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Munsch AE, Evans-Pickett A, Davis-Wilson H, Pietrosimone B, Rauch CM, Roth JD, Franz JR. Limb Underloading in Walking Transmits Less Dynamic Knee Joint Contact Forces after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2025; 57:849-856. [PMID: 39809224 PMCID: PMC11908909 DOI: 10.1249/mss.0000000000003607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Individuals with anterior cruciate ligament reconstruction (ACLR) often walk with a less dynamic vertical ground reaction force (vGRF), exemplified by a reduced first peak vGRF and elevated midstance vGRF compared with uninjured controls. However, the mechanism by which altered limb loading affects actual tibial plateau contact forces during walking remains unclear. METHODS Our purpose was to use musculoskeletal simulation to evaluate the effects of first peak vGRF biofeedback on bilateral tibiofemoral contact forces relevant to the development of post-traumatic osteoarthritis in 20 individuals with ACLR. We hypothesized that reduced first peak vGRF would produce less dynamic tibial plateau contact forces during walking in individuals with ACLR. RESULTS As the pivotal outcome from this study, and in support of our hypothesis, we found that less dynamic vGRF profiles in individuals with ACLR-observations that have associated in prior studies with more cartilage breakdown serum biomarkers and reduced proteoglycan density-are accompanied by less dynamic tibiofemoral joint contact forces during walking. CONCLUSION We conclude that more sustained limb-level loading, a phenotype that associates with worse knee joint health outcomes after ACLR and was prescribed herein using biofeedback, alters the loading profile and magnitude of force applied to tibiofemoral cartilage.
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Affiliation(s)
- Amanda E. Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | | | | | - Brian Pietrosimone
- Department of Exercise and Sport Science, UNC Chapel Hill, Chapel Hill, NC
| | - Carly M. Rauch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Joshua D. Roth
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
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Snyder SJ, Bell EM, Oh S, Ehsani H, Kambhamettu A, Kim B, Bera A, Miller RH, Shim JK. Walking While Acting Sad and Happy Emotions Influences Risk Factors of Knee Osteoarthritis. J Appl Biomech 2025:1-8. [PMID: 40118075 DOI: 10.1123/jab.2024-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 11/18/2024] [Accepted: 02/04/2025] [Indexed: 03/23/2025]
Abstract
Greater knee adduction moment is associated with increased risk and progression of knee osteoarthritis, and this biomechanical risk factor is modulated through kinematic gait modifications. Emotions are known to influence walking kinematics and speed, but the effect of different emotions on knee mechanics is unclear. To test this, 20 healthy participants walked while instrumented gait data was recorded. Participants initially walked naturally (baseline) and then acting 4 emotional walking conditions: Anger, Happy, Fear, and Sad, in randomized order. Statistical parametric mapping with an analysis of variance model determined the extent to which emotions influenced knee joint mechanics. Results indicated both the happy (P = .009) and sad (P < .001) condition resulted in lower knee adduction moment compared with baseline. Walking both happy and sad also resulted in walking speed changes from baseline (P < .001). A secondary analysis of covariance model with speed as the covariate indicated no significant effect of emotional condition on knee adduction moment (P > .05), which suggests that the changes from baseline can be attributed to the changes in walking speed. Decreased knee adduction is associated with reduced osteoarthritis progression and increased knee function, suggesting that walking while acting different emotions, specifically happy and sad, may moderate knee osteoarthritis risk.
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Affiliation(s)
- Samantha J Snyder
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Elizabeth M Bell
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - SeungJun Oh
- Convergence and Open Sharing System in BioHealth Sciences, Sangmyung University, Jongno-gu, Korea
| | - Hossein Ehsani
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Archit Kambhamettu
- Department of Mathematics, University of Maryland, College Park, MD, USA
- Department of Computer Science, University of Maryland, College Park, MD, USA
| | - Byeol Kim
- Seoul National University, Gwanak-gu, Korea
| | - Aniket Bera
- Department of Computer Science, University of Maryland, College Park, MD, USA
- Department of Computer Science, Purdue University, West Lafayette, IN, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Department of Mechanical Engineering, Kyung Hee University, Seoul, South Korea
| | - Jae Kun Shim
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Department of Mechanical Engineering, Kyung Hee University, Seoul, South Korea
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
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Hamsayeh Abbasi Niasar E, Li L. Implication of region-dependent material properties of articular cartilage in the contact mechanics of porcine knee joint. BMC Musculoskelet Disord 2025; 26:149. [PMID: 39953574 PMCID: PMC11827382 DOI: 10.1186/s12891-025-08290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 01/06/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND The site-specific tissue properties of knee cartilage may play an essential role in knee joint mechanical function, and mitigate joint injury and cartilage degeneration. The present study aimed to determine the significance of tissue inhomogeneity in knee joint contact mechanics using a porcine model. METHODS Finite element models were developed for a porcine knee with intact and total meniscectomy conditions to simulate whole-joint compression-relaxation tests under a 1.2-mm ramp-compression at 0.01, 0.1, or 1 mm/s. Two reference benchmarks were introduced for the implementation of poromechanical material properties of fibril-reinforced cartilage: Benchmark II consisted of 17 sets of cartilage properties, each for a region in the knee, representing site-specific inhomogeneity averaged from cartilage indentation maps of 14 porcine knees. Benchmark I was comprised of a single set of properties by taking the average properties of 17 regions in Benchmark II, assuming tissue homogeneity. To validate the modeling method, the reference benchmarks were used to produce results against whole-joint compression test data. RESULTS Both benchmarks were able to approximate experimental force-compression data obtained from the same knee with intact menisci and total meniscectomy, provided that the average properties from 14 knees were appropriately scaled to account for individual joint differences. Noticeable differences in stress and pressure distributions were observed between the benchmarks. For instance, benchmark I generated higher peak contact and fluid pressures in the medial tibial cartilage, but benchmark II produced the higher ones in the lateral tibial cartilage. The load sharing asymmetry between the lateral and medial compartments was reduced in benchmark II which was more pronounced for higher compression rates. On the other hand, benchmark II produced a more uniform stress distribution or lower maxima. Meniscectomy caused a slight shift of the contact centers in the tibial plateaus as compared to the intact joint. CONCLUSION The modeling results demonstrated substantial differences in loading distributions in the joint between the homogeneous and nonhomogeneous models represented by the two benchmarks, indicating the role of tissue inhomogeneity in the joint contact mechanics. Region-dependent tissue properties may need to be implemented in joint mechanical modeling to evaluate the site of cartilage prone to injury or degeneration.
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Affiliation(s)
- Erfan Hamsayeh Abbasi Niasar
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive, N.W., Calgary, AB, T2N 1N4, Canada
| | - LePing Li
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive, N.W., Calgary, AB, T2N 1N4, Canada.
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Tönük ŞB, Yorgancıoğlu ZR, Ramadan SU, Kocaoğlu S. Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study : Osteoarthritis cysts and bone mineral density. BMC Musculoskelet Disord 2024; 25:50. [PMID: 38212780 PMCID: PMC10782551 DOI: 10.1186/s12891-023-07141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Individuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study. METHODS This study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients' findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis. RESULTS The patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 - 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 - 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 - 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels. CONCLUSIONS Development of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.
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Affiliation(s)
- Şükrü Burak Tönük
- Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, Karacasu, Bolu, Turkey.
| | - Zeynep Rezan Yorgancıoğlu
- Department of Physical Medicine and Rehabilitation, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Selma Uysal Ramadan
- Department of Radiology, Ministry of Health Kecioren Training and Research Hospital, Ankara, Turkey
| | - Seher Kocaoğlu
- Department of Physical Medicine and Rehabilitation, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
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Tamura H, Hirohama K, Hamada K, Imura T, Mitsutake T, Tanaka R. Clinically significant effects of gait modification on knee pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2024; 37:3-12. [PMID: 37599518 DOI: 10.3233/bmr-220291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Knee pain is the main symptom of knee osteoarthritis. Walking is effective against knee pain, and some studies have shown that gait modification can also relieve this condition. However, the quality of evidence for the clinically significant effects of gait modification on knee pain has not been examined. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the level of evidence for the clinically significant effects of gait modification on knee pain and determine if the effects are greater than the minimal clinically important difference (MCID). METHODS We comprehensively searched electronic databases such as MEDLINE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. Intervention studies with experimental groups who received gait modification and control groups who did not were evaluated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the level of evidence. RESULTS Nine studies met the inclusion criteria. All were included in the systematic review and two in the meta-analysis. Results showed that gait modification have significant effects (p= 0.02), and the quality of evidence was very low. However, several studies have revealed that the effects of gait modification, when used as a foot-focused intervention, were greater than the MCID. CONCLUSIONS We concluded that there is a lack of high-quality evidence that supports the general efficacy of gait modification. Although based on low-quality evidence, when applied to the foot, it may have clinically significant effects.
