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Sample records for human knee joint

  1. Computational Poromechanics of Human Knee Joint

    NASA Astrophysics Data System (ADS)

    Kazemi, Mojtaba; Li, LePing

    2012-02-01

    Extensive computer modeling has been performed in the recent decade to investigate the mechanical response of the healthy and repaired knee joints. Articular cartilages and menisci have been commonly modeled as single-phase elastic materials in the previous 3D simulations. A comprehensive study considering the interplay of the collagen fibers and fluid pressurization in the tissues in situ remains challenging. We have developed a 3D model of the human knee accounting for the mechanical function of collagen fibers and fluid flow in the cartilages and menisci. An anatomically accurate structure of the human knee was used for this purpose including bones, articular cartilages, menisci and ligaments. The fluid pressurization in the femoral cartilage and menisci under combined creep loading was investigated. Numerical results showed that fluid flow and pressure in the tissues played an important role in the mechanical response of the knee joint. The load transfer in the joint was clearly seen when the fluid pressure was considered.

  2. Mathematical modeling of the human knee joint

    SciTech Connect

    Ricafort, Juliet

    1996-05-01

    A model was developed to determine the forces exerted by several flexor and extensor muscles of the human knee under static conditions. The following muscles were studied: the gastrocnemius, biceps femoris, semitendinosus, semimembranosus, and the set of quadricep muscles. The tibia and fibula were each modeled as rigid bodies; muscles were modeled by their functional lines of action in space. Assumptions based on previous data were used to resolve the indeterminacy.

  3. Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty.

    PubMed

    Dargel, Jens; Michael, Joern W P; Feiser, Janna; Ivo, Roland; Koebke, Juergen

    2011-04-01

    This study investigates differences in the anatomy of male and female knee joints to contribute to the current debate on sex-specific total knee implants. Morphometric data were obtained from 60 human cadaver knees, and sex differences were calculated. All data were corrected for height, and male and female specimens presenting with an identical length of the femur were analyzed as matched pairs. Male linear knee joint dimensions were significantly larger when compared with females. When corrected for differences in height, medial-lateral dimensions of male knees were significantly larger than female; however, matched paired analysis did not prove these differences to be consistent. Although implant design should focus interindividual variations in knee joint anatomy, our data do not support the concept of a female-specific implant design.

  4. Interpolation function for approximating knee joint behavior in human gait

    NASA Astrophysics Data System (ADS)

    Toth-Taşcǎu, Mirela; Pater, Flavius; Stoia, Dan Ioan

    2013-10-01

    Starting from the importance of analyzing the kinematic data of the lower limb in gait movement, especially the angular variation of the knee joint, the paper propose an approximation function that can be used for processing the correlation among a multitude of knee cycles. The approximation of the raw knee data was done by Lagrange polynomial interpolation on a signal acquired using Zebris Gait Analysis System. The signal used in approximation belongs to a typical subject extracted from a lot of ten investigated subjects, but the function domain of definition belongs to the entire group. The study of the knee joint kinematics plays an important role in understanding the kinematics of the gait, this articulation having the largest range of motion in whole joints, in gait. The study does not propose to find an approximation function for the adduction-abduction movement of the knee, this being considered a residual movement comparing to the flexion-extension.

  5. Knee joint replacement

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/002974.htm Knee joint replacement To use the sharing features on this page, please enable JavaScript. Knee joint replacement is a surgery to replace a knee ...

  6. Recent advances in computational mechanics of the human knee joint.

    PubMed

    Kazemi, M; Dabiri, Y; Li, L P

    2013-01-01

    Computational mechanics has been advanced in every area of orthopedic biomechanics. The objective of this paper is to provide a general review of the computational models used in the analysis of the mechanical function of the knee joint in different loading and pathological conditions. Major review articles published in related areas are summarized first. The constitutive models for soft tissues of the knee are briefly discussed to facilitate understanding the joint modeling. A detailed review of the tibiofemoral joint models is presented thereafter. The geometry reconstruction procedures as well as some critical issues in finite element modeling are also discussed. Computational modeling can be a reliable and effective method for the study of mechanical behavior of the knee joint, if the model is constructed correctly. Single-phase material models have been used to predict the instantaneous load response for the healthy knees and repaired joints, such as total and partial meniscectomies, ACL and PCL reconstructions, and joint replacements. Recently, poromechanical models accounting for fluid pressurization in soft tissues have been proposed to study the viscoelastic response of the healthy and impaired knee joints. While the constitutive modeling has been considerably advanced at the tissue level, many challenges still exist in applying a good material model to three-dimensional joint simulations. A complete model validation at the joint level seems impossible presently, because only simple data can be obtained experimentally. Therefore, model validation may be concentrated on the constitutive laws using multiple mechanical tests of the tissues. Extensive model verifications at the joint level are still crucial for the accuracy of the modeling.

  7. Recent Advances in Computational Mechanics of the Human Knee Joint

    PubMed Central

    Kazemi, M.; Dabiri, Y.; Li, L. P.

