showed that the medial femoral condyle was wider than the lateral femoral condyle (p < 0.05) in the resected surfaces. The intercondylar notch of the resected femur was wider than that of the prosthesis (p < 0.05). In the resected tibial plateau, the ratio of the anteroposterior length to the mediolateral width was larger than that of the prosthesis (p < 0.05). The length and width of the resected patella were greater than those of the implant (p < 0.05). According to the difference in morphometrical parameters between the resected surfaces and the knee prosthesis, we suggest that the dimensions of the resected surfaces of the osteoarthritic knee should be important design parameters in total knee prosthesis.
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Cammisa, Eugenio, Iacopo Sassoli, Matteo La Verde, Stefano Fratini, Vito Gaetano Rinaldi, Giada Lullini, Vittorio Vaccari, Stefano Zaffagnini, and Giulio Maria Marcheggiani Muccioli. "Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review." Journal of Clinical Medicine 11, no. 21 (November 6, 2022): 6580. http://dx.doi.org/10.3390/jcm11216580.
Анотація:
Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies.
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Smith, Matthew V., Jeffrey J. Nepple, Rick W. Wright, Matthew J. Matava, and Robert H. Brophy. "Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes." Sports Health: A Multidisciplinary Approach 9, no. 3 (December 1, 2016): 247–51. http://dx.doi.org/10.1177/1941738116683146.
Анотація:
Background: 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. Hypothesis: 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. Study Design: Retrospective cohort. Level of Evidence: Level 4. Methods: 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. Results: There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P < 0.001). The prevalence of knee OA was 4.0% in those without previous knee surgery, 11% in those with a history of meniscus repair, 24% of those with a history of ACL reconstruction, and 27% of those with a history of partial meniscectomy. Among knees with a previous ACL reconstruction, the rate of OA doubled in tibiofemoral compartments in which meniscal surgery was performed. BMI >30 kg/m2 was also associated with a higher risk of OA ( P = 0.007) but player position was not associated with knee OA. Conclusions: 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. Clinical Relevance: Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible.
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Driban, Jeffrey B., Easwaran Balasubramanian, Mamta Amin, Michael R. Sitler, Marvin C. Ziskin, and Mary F. Barbe. "The Potential of Multiple Synovial-Fluid Protein-Concentration Analyses in the Assessment of Knee Osteoarthritis." Journal of Sport Rehabilitation 19, no. 4 (November 2010): 411–21. http://dx.doi.org/10.1123/jsr.19.4.411.
Анотація:
Context:Joint trauma is a risk factor for osteoarthritis (OA), which is becoming an increasingly important orthopedic concern for athletes and nonathletes alike. For advances in OA prevention, diagnosis, and treatment to occur, a greater understanding of the biochemical environment of the affected joint is needed.Objective:To demonstrate the potential of a biochemical technique to enhance our understanding of and diagnostic capabilities for osteoarthritis.Design:Cross-sectional.Setting:Outpatient orthopedic practice.Participants:8 subjects: 4 OA-knee participants (65 ± 6 y of age) and 4 normal-knee participants (54 ± 10 y) with no history of knee OA based on bilateral standing radiographs.Intervention:The independent variable was group (OA knee, normal knee).Main Outcome Measures:16 knee synovial-protein concentrations categorized as follows: 4 as pro-inflammatory, or catabolic, cytokines; 5 as anti-inflammatory, or protective, cytokines; 3 as catabolic enzymes; 2 as tissue inhibitors of metalloproteinases [TIMPs]; and 2 as adipokines.Results:Two anti-inflammatory cytokines (interleukin [IL]-13 and osteoprotegerin) and a pro-inflammatory cytokine (IL-1β) were significantly lower in the OA knees. Two catabolic enzymes (matrix metalloproteinase [MMP]-2 and MMP-3) were significantly elevated in OA knees. TIMP-2, an inhibitor of MMPs, was significantly elevated in OA knees.Conclusions:Six of the 16 synovial-fluid proteins were significantly different between OA knees and normal knees in this study. Future research using a similar multiplex ELISA approach or other proteomic techniques may enable researchers and clinicians to develop more accurate biochemical profiles of synovial fluid to help diagnose OA, identify subsets of OA or individual characteristics, guide clinical decisions, and identify patients at risk for OA after knee injury.
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Tanaka, Noriyuki, and Minoru Hoshiyama. "ARTICULAR SOUND AND CLINICAL STAGES IN KNEE ARTHROPATHY." Journal of Musculoskeletal Research 14, no. 01 (March 2011): 1150006. http://dx.doi.org/10.1142/s0218957711500060.
Анотація:
Objective: To clarify the pathophysiology of knee arthropathy, articular sound in the knee joint was recorded using an accelerometer, vibroarthrography (VAG), during standing-up and sitting-down movements in patients with osteoarthropathy (OA) of the knees. Methods: VAG signals and angular changes of the knee joint during standing-up and sitting-down movements were recorded in patients with OA, including 17 knees with OA at Kellgren–Lawrence stage I and II, 16 knees with OA at III and IV stages, and 20 knees of age-matched control subjects. Results: The level of VAG signals was greater in knees with a higher stage of OA at 50–99 and 100–149 Hz among the groups (ANOVA with Tukey–Kramer multiple comparisons test, p < 0.01). The VAG signals did not correlate with WOMAC-pain or physical scores. Conclusions: We considered that the increase in VAG signals in these ranges of frequency corresponded with pathological changes of OA, but not self-reported clinical symptoms. This method of VAG can be used by clinicians during interventions to obtain pathological information regarding structural changes of the knee joint.
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Axe, Michael J., Katherine Linsay, and Lynn Snyder-Mackler. "The Relationship between Knee Hyperextension and Articular Pathology in the Anterior Cruciate Ligament Deficient Knee." Journal of Sport Rehabilitation 5, no. 2 (May 1996): 120–26. http://dx.doi.org/10.1123/jsr.5.2.120.
Анотація:
The purpose of this study was to determine whether there was a relationship between knee hyperextension and intra-articular pathology in 100 consecutive patients whose sole ligament injury was an arthroscopically confirmed anterior cruciate ligament (ACL) rupture. Hyperextension of both knees was measured using a supine heel-height measurement of high reliability. There was more articular damage to the total joint, lateral joint, and lateral meniscus in patients who hyperextended than in those who did not. There was more articular damage to the total joint and medial joint in patients who were chronically ACL deficient than in those who were acutely or subacutely ACL deficient. The results demonstrate that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose knees hyperextend less than 3 cm. This study further defines the role of knee hyperextension in ACL injuries and offers a useful and reliable means of measuring knee hyperextension.