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Affiliation(s)
- Hiroyuki Tamura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Karada care Business Promotion Office, NEC Livex Ltd., Tokyo, Japan
| | - Kenta Hirohama
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Kazuaki Hamada
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Wako Orthopedic Clinic, Hiroshima, Japan
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tsubasa Mitsutake
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
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Snyder SJ, Chu E, Um J, Heo YJ, Miller RH, Shim JK. Prediction of knee adduction moment using innovative instrumented insole and deep learning neural networks in healthy female individuals. Knee 2023; 41:115-123. [PMID: 36657209 DOI: 10.1016/j.knee.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The knee adduction moment, a biomechanical risk factor of knee osteoarthritis, is typically measured in a gait laboratory with expensive equipment and inverse dynamics modeling software. We aimed to develop a framework for a portable knee adduction moment estimation for healthy female individuals using deep learning neural networks and custom instrumented insole and evaluated its accuracy compared to the standard inverse dynamics approach. METHODS Feed-forward, convolutional, and recurrent neural networks were applied to the data extracted from five piezo-resistive force sensors attached to the insole of a shoe. RESULTS All models predicted knee adduction moment variables during walking with high correlation coefficients, r > 0.72, and low root mean squared errors (RMSE), ranging from 0.5% to 1.2%. The convolutional neural network is the most accurate predictor of average knee adduction moment (r = 0.96; RMSE = 0.5%) followed by the recurrent and feed-forward neural networks. CONCLUSION These findings and the methods presented in the current study are expected to facilitate a cost-effective clinical analysis of knee adduction moment for healthy female individuals and to facilitate future research on prediction of other biomechanical risk factors using similar methods.
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Affiliation(s)
- Samantha J Snyder
- Department of Kinesiology, University of Maryland, College Park, MD, USA.
| | - Edward Chu
- Department of Kinesiology, University of Maryland, College Park, MD, USA.
| | - Jumyung Um
- Department of Industrial & Management Systems Engineering, Kyung Hee University, Yongin-Si, Gyeonggi-do, South Korea.
| | - Yun Jung Heo
- Department of Mechanical Engineering, Kyung Hee University, Yongin-Si, Gyeonggi-do, South Korea; Integrated Education Institute for Frontier Science & Technology, Kyung Hee University, Gyeonggi-do 17104, South Korea.
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD, USA; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA.
| | - Jae Kun Shim
- Department of Kinesiology, University of Maryland, College Park, MD, USA; Department of Mechanical Engineering, Kyung Hee University, Yongin-Si, Gyeonggi-do, South Korea; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA; Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.
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Abstract
Knee osteoarthritis is rising in prevalence, and more imaging studies are being requested to evaluate these patients. Although conventional radiographs of the knee are the most widely requested and available studies, other imaging modalities such as MRI, CT, and ultrasound may also be used. This article reviews commonly used imaging modalities, advantages and limitations of each, and their clinical applicability in diagnosing and monitoring knee osteoarthritis. New and advanced imaging techniques are also discussed as possible methods of early diagnosis and improved understanding of osteoarthritis pathophysiology.
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Affiliation(s)
- Preeti A Sukerkar
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Zoe Doyle
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
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Thorsen T, Wen C, Zhang S. Are Medial and Lateral Tibiofemoral Compressive Forces Different in Uphill Compared to Level Walking for Patients Following Total Knee Arthroplasty? J Biomech Eng 2021; 143:101005. [PMID: 34008834 DOI: 10.1115/1.4051227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine how tibiofemoral joint compressive forces and knee joint-spanning muscle forces during uphill walking change compared to level walking in patients with total knee arthroplasty (TKA). A musculoskeletal model capable of resolving total (TCF), medial (MCF), and lateral (LCF) tibiofemoral compressive forces was used to determine compressive forces and muscle forces during level and uphill walking on a 10 deg incline for twenty-five post-TKA patients. A 2 × 2 (slope: level and 10 deg × limb: replaced and nonreplaced) repeated measures analysis of variance was used to detect differences in knee contact forces between slope and limb conditions and their interaction. Peak loading-response TCF, MCF, and LCF were greater during uphill walking than level walking for nonreplaced limbs. During uphill walking, peak loading-response TCF was smaller in replaced limbs compared to nonreplaced limbs with no change in MCF or LCF. Peak knee extension moment and knee extensor muscle force were smaller in replaced limbs compared to nonreplaced limbs during uphill walking. During level walking, replaced and nonreplaced limbs experienced rather equal joint loading; however, replaced limb experienced reduced joint loading during uphill walking. Differences in joint loading between replaced and nonreplaced limbs were not present during level walking, suggesting compensation from the replaced limb during the more difficult task. Uphill walking following TKA promotes more balanced loading of replaced limbs during stance; however, these benefits may come at the expense of increased loading on nonreplaced limbs.
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Affiliation(s)
- Tanner Thorsen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996
| | - Chen Wen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, 1914 Andy Holt Avenue Knoxville, TN 37996
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Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ. The compartmental distribution of knee osteoarthritis - a systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29:445-455. [PMID: 33253887 DOI: 10.1016/j.joca.2020.10.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES For a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof. METHODS PubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA. RESULTS 16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5-58.3%), bicompartmental 33% (23.1-37.2%) and tricompartmental only 17% (8.8-24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2-31.1%), 18% (9.9-22.7%) and 23% (14.1-27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5-18.7%). CONCLUSION Three-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used. TRIAL REGISTRATION NUMBER PROSPERO systematic review protocol (CRD42019140345).
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Affiliation(s)
- J C Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - O Dandridge
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - A Garner
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK; Health Education Kent, Surrey and Sussex Higher Surgical Training Programme, London, UK; Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, UK.
| | - J Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - R J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
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Apostolopoulos AP, Chronopoulos E, Michos IV, Mastrokalos D, Darras N, Nikolaou VS. Kinematic and Kinetic Waveform Changes of the Knee Joint Following a Mobile Bearing Total Knee Arthroplasty-Gait Analysis and Single Step Ascent. J Knee Surg 2020; 33:978-986. [PMID: 31127599 DOI: 10.1055/s-0039-1688963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study is to analyze the kinetic and kinematic changes of the osteoarthritic knee after a mobile bearing total knee arthroplasty. Kinematic and kinetic gait analysis of level walking was performed in 15 patients (eight female and seven male) with knee ostoarthritis. All patients were free of any neurological diseases that could affect their normal gait. Mean age was 68.6 ± 5.2 years, mean height 159.8 ± 6.9 cm, and mean weight was 78.5 ± 10.1 kg. Full body gait analysis was performed using the BioKin three-dimensional (3D) motion analysis system preoperatively and 9 months after total knee arthroplasty. A single-step ascending kinetic analysis and a plantar pressure distribution analysis were also performed in all patients. An increased average cadence (mean 99.39 step/min preoperatively and 104.64 step/min postoperatively; p = 0.152), step length (0.44 m preoperatively and 0.52 m postoperatively; p < 0.001), stride length (0.89 m preoperatively and 1.0 m postoperatively; p < 0.007), and walking velocity (0.73 m/sec preoperatively and 0.90 m/sec postoperatively; p = 0.005) were noted postoperatively and postoperatively. A decrease in the stance duration percentage and the knee adduction moment was also reported postoperatively. All patients showed a significant improvement of knee kinetics and kinematics after a mobile bearing total knee arthroplasty. Statistically significant differences were found in the step length, stride length, and walk velocity postoperatively. The knee adduction moment was also significantly reduced. Further research is warranted to determine the clinical relevance of these findings. This study is a prospective comparative one and reflects level II evidence.