    2013-01-01

    Computational mechanics has been advanced in every area of orthopedic biomechanics. The objective of this paper is to provide a general review of the computational models used in the analysis of the mechanical function of the knee joint in different loading and pathological conditions. Major review articles published in related areas are summarized first. The constitutive models for soft tissues of the knee are briefly discussed to facilitate understanding the joint modeling. A detailed review of the tibiofemoral joint models is presented thereafter. The geometry reconstruction procedures as well as some critical issues in finite element modeling are also discussed. Computational modeling can be a reliable and effective method for the study of mechanical behavior of the knee joint, if the model is constructed correctly. Single-phase material models have been used to predict the instantaneous load response for the healthy knees and repaired joints, such as total and partial meniscectomies, ACL and PCL reconstructions, and joint replacements. Recently, poromechanical models accounting for fluid pressurization in soft tissues have been proposed to study the viscoelastic response of the healthy and impaired knee joints. While the constitutive modeling has been considerably advanced at the tissue level, many challenges still exist in applying a good material model to three-dimensional joint simulations. A complete model validation at the joint level seems impossible presently, because only simple data can be obtained experimentally. Therefore, model validation may be concentrated on the constitutive laws using multiple mechanical tests of the tissues. Extensive model verifications at the joint level are still crucial for the accuracy of the modeling. PMID:23509602

  8. [Chronic knee joint discomfort].

    PubMed

    Wittke, R

    2005-06-23

    Chronic pain in the knee joint is frequently a sign of arthrosis in adults. This must be clearly differentiated from other knee problems. Patellofemoral stress syndrome (occurs mostly in young people) and arthritis with effusion in the knee joint after long and mostly unusual stress also allow only a reduced function of the knee joint. However, even when the knee joint is still fully functional, chronic problems could already exist: For example, for joggers, iliotibial band friction syndrome (runner's knee) or after high unphysiological stress, patellar tendinopathy (jumper's knee). These must be differentiated from pes anserinus syndrome and a plica mediopatellaris.

  9. Examining the knee joint.

    PubMed

    Monk, Daniel

    2013-04-01

    Appropriate history taking and examination can ensure accurate diagnosis of common knee problems, and rapid and effective interventions or referral to orthopaedic specialists. This article describes the anatomy of the knee joint and discusses relevant history taking, the examination process, special tests and radiology, as well as common knee injuries and their management.

  10. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  11. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  12. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  13. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  14. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  15. Evaluation of an intact, an ACL-deficient, and a reconstructed human knee joint finite element model.

    PubMed

    Vairis, Achilles; Stefanoudakis, George; Petousis, Markos; Vidakis, Nectarios; Tsainis, Andreas-Marios; Kandyla, Betina

    2016-02-01

    The human knee joint has a three-dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Understanding the complex mechanical interactions of these load-bearing structures is of use when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament (ACL) in the knee is one of four main ligaments that connects the femur to the tibia and is often torn during sudden twisting motions, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint and evaluate the differences in its response for three different states, i.e., intact, ACL-deficient, and surgically treated (reconstructed) knee. The finite element models corresponding to these states were developed. For the reconstructed model, a novel repair device was developed and patented by the author in previous work. Static load cases were applied, as have already been presented in a previous work, in order to compare the calculated results produced by the two models the ACL-deficient and the surgically reconstructed knee joint, under the exact same loading conditions. Displacements were calculated in different directions for the load cases studied and were found to be very close to those from previous modeling work and were in good agreement with experimental data presented in literature. The developed finite element model for both the intact and the ACL-deficient human knee joint is a reliable tool to study the kinematics of the human knee, as results of this study show. In addition, the reconstructed human knee joint model had kinematic behavior similar to the intact knee joint, showing that such reconstruction devices can restore human knee stability to an adequate extent.

  16. Modeling and simulating the neuromuscular mechanisms regulating ankle and knee joint stiffness during human locomotion

    PubMed Central

    Maculan, Marco; Pizzolato, Claudio; Reggiani, Monica; Farina, Dario

    2015-01-01

    This work presents an electrophysiologically and dynamically consistent musculoskeletal model to predict stiffness in the human ankle and knee joints as derived from the joints constituent biological tissues (i.e., the spanning musculotendon units). The modeling method we propose uses electromyography (EMG) recordings from 13 muscle groups to drive forward dynamic simulations of the human leg in five healthy subjects during overground walking and running. The EMG-driven musculoskeletal model estimates musculotendon and resulting joint stiffness that is consistent with experimental EMG data as well as with the experimental joint moments. This provides a framework that allows for the first time observing 1) the elastic interplay between the knee and ankle joints, 2) the individual muscle contribution to joint stiffness, and 3) the underlying co-contraction strategies. It provides a theoretical description of how stiffness modulates as a function of muscle activation, fiber contraction, and interacting tendon dynamics. Furthermore, it describes how this differs from currently available stiffness definitions, including quasi-stiffness and short-range stiffness. This work offers a theoretical and computational basis for describing and investigating the neuromuscular mechanisms underlying human locomotion. PMID:26245321

  17. Behavioral effect of knee joint motion on body's center of mass during human quiet standing.

    PubMed

    Yamamoto, Akio; Sasagawa, Shun; Oba, Naoko; Nakazawa, Kimitaka

    2015-01-01

    The balance control mechanism during upright standing has often been investigated using single- or double-link inverted pendulum models, involving the ankle joint only or both the ankle and hip joints, respectively. Several studies, however, have reported that knee joint motion during quiet standing cannot be ignored. This study aimed to investigate the degree to which knee joint motion contributes to the center of mass (COM) kinematics during quiet standing. Eight healthy adults were asked to stand quietly for 30s on a force platform. Angular displacements and accelerations of the ankle, knee, and hip joints were calculated from kinematic data obtained by a motion capture system. We found that the amplitude of the angular acceleration was smallest in the ankle joint and largest in the hip joint (ankle < knee < hip). These angular accelerations were then substituted into three biomechanical models with or without the knee joint to estimate COM acceleration in the anterior-posterior direction. Although the "without-knee" models greatly overestimated the COM acceleration, the COM acceleration estimated by the "with-knee" model was similar to the actual acceleration obtained from force platform measurement. These results indicate substantial effects of knee joint motion on the COM kinematics during quiet standing. We suggest that investigations based on the multi-joint model, including the knee joint, are required to reveal the physiologically plausible balance control mechanism implemented by the central nervous system.

  18. Principal component analysis in construction of 3D human knee joint models using a statistical shape model method.

    PubMed

    Tsai, Tsung-Yuan; Li, Jing-Sheng; Wang, Shaobai; Li, Pingyue; Kwon, Young-Min; Li, Guoan

    2015-01-01

    The statistical shape model (SSM) method that uses 2D images of the knee joint to predict the three-dimensional (3D) joint surface model has been reported in the literature. In this study, we constructed a SSM database using 152 human computed tomography (CT) knee joint models, including the femur, tibia and patella and analysed the characteristics of each principal component of the SSM. The surface models of two in vivo knees were predicted using the SSM and their 2D bi-plane fluoroscopic images. The predicted models were compared to their CT joint models. The differences between the predicted 3D knee joint surfaces and the CT image-based surfaces were 0.30 ± 0.81 mm, 0.34 ± 0.79 mm and 0.36 ± 0.59 mm for the femur, tibia and patella, respectively (average ± standard deviation). The computational time for each bone of the knee joint was within 30 s using a personal computer. The analysis of this study indicated that the SSM method could be a useful tool to construct 3D surface models of the knee with sub-millimeter accuracy in real time. Thus, it may have a broad application in computer-assisted knee surgeries that require 3D surface models of the knee.

  19. Modelling the propagation of ultrasound in the joint space of a human knee.

    PubMed

    White, Derrick; Evans, Joseph A; Truscott, John G; Chivers, Robin A

    2010-10-01

    There is strong evidence to support the clinical use of low-intensity pulsed ultrasound (LIPUS) to augment fracture healing. A previous experimental study showed that ultrasound can propagate in the joint space of a single human cadaveric knee. A full experimental investigation of this propagation is not possible due to poor reproducibility, the scarcity of human cadaveric tissues and the practical difficulties in making ultrasound measurements in the knee. The aim of the present work is to investigate whether a computer simulation (Wave2000 Pro®; Cyberlogic Inc., New York, NY, USA) can give a good representation of the experimental model. The simulations provided a good agreement with the experimental data, giving some confidence in the application of this computer simulation method as a means of determining whether ultrasound can propagate through different anatomical regions where bone is present.

  20. Anatomical study of the lateral collateral ligament and its circumference structures in the human knee joint.

    PubMed

    Yan, Jun; Sasaki, Wataru; Hitomi, Jiro

    2010-02-01

    Thirty-six cadavers (55 sides) were used to observe the innervation of the lateral collateral ligament (LCL) and its circumference structures with gross anatomical and histological methods to clarify the cause of indistinct pain in the lateral part of the knee joint. The innervating branches of the LCL could be divided into three types: (1) from the muscular branch of the biceps femoris muscle at lower 1/3 level of the thigh; (2) from the common fibular nerve (CFN) at the higher level of the fossa poplitea; (3) from the CFN at the level of the caput fibular. Furthermore, the three branches could singly or plurally distribute to the LCL (six types). Two of the connecting tissue membranes surrounding the surface of LCL formed an incomplete sheath structure, and a shutting "gap" was observed between the two membranes. Fine peripheral nervous branches were also observed in the two of the membranes. On the other hand, three types of nerve endings in the LCL (Type I/Ruffini mechanoreceptor; Type III/Golgi mechanoreceptor; Type IV/free nerve ending) were observed, and their presence was consistent with the ankle joint of humans. Therefore, the innervation of the two membranes (to form the shutting gap) in the surface of LCL may be associated with an indistinct pain when the knee joint is damaged.

  1. Improved dynamic model of the human knee joint and its response to impact loading on the lower leg.

    PubMed

    Engin, A E; Tümer, S T

    1993-05-01

    Almost a decade ago, three-dimensional formulation for the dynamic modeling of an articulating human joint was introduced. Two-dimensional version of this formulation was subsequently applied to the knee joint. However, because of the iterative nature of the solution technique, this model cannot handle impact conditions. In this paper, alternative solution methods are introduced which enable investigation of the response of the human knee to impact loading on the lower leg via an anatomically based model. In addition, the classical impact theory is applied to the same model and a closed-form solution is obtained. The shortcomings of the classical impact theory as applied to the impact problem of the knee joint are delineated.