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Affiliation(s)
- A P Apostolopoulos
- 4th Orthopaedic Department, Ascleipion Voulas General Hospital, Athens, Greece
- Trauma and Orthopaedic Department, Ealing Hospital, Imperial College Healltcare NHS Trust, London, United Kingdom
| | - E Chronopoulos
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - I V Michos
- 4th Orthopaedic Department, Ascleipion Voulas General Hospital, Athens, Greece
| | - D Mastrokalos
- 1st Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - N Darras
- Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | - V S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
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Trombini-Souza F, Fuller R, Goldenstein-Schainberg C, Sacco ICN. Long-term use of minimal footwear in older adult women with knee osteoarthritis: Mechanisms of action in the knee adduction moment. J Biomech 2020; 108:109885. [PMID: 32635999 DOI: 10.1016/j.jbiomech.2020.109885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/20/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Abstract
Studies have shown the short- and long-term effects of wearing minimalist footwear in reducing knee loads in patients with knee osteoarthritis (OA). This study aimed to investigate the mechanisms underpinning the reduction in external knee adduction moment (EKAM) in older adult women who wore this type of footwear through a randomized controlled trial. Fifty-six participants with medial compartment knee OA were equally allocated to either an intervention group (IG) that wore minimalist footwear (Moleca®) or to a control group (CG) that continued regular clinical treatment for OA for six months. The influence of lower limb joint kinematics and joint frontal moments, center of pressure displacement, and foot progression angle in predicting the reduction of EKAM were assessed after a six-month intervention. Surprisingly, none of the seven independent variables predicted the first peak EKAM in the multiple regression model for the IG. For the CG, the increase of one unit in the first peak of the hip adduction moment resulted in a 1.01 units increase in the first peak EKAM. Additionally, a one-unit reduction in the ankle eversion angle resulted in an increase of 0.16 units in the percent change in the first peak EKAM. Thus, wearing the Moleca® shoe for six months helped the participants keep a natural gait pattern without increasing the hip moment or the ankle inversion angle compared to the women who did not wear the Moleca® footwear. ClinicalTrials.gov (NCT01342458).
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Affiliation(s)
| | - Ricardo Fuller
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Isabel C N Sacco
- Faculdade de Medicina, Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, SP, Brazil
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12
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Lehtovirta S, Mäkitie RE, Casula V, Haapea M, Niinimäki J, Niinimäki T, Peuna A, Lammentausta E, Mäkitie O, Nieminen MT. Defective WNT signaling may protect from articular cartilage deterioration - a quantitative MRI study on subjects with a heterozygous WNT1 mutation. Osteoarthritis Cartilage 2019; 27:1636-1646. [PMID: 31299386 DOI: 10.1016/j.joca.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/01/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE WNT signaling is of key importance in chondrogenesis and defective WNT signaling may contribute to the pathogenesis of osteoarthritis and other cartilage diseases. Biochemical composition of articular cartilage in patients with aberrant WNT signaling has not been studied. Our objective was to assess the knee articular cartilage in WNT1 mutation-positive individuals using a 3.0T MRI unit to measure cartilage thickness, relaxation times, and texture features. DESIGN Cohort comprised mutation-positive (N = 13; age 17-76 years) and mutation-negative (N = 13; 16-77 years) subjects from two Finnish families with autosomal dominant WNT1 osteoporosis due to a heterozygous missense mutation c.652T>G (p.C218G) in WNT1. All subjects were imaged with a 3.0T MRI unit and assessed for cartilage thickness, T2 and T1ρ relaxation times, and T2 texture features contrast, dissimilarity and homogeneity of T2 relaxation time maps in six regions of interest (ROIs) in the tibiofemoral cartilage. RESULTS All three texture features showed opposing trends with age between the groups in the medial tibiofemoral cartilage (P = 0.020-0.085 for the difference of the regression coefficients), the mutation-positive individuals showing signs of cartilage preservation. No significant differences were observed in the lateral tibiofemoral cartilage. Cartilage thickness and means of T2 relaxation time did not differ between groups. Means of T1ρ relaxation time were significantly different in one ROI but the regression analysis displayed no differences. CONCLUSIONS Our results show less age-related cartilage deterioration in the WNT1 mutation-positive than the mutation-negative subjects. This suggests, that the WNT1 mutation may alter cartilage turnover and even have a potential cartilage-preserving effect.
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Affiliation(s)
- S Lehtovirta
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland
| | - R E Mäkitie
- Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FI-00290, Finland.
| | - V Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland
| | - M Haapea
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - J Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - T Niinimäki
- Department of Orthopedics, Oulu University Hospital, Oulu, FI-90220, Finland
| | - A Peuna
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - E Lammentausta
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - O Mäkitie
- Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FI-00290, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, FI-00290, Finland; Center for Molecular Medicine, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
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13
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Pfeiffer SJ, Valentine JA, Goodwin JS, Nissman DB, Blackburn T, Pietrosimone B. Effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following walking in varus-aligned individuals. Knee 2019; 26:1067-1072. [PMID: 31340891 DOI: 10.1016/j.knee.2019.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee varus alignment may increase loading in the medial tibiofemoral compartment, which can increase strain on the articular cartilage. Knee valgus unloader braces seek to reduce loading through the medial femoral compartment, but their effects on cartilage characteristics during dynamic tasks have not been evaluated. OBJECTIVE To determine the effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following a single 5000-step walking protocol in individuals with varus-knee alignment. METHODS Twenty-four healthy individuals (63% female, BMI = 22 ± 3 kg/m2, age = 21 ± 3 years) completed two testing sessions (braced and unbraced) separated by one week. During both sessions, femoral cartilage ultrasound images were acquired prior to and following a 5000-step treadmill walking protocol at self-selected speed. Percent change scores in medial cartilage cross-sectional area (MCCA) were calculated and used as the primary outcome, and compared between the braced and unbraced conditions. RESULTS There was no difference in percent change of MCCA between conditions (braced = -2.77%, unbraced = -3.15%, p = 0.699). Individuals whose cartilage deformed more than a previously established minimal detectable change (MDC ≥ 1.58 mm2) deformed less during the braced condition (braced = -2.94%, unbraced = -6.34%, p = 0.028), compared to individuals who did not deform greater than the MDC (n = 15, braced = -2.67%, unbraced = -1.23%, p = 0.210). CONCLUSIONS There was no significant difference in MCCA percent change between the braced and unbraced conditions across the entire cohort; yet a valgus unloader braces may serve as a potential intervention strategy for reducing articular cartilage deformation in certain varus-aligned individuals who normally undergo measurable deformation during walking.
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Affiliation(s)
- Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Joshua A Valentine
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Johnathan S Goodwin
- Department of Physical Therapy Education, Elon University, Elon, NC, United States of America
| | - Daniel B Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Troy Blackburn
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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14
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Morgan OJ, Hillstrom HJ, Ranawat A, Fragomen AT, Rozbruch SR, Hillstrom R. Effects of a Medial Knee Unloading Implant on Tibiofemoral Joint Mechanics During Walking. J Orthop Res 2019; 37:2149-2156. [PMID: 31119801 DOI: 10.1002/jor.24379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
The Atlas™ unicompartmental knee system is a second-generation extra-articular unloading implant for patients with mild to moderate medial knee osteoarthritis. The technology acts to reduce a portion of the weight-bearing load exerted on the medial knee during physical activity thereby, reducing the mechanical stress imposed on a degenerative joint. The purpose of the present study was to evaluate the effects of the Atlas™ on tibiofemoral joint mechanics during walking. A computer-aided design assembly of the Atlas™ was virtually implanted on the medial aspect of a previously validated finite element tibiofemoral joint model. Data for knee joint forces and moments from an anthropometrically matched male were applied to the model to quasi-statically simulate the stance phase of gait. Predictions of tibiofemoral joint mechanics were computed pre- and post-virtual implantation of the Atlas™. Compressive force in the medial tibiofemoral compartment was reduced by a mean of 53%, resulting in the decrement of mean cartilage-cartilage and cartilage-meniscus von Mises stress by 31% and 32%, respectively. The Atlas™ was not predicted to transfer net loading to the lateral compartment. The tibiofemoral joint model exhibited less internal-external rotation and anterior-posterior translation post-Atlas™, indicating a change in the kinematic environment of the knee. From a biomechanical perspective, extra-articular joint unloading may serve as a treatment option for patients recalcitrant to conservative care. Evaluation of mechanical changes in the tibiofemoral joint demonstrate the potential treatment mechanism of the Atlas™, in accordance with the available clinical data. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2149-2156, 2019.