  2. Exercise and the Knee Joint.

    ERIC Educational Resources Information Center

    Clarke, H. Harrison, Ed.

    1976-01-01

    This report by the President's Council on Physical Fitness and Sports examines the effects of various forms of physical exercise on the knee joint which, because of its vulnerability, is especially subject to injury. Discussion centers around the physical characteristics of the joint, commonly used measurements for determining knee stability,…

  3. Moderate loading of the human osteoarthritic knee joint leads to lowering of intraarticular cartilage oligomeric matrix protein.

    PubMed

    Helmark, Ida C; Petersen, Marie C H; Christensen, Helle E; Kjaer, Michael; Langberg, Henning

    2012-04-01

    The non-pharmacological treatment of osteoarthritis (OA) includes exercise therapy; however, little is known about the specific effect of exercise on the joint per se. The purpose of the present study was to investigate the direct effects of a load-bearing exercise upon cartilage in a single, human osteoarthritic joint determined by biochemical markers of cartilage turnover and inflammation in the synovial fluid (SF), serum and urine. Eleven subjects with OA of the knee(s), but with no other joint- or inflammatory disorders, volunteered for the study and had samples of blood, urine and synovial fluid drawn both at baseline and following 30-min one-legged knee-extension exercise. Workload: 60% of 1 RM (Repetition Maximum). Determination of cartilage oligomeric matrix protein (COMP), aggrecan, C-terminal collagen II peptide (CTX-II) and interleukin (IL)-6 were performed in synovial fluid (SF), serum and urine. A significant decrease was found in SF concentration of COMP following exercise, whereas aggrecan, CTX-II and IL-6 remained unchanged. No differences in any of the tested markers were found in serum and urine between baseline and post-exercise. Thirty minutes of mechanical loading of a single knee joint in human subjects with knee OA resulted in a reduced COMP concentration in SF.

  4. Biomechanics of knee joint — A review

    NASA Astrophysics Data System (ADS)

    Madeti, Bhaskar Kumar; Chalamalasetti, Srinivasa Rao; Bolla Pragada, S. K. Sundara siva rao

    2015-06-01

    The present paper is to know how the work is carried out in the field of biomechanics of knee. Various model formulations are discussed and further classified into mathematical model, two-dimensional model and three-dimensional model. Knee geometry is a crucial part of human body movement, in which how various views of knee is shown in different planes and how the forces act on tibia and femur are studied. It leads to know the forces acting on the knee joint. Experimental studies of knee geometry and forces acting on knee shown by various researchers have been discussed, and comparisons of results are made. In addition, static and dynamic analysis of knee has been also discussed respectively to some extent.

  5. Can ultrasound propagate in the joint space of a human knee?

    PubMed

    White, D; Evans, J A; Truscott, J G; Chivers, R A

    2007-07-01

    A large body of evidence supports the principle that the use of low-intensity pulsed ultrasound with a frequency of 1.5 MHz can reduce fracture healing time. It is hypothesized that similar therapeutic benefits may be achieved in damaged articular cartilage. This study looks specifically at a 22-mm circular ultrasound transducer delivering ultrasound with a frequency of 1.5 MHz. A human cadaver knee was imaged using CT, the resulting images were used to help map a number of hydrophone positions in the joint from which measurements were taken. The experimental results suggest that at best there is a 30-mm window in which to place the ultrasound transducer for ultrasound to propagate through the joint space. In terms of a clinical device delivering an I(SATA) of 30 mW cm(-2) to anterior regions of the joint, the I(SATA) in posterior regions will at best be in the region of 10 mW cm(-2). The clinical implications of this are not known and require further investigation.

  6. Techniques for assessing knee joint pain in arthritis

    PubMed Central

    Neugebauer, Volker; Han, Jeong S; Adwanikar, Hita; Fu, Yu; Ji, Guangchen

    2007-01-01

    The assessment of pain is of critical importance for mechanistic studies as well as for the validation of drug targets. This review will focus on knee joint pain associated with arthritis. Different animal models have been developed for the study of knee joint arthritis. Behavioral tests in animal models of knee joint arthritis typically measure knee joint pain rather indirectly. In recent years, however, progress has been made in the development of tests that actually evaluate the sensitivity of the knee joint in arthritis models. They include measurements of the knee extension angle struggle threshold, hind limb withdrawal reflex threshold of knee compression force, and vocalizations in response to stimulation of the knee. A discussion of pain assessment in humans with arthritis pain conditions concludes this review. PMID:17391515

  7. Modeling of Human Joint Structures.

    DTIC Science & Technology

    1982-09-01

    Radial Lateral " epicondyle Olecranon Radius Ulna Figure 3. Lateral aspect of the right elbow joint. -17- Annular Ligament This strong band encircles... elbow joint, knee joint, human joints, shoulder joint, ankle joint, joint models, hip joint, ligaments. 20. ABSTRACT (Continue on reverse side If...ligaments. -A rather extended discussion of the articulations and anatomical descriptions of the elbow , shoulder, hip, knee and ankle joints are

  8. Nonlinear dynamic behavior of the human knee joint--Part I: Postmortem frequency domain analyses.

    PubMed

    Dortmans, L; Jans, H; Sauren, A; Huson, A

    1991-11-01

    Characteristics results of postmortem experiments on five knee-joint specimens are reported. The experiments were performed to investigate the applicability of a local linearization technique that would make it possible to describe the dynamic behavior of the joint in terms of transfer functions. The results indicate that the stiffness of the bracing wires, attached to muscle tendons to create a static equilibrium position, can be accounted for when determining the stiffness of the joint. Besides the static equilibrium configuration, the magnitude of the dynamic load and the type of dynamic load applied to the joint can be shown to have their influence. As the influence of the dynamic load is significant, it has to be concluded that in essence the knee joint has to be regarded as a nonlinear system, making application of a Local Linearization Technique questionable. However, when the magnitude of the dynamic load is included as an additional measurement parameter, an indication can be obtained about the behavior of the joint and the degree of nonlinearity.

  9. Spacesuit mobility knee joints

    NASA Technical Reports Server (NTRS)

    Vykukal, H. C. (Inventor)

    1979-01-01

    Pressure suit mobility joints are for use in interconnecting adjacent segments of an hermetically sealed spacesuit in which low torques, low leakage and a high degree of reliability are required. Each of the joints is a special purpose joint characterized by substantially constant volume and low torque characteristics and includes linkages which restrain the joint from longitudinal distension and includes a flexible, substantially impermeable diaphragm of tubular configuration spanning the distance between pivotally supported annuli. The diaphragms of selected joints include rolling convolutions for balancing the joints, while various joints include wedge-shaped sections which enhance the range of motion for the joints.

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

    PubMed Central

    Raiteri, Roberto; Loparic, Marko; Düggelin, Marcel; Mathys, Daniel; Friederich, Niklaus F.; Bruckner, Peter

    2016-01-01

    Cartilage matrix is a composite of discrete, but interacting suprastructures, i.e. cartilage fibers with microfibrillar or network-like aggregates and penetrating extrafibrillar proteoglycan matrix. The biomechanical function of the proteoglycan matrix and the collagen fibers are to absorb compressive and tensional loads, respectively. Here, we are focusing on the suprastructural organization of collagen fibrils and the degradation process of their hierarchical organized fiber architecture studied at high resolution at the authentic location within cartilage. We present electron micrographs of the collagenous cores of such fibers obtained by an improved protocol for scanning electron microscopy (SEM). Articular cartilages are permeated by small prototypic fibrils with a homogeneous diameter of 18 ± 5 nm that can align in their D-periodic pattern and merge into larger fibers by lateral association. Interestingly, these fibers have tissue-specific organizations in cartilage. They are twisted ropes in superficial regions of knee joints or assemble into parallel aligned cable-like structures in deeper regions of knee joint- or throughout hip joints articular cartilage. These novel observations contribute to an improved understanding of collagen fiber biogenesis, function, and homeostasis in hyaline cartilage. PMID:27780246

  11. Kinematic and dynamic analysis of an anatomically based knee joint.

    PubMed

    Lee, Kok-Meng; Guo, Jiajie

    2010-05-07

    This paper presents a knee-joint model to provide a better understanding on the interaction between natural joints and artificial mechanisms for design and control of rehabilitation exoskeletons. The anatomically based knee model relaxes several commonly made assumptions that approximate a human knee as engineering pin-joint in exoskeleton design. Based on published MRI data, we formulate the kinematics of a knee-joint and compare three mathematical approximations; one model bases on two sequential circles rolling a flat plane; and the other two are mathematically differentiable ellipses-based models with and without sliding at the contact. The ellipses-based model taking sliding contact into accounts shows that the rolling-sliding ratio of a knee-joint is not a constant but has an average value consistent with published measurements. This knee-joint kinematics leads to a physically more accurate contact-point trajectory than methods based on multiple circles or lines, and provides a basis to derive a knee-joint kinetic model upon which the effects of a planar exoskeleton mechanism on the internal joint forces and torque during flexion can be numerically investigated. Two different knee-joint kinetic models (pin-joint approximation and anatomically based model) are compared against a condition with no exoskeleton. The leg and exoskeleton form a closed kinematic chain that has a significant effect on the joint forces in the knee. Human knee is more tolerant than pin-joint in negotiating around a singularity but its internal forces increase with the exoskeleton mass-to-length ratio. An oversimplifying pin-joint approximation cannot capture the finite change in the knee forces due to the singularity effect.

  12. Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty.

    PubMed

    Lo, JiaHsuan; Müller, Otto; Dilger, Torsten; Wülker, Nikolaus; Wünschel, Markus

    2011-12-01

    This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior-posterior translation, valgus-varus, and internal-external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provided functional ligamentous structures, bicruciate-retaining BKA is a biomechanically attractive treatment for joint degenerative disease.