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Affiliation(s)
- Oliver J Morgan
- Medical Engineering Research Group, Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Howard J Hillstrom
- Leon Root, Motion Analysis Laboratory, Hospital for Special Surgery, New York, New York
| | - Anil Ranawat
- Sports Medicine and Hip Preservation Centre, Hospital for Special Surgery, New York, New York
| | - Austin T Fragomen
- Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, New York, New York
| | - S Robert Rozbruch
- Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, New York, New York
| | - Rajshree Hillstrom
- Medical Engineering Research Group, Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, United Kingdom
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15
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Hontoir F, Pirson R, Simon V, Clegg P, Nisolle JF, Kirschvink N, Vandeweerd JME. Age-related morphometric changes of the tidemark in the ovine stifle. Anat Histol Embryol 2019; 48:366-374. [PMID: 31106466 DOI: 10.1111/ahe.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 01/17/2023]
Abstract
Though the ovine stifle is commonly used to study osteoarthritis, there is limited information about the age-related morphometric changes of the tidemark. The objective of this study was to document the number of tidemarks in the stifle of research sheep without clinical signs of osteoarthritis and of various ages (n = 80). Articular cartilage of the medial and lateral tibial condyles and of the medial and lateral femoral condyles was assessed by histology: (a) to count the number of tidemark; and (b) to assess the OARSI (Osteoarthritis Research Society International) score for structural changes of cartilage. The number of tidemarks varied between anatomical regions, respectively, from 4.2 in the medial femoral condyle to 5.0 in the lateral tibial condyle. The axial part showed a significant higher number of tidemarks than the abaxial part, for all regions except the medial tibial condyle. Whilst the tidemark count strongly correlated with age (Spearman's correlation coefficient = 0.70; 95% confidence interval (95% CI): 0.67-0.73; p < 0.0001), the OARSI score was weakly correlated with age in our cohort of sheep (Spearman's correlation coefficient = 0.25; 95% CI: 0.19-0.30; p < 0.0001). Interestingly, no tidemark was seen in the three animals aged 6 months. Our data indicate that the number of tidemarks increases with age and vary with anatomical region. The regional variation also revealed a higher number of tidemarks in the tibia than in the femur. This could be attributed to the local variation in cartilage response to strain and to the difference in chondrocyte biology and density.
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Affiliation(s)
- Fanny Hontoir
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Romain Pirson
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Vincent Simon
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Peter Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease, University of Liverpool, Liverpool, UK
| | - Jean-François Nisolle
- Centre Hospitalier Universitaire (CHU) UCL Namur Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Nathalie Kirschvink
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Jean-Michel E Vandeweerd
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
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16
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Xu R, Ming D, Ding Z, Bull AMJ. Extra excitation of biceps femoris during neuromuscular electrical stimulation reduces knee medial loading. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181545. [PMID: 31032011 PMCID: PMC6458370 DOI: 10.1098/rsos.181545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Medial knee joint osteoarthritis (OA) is a debilitating and prevalent condition. Surgical treatment consists of redistributing the forces from the medial to the lateral compartment through osteotomy, or replacing the joint surfaces. As the mediolateral load distribution is related to the action of the musculature around the knee, the aim of this study was to devise a technique to redistribute these forces non-surgically through changes in muscle excitation. Eight healthy subjects participated in the experiment, and neuromuscular electrical stimulation was used to change the muscle forces around the knee. A musculoskeletal model was used to quantify the loading on the medial compartment of the knee, and a novel algorithm devised and implemented to simulate neuromuscular electrical stimulation. The forces and moments at the knee, ground reaction forces, walking velocity and step length were quantified before and after stimulation. Stimulation of the biceps femoris resulted in a significant decrease in the second peak of the medial knee joint loading by up to 0.17 body weight (p = 0.016). Kinematic parameters were not significantly affected. Neuromuscular electrical stimulation can decrease the peak loads on the medial compartment of the knee, and thus offers a promising therapy for medial knee joint OA.
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Affiliation(s)
- Rui Xu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
- Department of Bioengineering, Imperial College, London SW7 2AZ, UK
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
| | - Ziyun Ding
- Department of Bioengineering, Imperial College, London SW7 2AZ, UK
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17
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Trepczynski A, Kutzner I, Schütz P, Dymke J, List R, von Roth P, Moewis P, Bergmann G, Taylor WR, Duda GN. Tibio-Femoral Contact Force Distribution is Not the Only Factor Governing Pivot Location after Total Knee Arthroplasty. Sci Rep 2019; 9:182. [PMID: 30655583 PMCID: PMC6336768 DOI: 10.1038/s41598-018-37189-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/30/2018] [Indexed: 01/11/2023] Open
Abstract
Total knee arthroplasty aims to mimic the natural knee kinematics by optimizing implant geometry, but it is not clear how loading relates to tibio-femoral anterior-posterior translation or internal-external pivoting. We hypothesised that the point of pivot in the transverse plane is governed by the location of the highest axial force. Tibio-femoral loading was measured using an instrumented tibial component in six total knee arthroplasty patients (aged 65–80y, 5–7y post-op) during 5–6 squat repetitions, while knee kinematics were captured using a mobile video-fluoroscope. In the range of congruent tibio-femoral contact the medial femoral condyle remained approximately static while the lateral condyle translated posteriorly by 4.1 mm (median). Beyond the congruent range, the medial and lateral condyle motions both abruptly changed to anterior sliding by 4.6 mm, and 2.6 mm respectively. On average, both the axial loading and pivot position were more medial near extension, and transferred to the lateral side in flexion. However, no consistent relationship between pivoting and load distribution was found across all patients throughout flexion, with R2 values ranging from 0.00 to 0.65. Tibio-femoral kinematics is not related to the load distribution alone: medial loading of the knee does not necessarily imply a medial pivot location.
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Affiliation(s)
- A Trepczynski
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - I Kutzner
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Schütz
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - J Dymke
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - R List
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - P von Roth
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Moewis
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - G Bergmann
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - W R Taylor
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - G N Duda
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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18
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Chen Y, Hu Y, Yu YE, Zhang X, Watts T, Zhou B, Wang J, Wang T, Zhao W, Chiu KY, Leung FK, Cao X, Macaulay W, Nishiyama KK, Shane E, Lu WW, Guo XE. Subchondral Trabecular Rod Loss and Plate Thickening in the Development of Osteoarthritis. J Bone Miner Res 2018; 33:316-327. [PMID: 29044705 DOI: 10.1002/jbmr.3313] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/21/2022]
Abstract
Developing effective treatment for osteoarthritis (OA), a prevalent and disabling disease, has remained a challenge, primarily because of limited understanding of its pathogenesis and late diagnosis. In the subchondral bone, rapid bone loss after traumatic injuries and bone sclerosis at the advanced stage of OA are well-recognized hallmarks of the disease. Recent studies have further demonstrated the crucial contribution of subchondral bone in the development of OA. However, the microstructural basis of these bone changes has not been examined thoroughly, and the paradox of how abnormal resorption can eventually lead to bone sclerosis remains unanswered. By applying a novel microstructural analysis technique, individual trabecula segmentation (ITS), to micro-computed tomography (μCT) images of human OA knees, we have identified a drastic loss of rod-like trabeculae and thickening of plate-like trabeculae that persisted in all regions of the tibial plateau, underneath both severely damaged and still intact cartilage. The simultaneous reduction in trabecular rods and thickening of trabecular plates provide important insights to the dynamic and paradoxical subchondral bone changes observed in OA. Furthermore, using an established guinea pig model of spontaneous OA, we discovered similar trabecular rod loss and plate thickening that preceded cartilage degradation. Thus, our study suggests that rod-and-plate microstructural changes in the subchondral trabecular bone may play an important role in the development of OA and that advanced microstructural analysis techniques such as ITS are necessary in detecting these early but subtle changes. With emerging high-resolution skeletal imaging modalities such as the high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular rod loss identified by ITS could potentially be used as a marker in assessing the progression of OA in future longitudinal studies or clinical diagnosis. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Yan Chen
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA.,Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong.,Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Y Eric Yu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Xingjian Zhang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Tezita Watts
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ting Wang
- Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Weiwei Zhao
- Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Kwong Yuen Chiu
- Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Frankie Kl Leung
- Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Macaulay
- Department of Orthopedic Surgery, New York University Langone/Hospital for Joint Diseases, New York, NY, USA
| | - Kyle K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - William W Lu
- Department of Orthopedics and Traumatology, The University of Hong Kong, Hong Kong
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
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19
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology 2017; 284:508-520. [PMID: 28463057 DOI: 10.1148/radiol.2017161005] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose To investigate the association of weight loss with progression of cartilage changes at magnetic resonance (MR) imaging over 48 months in overweight and obese participants compared with participants of stable weight. Materials and Methods The institutional review boards of the four participating centers approved this HIPAA-compliant study. Included were (a) 640 participants (mean age, 62.9 years ± 9.1 [standard deviation]; 398 women) who were overweight or obese (body mass index cutpoints of 25 and 30 kg/m2, respectively) from the Osteoarthritis Initiative, with risk factors for osteoarthritis or mild to moderate radiographic findings of osteoarthritis, categorized into groups with (a) weight loss of more than 10% (n = 82), (b) weight loss of 5%-10% (n = 238), or (c) stable weight (n = 320) over 48 months. Participants were frequency-matched for age, sex, baseline body mass index, and Kellgren-Lawrence score. Two radiologists assessed cartilage and meniscus defects on right knee 3-T MR images at baseline and 48 months by using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Progression of the subscores was compared between the weight loss groups by using multivariable logistic regression models. Results Over 48 months, adjusted mean increase of cartilage WORMS was significantly smaller in the 5%-10% weight loss group (1.6; 95% confidence interval [CI]: 1.3, 1.9; P = .002) and even smaller in the group with more than 10% weight loss (1.0; 95% CI: 0.6, 1.4; P = .001) when compared with the stable weight group (2.3; 95% CI: 2.0, 2.7). Moreover, percentage of weight change was significantly associated with increase in cartilage WORMS (β = 0.2; 95% CI: 0.02, 0.4; P = .007). Conclusion Participants who lost weight over 48 months showed significantly lower cartilage degeneration, as assessed with MR imaging; rates of progression were lower with greater weight loss. © RSNA, 2017.