  13. Development of a knee joint motion simulator to evaluate deep knee flexion of artificial knee joints.

    PubMed

    Takano, Y; Ueno, M; Kiguchi, K; Ito, J; Mawatari, M; Hotokebuchi, T

    2008-01-01

    A purpose of this study is to examine the effect that quadriceps femoris force gives to rotation angle and joint reaction force of total knee prosthesis during deep knee flexion such as a unique sitting style called 'seiza' in Japanese. For the evaluation, we developed the knee motion simulator which could bend to 180 degrees continually simulating the passive flexion performed by clinicians. A total knee prosthesis, which is a specially-devised posterior stabilized type and capable of flexion up to 180 degrees, was inserted into bone model. And this prosthesis pulled by three kinds of quadriceps femoris forces to perform parameter study. The results obtained in this study were showed the same tendency with those in the past cadaveric experiment. It is suggested that the rotation angle and joint reaction force of total knee prosthesis are affected by shape of prosthesis, a vector of quadriceps femoris force, and bony aliments during deep knee flexion.

  14. The elephant knee joint: morphological and biomechanical considerations

    PubMed Central

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

    2006-01-01

    Elephant limbs display unique morphological features which are related mainly to supporting the enormous body weight of the animal. In elephants, the knee joint plays important roles in weight bearing and locomotion, but anatomical data are sparse and lacking in functional analyses. In addition, the knee joint is affected frequently by arthrosis. Here we examined structures of the knee joint by means of standard anatomical techniques in eight African (Loxodonta africana) and three Asian elephants (Elephas maximus). Furthermore, we performed radiography in five African and two Asian elephants and magnetic resonance imaging (MRI) in one African elephant. Macerated bones of 11 individuals (four African, seven Asian elephants) were measured with a pair of callipers to give standardized measurements of the articular parts. In one Asian and three African elephants, kinematic and functional analyses were carried out using a digitizer and according to the helical axis concept. Some peculiarities of healthy and arthrotic knee joints of elephants were compared with human knees. In contrast to those of other quadruped mammals, the knee joint of elephants displays an extended resting position. The femorotibial joint of elephants shows a high grade of congruency and the menisci are extremely narrow and thin. The four-bar mechanism of the cruciate ligaments exists also in the elephant. The main motion of the knee joint is extension–flexion with a range of motion of 142°. In elephants, arthrotic alterations of the knee joint can lead to injury or loss of the cranial (anterior) cruciate ligament. PMID:16420379

  15. Automatically Locking/Unlocking Orthotic Knee Joint

    NASA Technical Reports Server (NTRS)

    Weddendorf, Bruce

    1994-01-01

    Proposed orthotic knee joint locks and unlocks automatically, at any position within range of bend angles, without manual intervention by wearer. Includes tang and clevis, locks whenever wearer transfers weight to knee and unlocks when weight removed. Locking occurs at any angle between 45 degrees knee bend and full extension.

  16. Automatic locking knee brace joint

    NASA Technical Reports Server (NTRS)

    Weddendorf, Bruce (Inventor)

    1995-01-01

    This invention is an apparatus for controlling the pivotal movement of a knee brace comprising a tang-and-clevis joint that has been uniquely modified. Both the tang and the clevis have a set of teeth that, when engaged, can lock the tang and the clevis together. In addition, the tang is biased away from the clevis. Consequently, when there is no axial force (i.e., body weight) on the tang, the tang is free to pivot within the clevis. However, when an axial force is exerted on the tang, the tang is pushed into the clevis, both sets of teeth engage, and the tang and the clevis lock together.

  17. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  18. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  19. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  20. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  1. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  2. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  3. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  4. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  5. [Ossifying bursitis praepatellaris of the knee joint].

    PubMed

    Erler, M

    2009-01-01

    A 53-year-old patient was admitted to our hospital with a tumour at the site of the left knee joint praepatellar. The diagnostic imaging, operative findings and histology showed a chronic ossifying bursitis praepatellaris of the knee joint. Aetiology and pathogenesis of the ossifying bursitis are discussed.

  6. Cryotherapy impairs knee joint position sense.

    PubMed

    Oliveira, R; Ribeiro, F; Oliveira, J

    2010-03-01

    The effects of cryotherapy on joint position sense are not clearly established; however it is paramount to understand its impact on peripheral feedback to ascertain the safety of using ice therapy before resuming exercise on sports or rehabilitation settings. Thus, the aim of the present study was to determine the effects of cryotherapy, when applied over the quadriceps and over the knee joint, on knee position sense. This within-subjects repeated-measures study encompassed fifteen subjects. Knee position sense was measured by open kinetic chain technique and active positioning at baseline and after cryotherapy application. Knee angles were determined by computer analysis of the videotape images. Twenty-minute ice bag application was applied randomly, in two sessions 48 h apart, over the quadriceps and the knee joint. The main effect for cryotherapy application was significant (F (1.14)=7.7, p=0.015) indicating an increase in both absolute and relative angular errors after the application. There was no significant main effect for the location of cryotherapy application, indicating no differences between the application over the quadriceps and the knee joint. In conclusion, cryotherapy impairs knee joint position sense in normal knees. This deleterious effect is similar when cryotherapy is applied over the quadriceps or the knee joint.