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Affiliation(s)
- Alexandra S Gersing
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Benedikt J Schwaiger
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Michael C Nevitt
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Gabby B Joseph
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Nattagan Chanchek
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Julio B Guimaraes
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - John Mbapte Wamba
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Luca Facchetti
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Charles E McCulloch
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Thomas M Link
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
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Hontoir F, Clegg P, Simon V, Kirschvink N, Nisolle JF, Vandeweerd JM. Accuracy of computed tomographic arthrography for assessment of articular cartilage defects in the ovine stifle. Vet Radiol Ultrasound 2017; 58:512-523. [PMID: 28429403 DOI: 10.1111/vru.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 01/30/2023] Open
Abstract
Articular cartilage defects are one of the features of osteoarthritis in animals and humans. Early detection of cartilage defects is a challenge in clinical veterinary practice and also in translational research studies. An accurate, diagnostic imaging method would be desirable for detecting and following up lesions in specific anatomical regions of the articular surface. The current prospective experimental study aimed to describe the accuracy of computed tomographic arthrography (CTA) for detecting cartilage defects in a common animal model used for osteoarthritis research, the ovine stifle (knee, femoropatellar/femorotibial) joint. Joints in cadaver limbs (n = 42) and in living animals under anesthesia (n = 13) were injected with a contrast medium and imaged using a standardized CT protocol. Gross anatomy and histological assessment of specific anatomic regions were used as a gold standard for the evaluation of sensitivity, specificity, negative predictive value, and positive predictive value for CTA identification of articular cartilage defects in those regions. Pooled estimated sensitivity and specificity were 90.32% and 97.30%, respectively, in cadaver limbs, and 81.82% and 95.24%, respectively, in living animals. Pooled estimated positive predictive value and negative predictive values were 98.25% and 85.71%, respectively, in cadaver limbs, and 81.82% and 95.24%, respectively, in living animals. The delineation of cartilage surface was good for anatomical regions most frequently affected by cartilage defects in the ovine stifle: medial femoral condyle, medial tibial condyle, and patella. This study supported the use of CTA as an imaging technique for detecting and monitoring articular cartilage defects in the ovine stifle joint.
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Affiliation(s)
- Fanny Hontoir
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | - Peter Clegg
- Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Vincent Simon
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | - Nathalie Kirschvink
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | | | - Jean-Michel Vandeweerd
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
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Reduced step length reduces knee joint contact forces during running following anterior cruciate ligament reconstruction but does not alter inter-limb asymmetry. Clin Biomech (Bristol, Avon) 2017; 43:79-85. [PMID: 28214426 DOI: 10.1016/j.clinbiomech.2017.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction is associated with early onset knee osteoarthritis. Running is a typical activity following this surgery, but elevated knee joint contact forces are thought to contribute to osteoarthritis degenerative processes. It is therefore clinically relevant to identify interventions to reduce contact forces during running among individuals after anterior cruciate ligament reconstruction. The primary purpose of this study was to evaluate the effect of reducing step length during running on patellofemoral and tibiofemoral joint contact forces among people with a history of anterior cruciate ligament reconstruction. Inter limb knee joint contact force differences during running were also examined. METHODS 18 individuals at an average of 54.8months after unilateral anterior cruciate ligament reconstruction ran in 3 step length conditions (preferred, -5%, -10%). Bilateral patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, loading rate, impulse, and impulse per kilometer were evaluated between step length conditions and limbs using separate 2 factor analyses of variance. FINDINGS Reducing step length 5% decreased patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, impulse, and impulse per kilometer bilaterally. A 10% step length reduction further decreased peak forces and force impulses, but did not further reduce force impulses per kilometer. Tibiofemoral joint impulse, impulse per kilometer, and patellofemoral joint loading rate were lower in the previously injured limb compared to the contralateral limb. INTERPRETATION Running with a shorter step length is a feasible clinical intervention to reduce knee joint contact forces during running among people with a history of anterior cruciate ligament reconstruction.
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Upadhyay B, Mo J, Beadsmoore C, Marshall T, Toms A, Buscombe J. Technetium-99m Methylene Diphosphonate Single-photon Emission Computed Tomography/Computed Tomography of the Foot and Ankle. World J Nucl Med 2017; 16:88-100. [PMID: 28553174 PMCID: PMC5436330 DOI: 10.4103/1450-1147.203077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The complex anatomy and function of the foot and ankle can make it difficult to determine the cause of symptoms in patients with foot and ankle pathology. Following initial clinical and radiographic assessment, additional imaging with magnetic resonance imaging may be required, which is often seen as the modality of choice. Although sensitive to pathological changes in bone metabolism and vascularity, technetium-99m (Tc-99m) bone scintigraphy often lacks the specificity and resolution required to evaluate the structures of the foot and ankle. Tc-99m methylene diphosphonate single-photon emission computed tomography/computed tomography (SPECT/CT) combines this sensitivity with the superior anatomical detail of CT, enabling better localization of pathological uptake and evaluation of associated structural changes. As a result, SPECT/CT has been growing in popularity for the assessment of patients with foot and ankle pathology where it can provide additional information that may change the initial diagnosis and subsequent management plan. Studies have reported modification of the surgical approach and site of intra-articular local anesthetic injections following SPECT/CT with good results. Interpretation of SPECT/CT studies requires an understanding of the pathological changes that result in increased tracer accumulation in addition to the CT changes that may be seen. This review aims to highlight the advantages of SPECT/CT, potential applications and explain the imaging appearances of common pathologies that may be observed.
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Affiliation(s)
- Bhavin Upadhyay
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Jonathan Mo
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Clare Beadsmoore
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Tom Marshall
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Andoni Toms
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - John Buscombe
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge, UK
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Rane L, Bull AMJ. Functional electrical stimulation of gluteus medius reduces the medial joint reaction force of the knee during level walking. Arthritis Res Ther 2016; 18:255. [PMID: 27809923 PMCID: PMC5094077 DOI: 10.1186/s13075-016-1155-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background By altering muscular activation patterns, internal forces acting on the human body during dynamic activity may be manipulated. The magnitude of one of these forces, the medial knee joint reaction force (JRF), is associated with disease progression in patients with early osteoarthritis (OA), suggesting utility in its targeted reduction. Increased activation of gluteus medius has been suggested as a means to achieve this. Methods Motion capture equipment and force plate transducers were used to obtain kinematic and kinetic data for 15 healthy subjects during level walking, with and without the application of functional electrical stimulation (FES) to gluteus medius. Musculoskeletal modelling was employed to determine the medial knee JRF during stance phase for each trial. A further computer simulation of increased gluteus medius activation was performed using data from normal walking trials by a manipulation of modelling parameters. Relationships between changes in the medial knee JRF, kinematics and ground reaction force were evaluated. Results In simulations of increased gluteus medius activity, the total impulse of the medial knee JRF was reduced by 4.2 % (p = 0.003) compared to control. With real-world application of FES to the muscle, the magnitude of this reduction increased to 12.5 % (p < 0.001), with significant inter-subject variation. Across subjects, the magnitude of reduction correlated strongly with kinematic (p < 0.001) and kinetic (p < 0.001) correlates of gluteus medius activity. Conclusions The results support a major role for gluteus medius in the protection of the knee for patients with OA, establishing the muscle’s central importance to effective therapeutic regimes. FES may be used to achieve increased activation in order to mitigate distal internal loads, and much of the benefit of this increase can be attributed to resulting changes in kinematic parameters and the ground reaction force. The utility of interventions targeting gluteus medius can be assessed in a relatively straightforward way by determination of the magnitude of reduction in pelvic drop, an easily accessed marker of aberrant loading at the knee.