  7. Biomechanical Effects of Stiffness in Parallel With the Knee Joint During Walking.

    PubMed

    Shamaei, Kamran; Cenciarini, Massimo; Adams, Albert A; Gregorczyk, Karen N; Schiffman, Jeffrey M; Dollar, Aaron M

    2015-10-01

    The human knee behaves similarly to a linear torsional spring during the stance phase of walking with a stiffness referred to as the knee quasi-stiffness. The spring-like behavior of the knee joint led us to hypothesize that we might partially replace the knee joint contribution during stance by utilizing an external spring acting in parallel with the knee joint. We investigated the validity of this hypothesis using a pair of experimental robotic knee exoskeletons that provided an external stiffness in parallel with the knee joints in the stance phase. We conducted a series of experiments involving walking with the exoskeletons with four levels of stiffness, including 0%, 33%, 66%, and 100% of the estimated human knee quasi-stiffness, and a pair of joint-less replicas. The results indicated that the ankle and hip joints tend to retain relatively invariant moment and angle patterns under the effects of the exoskeleton mass, articulation, and stiffness. The results also showed that the knee joint responds in a way such that the moment and quasi-stiffness of the knee complex (knee joint and exoskeleton) remains mostly invariant. A careful analysis of the knee moment profile indicated that the knee moment could fully adapt to the assistive moment; whereas, the knee quasi-stiffness fully adapts to values of the assistive stiffness only up to ∼80%. Above this value, we found biarticular consequences emerge at the hip joint.

  8. Parametric modelling of a knee joint prosthesis.

    PubMed

    Khoo, L P; Goh, J C; Chow, S L

    1993-01-01

    This paper presents an approach for the establishment of a parametric model of knee joint prosthesis. Four different sizes of a commercial prosthesis are used as an example in the study. A reverse engineering technique was employed to reconstruct the prosthesis on CATIA, a CAD (computer aided design) system. Parametric models were established as a result of the analysis. Using the parametric model established and the knee data obtained from a clinical study on 21 pairs of cadaveric Asian knees, the development of a prototype prosthesis that suits a patient with a very small knee joint is presented. However, it was found that modification to certain parameters may be inevitable due to the uniqueness of the Asian knee. An avenue for rapid modelling and eventually economical production of a customized knee joint prosthesis for patients is proposed and discussed.

  9. Alterations in walking knee joint stiffness in individuals with knee osteoarthritis and self-reported knee instability.

    PubMed

    Gustafson, Jonathan A; Gorman, Shannon; Fitzgerald, G Kelley; Farrokhi, Shawn

    2016-01-01

    Increased walking knee joint stiffness has been reported in patients with knee osteoarthritis (OA) as a compensatory strategy to improve knee joint stability. However, presence of episodic self-reported knee instability in a large subgroup of patients with knee OA may be a sign of inadequate walking knee joint stiffness. The objective of this work was to evaluate the differences in walking knee joint stiffness in patients with knee OA with and without self-reported instability and examine the relationship between walking knee joint stiffness with quadriceps strength, knee joint laxity, and varus knee malalignment. Overground biomechanical data at a self-selected gait velocity was collected for 35 individuals with knee OA without self-reported instability (stable group) and 17 individuals with knee OA and episodic self-reported instability (unstable group). Knee joint stiffness was calculated during the weight-acceptance phase of gait as the change in the external knee joint moment divided by the change in the knee flexion angle. The unstable group walked with lower knee joint stiffness (p=0.01), mainly due to smaller heel-contact knee flexion angles (p<0.01) and greater knee flexion excursions (p<0.01) compared to their knee stable counterparts. No significant relationships were observed between walking knee joint stiffness and quadriceps strength, knee joint laxity or varus knee malalignment. Reduced walking knee joint stiffness appears to be associated with episodic knee instability and independent of quadriceps muscle weakness, knee joint laxity or varus malalignment. Further investigations of the temporal relationship between self-reported knee joint instability and walking knee joint stiffness are warranted.

  10. Knee joint forces: prediction, measurement, and significance

    PubMed Central

    D’Lima, Darryl D.; Fregly, Benjamin J.; Patil, Shantanu; Steklov, Nikolai; Colwell, Clifford W.

    2011-01-01

    Knee forces are highly significant in osteoarthritis and in the survival and function of knee arthroplasty. A large number of studies have attempted to estimate forces around the knee during various activities. Several approaches have been used to relate knee kinematics and external forces to internal joint contact forces, the most popular being inverse dynamics, forward dynamics, and static body analyses. Knee forces have also been measured in vivo after knee arthroplasty, which serves as valuable validation of computational predictions. This review summarizes the results of published studies that measured knee forces for various activities. The efficacy of various methods to alter knee force distribution, such as gait modification, orthotics, walking aids, and custom treadmills are analyzed. Current gaps in our knowledge are identified and directions for future research in this area are outlined. PMID:22468461