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Affiliation(s)
- Lance Rane
- Department of Bioengineering, Imperial College London, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK.
| | - Anthony Michael James Bull
- Department of Bioengineering, Imperial College London, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK
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Bowersock CD, Willy RW, DeVita P, Willson JD. Independent effects of step length and foot strike pattern on tibiofemoral joint forces during running. J Sports Sci 2016; 35:2005-2013. [PMID: 27800702 DOI: 10.1080/02640414.2016.1249904] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine the effects of step length and foot strike pattern along with their interaction on tibiofemoral joint (TFJ) and medial compartment TFJ kinetics during running. Nineteen participants ran with a rear foot strike pattern at their preferred speed using a short (-10%), preferred, and long (+10%) step length. These step length conditions were then repeated using a forefoot strike pattern. Regardless of foot strike pattern, a 10% shorter step length resulted in decreased peak contact force, force impulse per step, force impulse per kilometre, and average loading rate at the TFJ and medial compartment, while a 10% increased step length had the opposite effects (all P < 0.05). A forefoot strike pattern significantly lowered TFJ and medial compartment TFJ average loading rates compared with a rear foot strike pattern (both <0.05) but did not change TFJ or medial compartment peak force, force impulse per step, or force impulse per km. The combination of a shorter step length and forefoot strike pattern produced the greatest reduction in peak medial compartment contact force (P < 0.05). Knowledge of these running modification effects may be relevant to the management or prevention of TFJ injury or pathology among runners.
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Affiliation(s)
- Collin D Bowersock
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - Richard W Willy
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
| | - Paul DeVita
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - John D Willson
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
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SAXBY DAVIDJOHN, BRYANT ADAML, MODENESE LUCA, GERUS PAULINE, KILLEN BRYCEA, KONRATH JASON, FORTIN KARINE, WRIGLEY TIMV, BENNELL KIML, CICUTTINI FLAVIAM, VERTULLO CHRISTOPHER, FELLER JULIANA, WHITEHEAD TIM, GALLIE PRICE, LLOYD DAVIDG. Tibiofemoral Contact Forces in the Anterior Cruciate Ligament–Reconstructed Knee. Med Sci Sports Exerc 2016; 48:2195-2206. [DOI: 10.1249/mss.0000000000001021] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M. The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2016; 24:1697-1707. [PMID: 27188684 DOI: 10.1016/j.joca.2016.05.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of radiographic patellofemoral osteoarthritis (OA) from population- and symptom-based cohorts and to evaluate if knee pain, physical function and quality of life (QOL) differ between people with isolated patellofemoral OA, isolated tibiofemoral OA and combined patellofemoral and tibiofemoral OA. METHOD Terms associated with "patellofemoral OA", "prevalence" and "clinical features" were used to search Medline, EMBASE, CINAHL, SCOPUS, AMED and Web of Science databases with no language restriction' from inception to August 2014. Two independent reviewers screened papers for eligibility. Studies were included if they reported prevalence of compartmental patterns of radiographic knee OA in population- or symptom-based cohorts. Studies were excluded if they evaluated a targeted sample (e.g., occupation-specific participants) or repeated already reported data from the same cohorts. Point prevalence estimates of patellofemoral OA were extracted from eligible studies, pooled and quantitatively analysed. A critical appraisal tool was used to evaluate methodological quality. RESULTS The search yielded 1891 records. The inclusion criteria were met by 32 studies. The crude prevalence of patellofemoral OA was 25% in the population-based cohorts (aged >20 years) and 39% in the symptom-based cohorts (aged >30 years). Eight studies reported knee pain, physical function and QOL in people with different compartmental disease; however no significant differences were found. CONCLUSION These findings confirm the substantial prevalence of patellofemoral OA, demonstrating the need to specifically consider the patellofemoral joint in knee OA research and clinical settings.
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Affiliation(s)
- S Kobayashi
- Faculty of Health Sciences, University of Sydney, 75 East St., Lidcombe, NSW 2141, Australia.
| | - E Pappas
- Department of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - M Fransen
- Department of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - K Refshauge
- Department of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - M Simic
- Department of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
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27
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Rudberg U, Ahlbäck SO, Rydberg J. The Condyle View. Acta Radiol 2016. [DOI: 10.1177/028418518802900525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- U. Rudberg
- Department of Diagnostic Radiology, St. Görans Sjukhus, S-11281 Stockholm, Sweden
| | - S.-O. Ahlbäck
- Department of Diagnostic Radiology, St. Görans Sjukhus, S-11281 Stockholm, Sweden
| | - J. Rydberg
- Department of Diagnostic Radiology, St. Görans Sjukhus, S-11281 Stockholm, Sweden
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Abstract
Patella height was defined by the distance between the midpoint of the articular surface of the patella and the condylar plane, which was constructed perpendicular to the mechanical axis of the tibia. In two series of normal individuals the measured distances were related to body height and the length of the lower leg and thus expressed as its ratio, which was the same in both sexes. The measurements were performed on lateral radiographs of the knee and lower leg obtained in weight-bearing and 30° to 40° of knee flexion using a simple device to obtain a standardized position of the lower leg during the examination. The standing position is proposed for these measurements since the patellar ligament is shorter in the recumbent position. The method can be used for biomechanical analysis of the femoropatellar joint.
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Egund N, Frost S, Brismar J, Gustafson T. Radiography and Scintigraphy in the Assessment of Early Gonarthrosis. Acta Radiol 2016. [DOI: 10.1177/028418518802900414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The radiographic and scintigraphic appearances in early gonarthrosis were compared in 62 knees. Early femorotibial osteoarthrosis was found to be confined to one compartment (medial or lateral) of the joint. However, concomitant patellofemoral osteoarthrosis was common. 99Tcm-MDP scintigraphy was consistently positive when the joint space (femorotibial and patellofemoral) was reduced by 75 per cent or more. Joint space narrowing by as much as 50 per cent could be observed in a scintigraphically normal knee. The inconsistency between the radiologic and scintigraphic findings in the earliest stages of gonarthrosis points to the importance of appropriate radiographic technique.
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30
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El-Brashy AEWS, El-Tanawy RM, Hassan WA, Shaban HM, Bhnasawy MMI. Potential role of vitamin K in radiological progression of early knee osteoarthritis patients. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review. World J Rheumatol 2015; 5:69-81. [DOI: 10.5499/wjr.v5.i2.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis (OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint, ultimately causing pain, stiffness, deformity and disability in many people. Radiographs are commonly used for the clinical assessment of knee OA incidence and progression, and to assess for risk factors. One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities (LE). The hip-knee-ankle (HKA) angle, assessed from a full-length LE radiograph, is ideally used to assess LE alignment. Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle. Since full-length LE radiographs are not always available, the femoral shaft - tibial shaft (FS-TS) angle may be calculated from a knee radiograph instead. However, the FS-TS angle is more variable than the HKA angle and it should be used with caution. Knee radiographs are used to assess the severity of knee OA and its progression. There are three types of ordinal grading scales for knee OA: global, composite and individual feature scales. Each grade on a global scale describes one or more features of knee OA. The entire description must be met for a specific grade to be assigned. The Kellgren-Lawrence scale is the most commonly-used global scale. Composite scales grade several features of knee OA individually and sum the grades to create a total score. One example is the compartmental grading scale for knee OA. Composite scales can respond to change in a variety of presentations of knee OA. Individual feature scales assess one or more OA features individually and do not calculate a total score. They are most often used to monitor change in one OA feature, commonly joint space narrowing. The most commonly-used individual feature scale is the OA Research Society International atlas. Each type of scale has its advantages; however, composite scales may offer greater content validity. Responsiveness to change is unknown for most scales and deserves further evaluation.
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Blazek K, Favre J, Asay J, Erhart-Hledik J, Andriacchi T. Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis. J Orthop Res 2014; 32:394-402. [PMID: 24281940 DOI: 10.1002/jor.22530] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 11/12/2013] [Indexed: 02/04/2023]
Abstract
Articular cartilage is sensitive to mechanical loading, so increased risk of osteoarthritis in older or obese individuals may be linked to changes in the relationship between cartilage properties and extrinsic joint loads. A positive relationship has been reported between ambulatory loads and cartilage thickness in young individuals, but whether this relationship exists in individuals who are older or obese is unknown. This study examined the relationship between femoral cartilage thickness and load, measured by weight × height and the peak adduction moment, in young normal-weight (28 subjects, age: 28.0 ± 3.8 years, BMI: 21.9 ± 1.9 kg/m(2)), middle-aged normal-weight (27 subjects, 47.0 ± 6.5 years, 22.7 ± 1.7 kg/m(2)), young overweight/obese (27 subjects, 28.4 ± 3.6 years, 33.3 ± 4.6 kg/m(2)), and middle-aged overweight/obese (27 subjects, 45.8 ± 7.2 years, 31.9 ± 4.4 kg/m(2)) individuals. On the lateral condyle, cartilage thickness was positively correlated with weight × height for all groups (R(2) = 0.26-0.20) except the middle-aged overweight/obese. On the medial condyle, weight × height was significantly correlated only in young normal-weight subjects (R(2) = 0.19), as was the case for the correlation between adduction moment and medial-lateral thickness ratio (R(2) = 0.20). These results suggest that aging and obesity are both associated with a loss of the positive relationship between cartilage thickness and ambulatory loads, and that the relationship is dependent on the compartment and whether the load is generated by body size or subject-specific gait mechanics.
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Affiliation(s)
- Katerina Blazek
- Mechanical Engineering Department, BioMotion Laboratory, Stanford University, 496 Lomita Mall, Durand 061, Stanford, California, 94306; Center for Tissue Regeneration, Repair, and Restoration, Veterans Administration Hospital, Palo Alto, California
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Blazek K, Asay JL, Erhart-Hledik J, Andriacchi T. Adduction moment increases with age in healthy obese individuals. J Orthop Res 2013; 31:1414-22. [PMID: 23737249 DOI: 10.1002/jor.22390] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 04/23/2013] [Indexed: 02/04/2023]
Abstract
There is a need to understand how obesity and aging interact to cause an increased risk of medial knee osteoarthritis (OA). This study tested whether the knee adduction and flexion moments increase with age in healthy normal-weight and obese adults, as well as the mechanism of this increase. We analyzed whether ground reaction force magnitude, knee alignment, step width, toe-out angle, body volume distribution, and limb position (knee position relative to the pelvis center) are associated with the adduction moment and whether these variables also change with age. Ninety-six healthy volunteers (60 normal-weight and 36 obese) were tested using marker-based gait analysis; knee alignment was based on marker positions during quiet standing. Adduction moment increased with age in obese (R(2) = 0.19), but not in normal-weight individuals (R(2) = 0.01); knee flexion moment did not change with age in either group. In the obese, only knee alignment and limb position were related to the adduction moment (R(2) = 0.19 and 0.51), but only limb position changed with age (R(2) = 0.26). The resulting increase in adduction moment suggests greater medial compartment loads, which may combine with elevated levels of inflammation to contribute to the increased risk of medial OA in this population.
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Affiliation(s)
- Katerina Blazek
- Mechanical Engineering Department, Stanford University BioMotion Laboratory, 496 Lomita Mall, Durand 061, Stanford, California 94305, USA.
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Wong JML, Khan T, Jayadev CS, Khan W, Johnstone D. Anterior cruciate ligament rupture and osteoarthritis progression. Open Orthop J 2012; 6:295-300. [PMID: 22896777 PMCID: PMC3415702 DOI: 10.2174/1874325001206010295] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/10/2012] [Accepted: 03/11/2012] [Indexed: 02/05/2023] Open
Abstract
Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial.The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction.There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations.
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Hwang SH, Jung KA, Lee WJ, Yang KH, Lee DW, Carter A, Park CH, Hunter DJ. Morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis of the knee. Osteoarthritis Cartilage 2012; 20:110-116. [PMID: 22133800 DOI: 10.1016/j.joca.2011.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 11/01/2011] [Accepted: 11/08/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis (OA) of the knee. METHODS One hundred fifty-eight knee joints from 133 patients that subsequently underwent total knee joint arthroplasty from January 2008 to December 2009 were enrolled. There were 26 men and 107 women. Their ages ranged from 56 to 81 (mean 67.4 ± 6.5 years). All study participants had complete obliteration of the lateral joint space identified by weight-bearing radiography. Meniscal position was assessed by measuring meniscal subluxation and meniscal height. The meniscal morphology was assessed using a modification of the whole-organ magnetic resonance imaging score (WORMS). The frequency of different meniscal morphology and their respective positions was calculated. RESULTS The predominant type (42.4%, 53.8% and 52.5% in the anterior horn, mid-body and posterior horn, respectively) of abnormal meniscal morphology was a complete maceration/destruction or complete resection. The anterior horn of non-macerated lateral meniscus was more subluxed than that of the non-macerated medial meniscus in patients with lateral OA. CONCLUSION This study suggests that the lateral meniscus in persons with end-stage lateral OA are mostly macerated or destroyed. Also, unlike isolated end-staged medial compartment OA, the anterior horn of the lateral meniscus in isolated end-stage lateral OA is commonly affected.
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Affiliation(s)
- S H Hwang
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
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Darwish AF, Abdel-Ghany HS, El-Sherbini YM. Diagnostic and prognostic value of some biochemical markers in early knee osteoarthritis. EGYPTIAN RHEUMATOLOGIST 2012. [DOI: 10.1016/j.ejr.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Haim A, Wolf A, Rubin G, Genis Y, Khoury M, Rozen N. Effect of center of pressure modulation on knee adduction moment in medial compartment knee osteoarthritis. J Orthop Res 2011; 29:1668-74. [PMID: 21491477 DOI: 10.1002/jor.21422] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 03/07/2011] [Indexed: 02/04/2023]
Abstract
The knee adduction moment (KAM) provides a major contribution to the elevated load in the medial compartment of the knee. An abnormally high KAM has been linked with the progression of knee osteoarthritis (OA). Footwear-generated biomechanical manipulations reduce the magnitude of this moment by conveying a more laterally shifted trajectory of the foot's center of pressure (COP), reducing the distance between the ground reaction force and the center of the knee joint, thus lowering the magnitude of the torque. We sought to examine the outcome of a COP shift in a cohort of female patients suffering from medial knee OA. Twenty-two female patients suffering from medial compartment knee OA underwent successive gait analysis testing and direct pedobarographic examination of the COP trajectory with a foot-worn biomechanical device allowing controlled manipulation of the COP. Modulation of the COP coronal trajectory from medial to lateral offset resulted in a significant reduction of the KAM. This trend was demonstrated in subjects with mild-to-moderate OA and in patients suffering from severe stages of the disease. Our results indicate that controlled manipulation of knee coronal kinetics in individuals suffering from medial knee OA can be facilitated by customized COP modification.
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Affiliation(s)
- Amir Haim
- Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa, Israel.
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Shin CS, Souza RB, Kumar D, Link TM, Wyman BT, Majumdar S. In vivo tibiofemoral cartilage-to-cartilage contact area of females with medial osteoarthritis under acute loading using MRI. J Magn Reson Imaging 2011; 34:1405-13. [DOI: 10.1002/jmri.22796] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 07/29/2011] [Indexed: 11/12/2022] Open
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Erhart JC, Dyrby CO, D'Lima DD, Colwell CW, Andriacchi TP. Changes in in vivo knee loading with a variable-stiffness intervention shoe correlate with changes in the knee adduction moment. J Orthop Res 2010; 28:1548-53. [PMID: 20973058 PMCID: PMC2965044 DOI: 10.1002/jor.21183] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
External knee adduction moment can be reduced using footwear interventions, but the exact changes in in vivo medial joint loading remain unknown. An instrumented knee replacement was used to assess changes in in vivo medial joint loading in a single patient walking with a variable-stiffness intervention shoe. We hypothesized that during walking with a load modifying variable-stiffness shoe intervention: (1) the first peak knee adduction moment will be reduced compared to a subject's personal shoes; (2) the first peak in vivo medial contact force will be reduced compared to personal shoes; and (3) the reduction in knee adduction moment will be correlated with the reduction in medial contact force. The instrumentation included a motion capture system, force plate, and the instrumented knee prosthesis. The intervention shoe reduced the first peak knee adduction moment (13.3%, p = 0.011) and medial compartment joint contact force (12.3%; p = 0.008) compared to the personal shoe. The change in first peak knee adduction moment was significantly correlated with the change in first peak medial contact force (R(2) = 0.67, p = 0.007). Thus, for a single subject with a total knee prosthesis the variable-stiffness shoe reduces loading on the affected compartment of the joint. The reductions in the external knee adduction moment are indicative of reductions in in vivo medial compressive force with this intervention.
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Affiliation(s)
- Jennifer C Erhart
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA.
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Guermazi A, Eckstein F, Hellio Le Graverand-Gastineau MP, Conaghan PG, Burstein D, Keen H, Roemer FW. Osteoarthritis: current role of imaging. Med Clin North Am 2009; 93:101-26, xi. [PMID: 19059024 DOI: 10.1016/j.mcna.2008.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoarthritis (OA) is the most prevalent joint disease; it is increasingly common in the aging population of Western society and has a major health economic impact. Despite surgery and symptom-oriented approaches there is no efficient treatment. Conventional radiography has played a role in the past in confirming diagnosis and demonstrating late bony changes and joint space narrowing. MRI has become the method of choice in large research endeavors and may become important for individualized treatment planning. This article focuses on radiography and MRI, with insight into other modalities, such as ultrasound, scintigraphy, and CT. Their role in OA diagnosis, follow-up, and research is discussed.
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Affiliation(s)
- Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, Third Floor, Boston, MA 02118, USA.
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Abstract
BACKGROUND AND PURPOSE Studies have identified factors that contribute to functional limitations in people with knee osteoarthritis (OA), including quadriceps femoris muscle weakness, joint laxity, and reports of knee instability. However, little is known about the relationship among these factors or their relative influence on function. The purpose of this study was to investigate self-reported knee instability and its relationships with knee laxity and function in people with medial knee osteoarthritis (OA). PARTICIPANTS Fifty-two individuals with medial knee OA participated in the study. METHODS Each participant was classified into 1 of 3 groups based on reports of knee instability. Limb alignment, knee laxity, and quadriceps femoris muscle strength (force-generating capacity) were assessed. Function was measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a stair-climbing test (SCT). Group differences were detected with one-way analyses of variance, and relationships among variables were assessed with the Eta(2) statistic and hierarchical regression analysis. RESULTS There were no differences in alignment, laxity, or strength among the 3 groups. Self-reported knee instability did not correlate with medial laxity, limb alignment, or quadriceps femoris muscle strength. Individuals reporting worse knee instability scored worse on all subsets of the KOOS. Self-reported knee instability scores significantly contributed to the prediction of all measures of function above that explained by quadriceps femoris muscle force, knee laxity, and alignment. Neither laxity nor alignment contributed to any measure of function. DISCUSSION AND CONCLUSION Self-reported knee instability is a factor that is not directly associated with knee laxity and contributes to worse function. Further research is necessary to delineate the factors that contribute to self-reported knee instability and reduced function in this population.
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Schmitt LC, Rudolph KS. Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability. J Orthop Res 2008; 26:1180-5. [PMID: 18404657 PMCID: PMC3112363 DOI: 10.1002/jor.20619] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sensation of knee instability (shifting, buckling. and giving way) is common in people with medial knee osteoarthritis (OA). Its influence on knee stabilization strategies is unknown. This study investigated the influence of knee instability on muscle activation during walking when knee stability was challenged. Twenty people with medial knee OA participated and were grouped as OA Stable (OAS) (n = 10) and OA Unstable (OAU) (n = 10) based on self-reported knee instability during daily activities. Quadriceps strength, passive knee laxity, and varus alignment were assessed and related to knee instability and muscle cocontraction during walking when the support surface translated laterally. Few differences in knee joint kinematics between the groups were seen; however, there were pronounced differences in muscle activation. The OAU group used greater medial muscle cocontraction before, during, and following the lateral translation. Self-reported knee instability predicted medial muscle cocontraction, but medial laxity and limb alignment did not. The higher muscle cocontraction used by the OAU subjects appears to be an ineffective strategy to stabilize the knee. Instability and high cocontraction can be detrimental to joint integrity, and should be the focus of future research.
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Affiliation(s)
- Laura C. Schmitt
- University of Cincinnati College of Medicine, Sports Medicine Biodynamics Center, Occupational Therapy and Physical Therapy Department, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229
| | - Katherine S. Rudolph
- Department of Physical Therapy and Program in Biomechanics and Movement Science, University of Delaware, 301 McKinly Lab, Newark, Delaware 19716
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Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand-Gastineau MP, Keen H, Roemer FW. Imaging in Osteoarthritis. Rheum Dis Clin North Am 2008; 34:645-87. [DOI: 10.1016/j.rdc.2008.04.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schmitt LC, Rudolph KS. Influences on knee movement strategies during walking in persons with medial knee osteoarthritis. ACTA ACUST UNITED AC 2007; 57:1018-26. [PMID: 17665469 PMCID: PMC2213278 DOI: 10.1002/art.22889] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the movement and muscle activation strategies during walking of individuals with medial knee osteoarthritis (OA) to determine the influence of quadriceps strength, medial knee laxity, limb alignment, and self-reported knee instability on knee motion. METHODS Twenty-eight persons with medial knee OA and 26 control subjects participated. Quadriceps strength, medial knee laxity, and limb alignment were measured. Knee instability (I(KOS) score) was assessed with the Activities of Daily Living Scale of the Knee Outcome Survey. Knee motion and muscle activation patterns were measured with motion analysis. Group differences were detected with independent samples t-tests and predictive relationships were determined with linear and hierarchical regression analyses. RESULTS Individuals with OA were weaker, had greater medial knee laxity, and had more varus alignment. The OA group used less knee motion and higher muscle co-contraction during weight acceptance and single-limb support. Quadriceps strength and I(KOS) score significantly strengthened the prediction of knee motion during weight acceptance and single-limb support, whereas limb alignment and medial laxity did not. CONCLUSION The knee stiffening and higher muscle co-contraction used by the OA group may be detrimental to joint integrity. I(KOS) scores predicted knee motion after accounting for quadriceps strength, underscoring the importance of addressing knee instability with appropriate rehabilitation strategies in persons with medial knee OA in order to promote long-term joint integrity.
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Lubowitz JH, Verdonk PCM, Reid JB, Verdonk R. Meniscus allograft transplantation: a current concepts review. Knee Surg Sports Traumatol Arthrosc 2007; 15:476-92. [PMID: 17333124 DOI: 10.1007/s00167-006-0216-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 09/13/2006] [Indexed: 12/31/2022]
Abstract
Meniscus allotransplantation represents the biological solution for the symptomatic, meniscus-deficient patient who has not developed advanced osteoarthritis. A growing body of evidence suggests that pain relief and functional improvement may reliably be achieved at short- and medium-term follow-up, and even, in some cases, at long-term (>10 years) follow-up. Future research must address the issue of optimal timing of the procedure and whether meniscal transplantation results in demonstrable long-term benefits, especially with regard to protection of articular cartilage.
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Kijowski R, Blankenbaker D, Stanton P, Fine J, De Smet A. Correlation between radiographic findings of osteoarthritis and arthroscopic findings of articular cartilage degeneration within the patellofemoral joint. Skeletal Radiol 2006; 35:895-902. [PMID: 16680465 DOI: 10.1007/s00256-006-0111-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 02/15/2006] [Accepted: 02/17/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain. SUBJECTS AND METHODS The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined. RESULTS The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively. CONCLUSION Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin Hospital Clinical Science Center-E3/311, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
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Bhattacharya R, Kumar V, Safawi E, Finn P, Hui AC. The knee skyline radiograph: its usefulness in the diagnosis of patello-femoral osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2006; 31:247-52. [PMID: 16783548 PMCID: PMC2267568 DOI: 10.1007/s00264-006-0167-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 03/28/2006] [Accepted: 03/30/2006] [Indexed: 10/24/2022]
Abstract
The aim of this study was to determine the usefulness of the skyline radiograph in the diagnosis of patellofemoral osteoarthritis. Additionally, we wanted to assess the usefulness of patello-femoral crepitus as a clinical sign of this condition. Seventy-seven patients scheduled to undergo knee surgery had standard antero-posterior, lateral and skyline X-rays of their affected knee. The presence of clinical patello-femoral crepitus was also documented preoperatively. At the operation, their patellofemoral joints were graded into two groups according to the presence or absence of osteoarthritis. The lateral and skyline view X-rays as well as patello-femoral crepitus were compared individually against the operative findings. The skyline view had a sensitivity of 79% and a specificity of 80%. The lateral view had a sensitivity of 82% and specificity of 65%. Patello-femoral crepitus as a sign had a sensitivity of 89% and a specificity of 82%. There was no statistically significant difference between the two radiological views in terms of sensitivity and specificity in the diagnosis of patellofemoral osteoarthritis. Hence, we cannot recommend the skyline view as a routine radiological investigation in all cases of suspected patellofemoral osteoarthritis.
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Affiliation(s)
- R. Bhattacharya
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW UK
| | - V. Kumar
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW UK
- 32, Grosvenor Road, Billingham, Cleveland TS22 5HA UK
| | - E. Safawi
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW UK
| | - P. Finn
- School of Health and Social Care, University of Teesside, Tees Valley, TS1 3BA Middlesbrough, UK
| | - A. C. Hui
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW UK
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Nevitt MC, Sharma L. OMERACT workshop radiography session 1. Osteoarthritis Cartilage 2006; 14 Suppl A:A4-9. [PMID: 16753308 DOI: 10.1016/j.joca.2006.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 02/26/2006] [Indexed: 02/02/2023]
Affiliation(s)
- M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA.
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