  11. Determination of representative dimension parameter values of Korean knee joints for knee joint implant design.

    PubMed

    Kwak, Dai Soon; Tao, Quang Bang; Todo, Mitsugu; Jeon, Insu

    2012-05-01

    Knee joint implants developed by western companies have been imported to Korea and used for Korean patients. However, many clinical problems occur in knee joints of Korean patients after total knee joint replacement owing to the geometric mismatch between the western implants and Korean knee joint structures. To solve these problems, a method to determine the representative dimension parameter values of Korean knee joints is introduced to aid in the design of knee joint implants appropriate for Korean patients. Measurements of the dimension parameters of 88 male Korean knee joint subjects were carried out. The distribution of the subjects versus each measured parameter value was investigated. The measured dimension parameter values of each parameter were grouped by suitable intervals called the "size group," and average values of the size groups were calculated. The knee joint subjects were grouped as the "patient group" based on "size group numbers" of each parameter. From the iterative calculations to decrease the errors between the average dimension parameter values of each "patient group" and the dimension parameter values of the subjects, the average dimension parameter values that give less than the error criterion were determined to be the representative dimension parameter values for designing knee joint implants for Korean patients.

  12. [Research on point cloud smoothing in knee joint prosthesis modeling based on reverse engineering].

    PubMed

    Zhang, Guoliang; Yao, Jin; Wei, Xing; Pei, Fuxing; Zhou, Zongke

    2008-10-01

    At present, foreign standard knee joint prosthesis is mostly used in clinical practice; it can well represent the biological characteristic of knee joint on human being. So this paper adopts the reverse engineering technology in that connexion, presents novel positioning method of acquiring the point data on the surface of knee joint prosthesis, puts forward the algorithm of three-point angle method for removing the noise error and correcting the noise error based on the least squares plane to smooth point cloud. And then, the surface of knee joint prosthesis with better accuracy and smoothness can be generated. Finally, the knee joint prosthesis model can be generated. Thus, a basis is provided for the localization of knee joint prosthesis. This new algorithm is mainly used for the surface modeling based on point cloud smoothing, including the surface of knee joint prosthesis, the surface of regular shape, and the surface with gentle change in curvature.

  13. Unsupervised definition of the tibia-femoral joint regions of the human knee and its applications to cartilage analysis

    NASA Astrophysics Data System (ADS)

    Tamez-Peña, José G.; Barbu-McInnis, Monica; Totterman, Saara

    2006-03-01

    Abnormal MR findings including cartilage defects, cartilage denuded areas, osteophytes, and bone marrow edema (BME) are used in staging and evaluating the degree of osteoarthritis (OA) in the knee. The locations of the abnormal findings have been correlated to the degree of pain and stiffness of the joint in the same location. The definition of the anatomic region in MR images is not always an objective task, due to the lack of clear anatomical features. This uncertainty causes variance in the location of the abnormality between readers and time points. Therefore, it is important to have a reproducible system to define the anatomic regions. This works present a computerized approach to define the different anatomic knee regions. The approach is based on an algorithm that uses unique features of the femur and its spatial relation in the extended knee. The femur features are found from three dimensional segmentation maps of the knee. From the segmentation maps, the algorithm automatically divides the femur cartilage into five anatomic regions: trochlea, medial weight bearing area, lateral weight bearing area, posterior medial femoral condyle, and posterior lateral femoral condyle. Furthermore, the algorithm automatically labels the medial and lateral tibia cartilage. The unsupervised definition of the knee regions allows a reproducible way to evaluate regional OA changes. This works will present the application of this automated algorithm for the regional analysis of the cartilage tissue.

  14. Improved Automatically Locking/Unlocking Orthotic Knee Joint

    NASA Technical Reports Server (NTRS)

    Weddendorf, Bruce

    1995-01-01

    Proposed orthotic knee joint improved version of one described in "Automatically Locking/Unlocking Orthotic Knee Joint" (MFS-28633). Locks automatically upon initial application of radial force (wearer's weight) and unlocks automatically, but only when all loads (radial force and bending) relieved. Joints lock whenever wearer applies weight to knee at any joint angle between full extension and 45 degree bend. Both devices offer increased safety and convenience relative to conventional orthotic knee joints.

  15. Should a native depth-dependent distribution of human meniscus constitutive components be considered in FEA-models of the knee joint?

    PubMed

    Párraga Quiroga, J M; Emans, P; Wilson, W; Ito, K; van Donkelaar, C C

    2014-10-01

    The depth-dependent matrix composition of articular cartilage is important for its mechanical behavior. It is unknown whether the depth-dependent matrix composition of a meniscus is similarly important for its load-bearing function. The present objective was to determine whether it is necessary to account for the native distribution of matrix components in the cross-sectional plane of the meniscus, when studying its mechanical behavior in numerical models. To address this objective, measured depth-dependent distribution of matrix contents in the human meniscus, and fitted visco-elastic mechanical properties of the collagen were used as input in FEA simulations of a knee joint. The importance of including the depth-dependent matrix component constitution in the meniscus was determined by comparing simulations with an axisymmetric representation of the knee joint, which incorporated either the depth-dependent matrix composition or homogenized matrix. Depth-dependent differences in water, collagen and proteoglycan contents were observed, but these were not significantly different. The anterior region, with significantly higher collagen content, was statistically stiffer than the posterior region. However, depth wise, stiffness did not correlate to the constitution of the tissue. GAG content was significantly higher in the posterior than in the anterior region. Visco-elastic properties of meniscus collagen were fitted against tensile test data. Simulations show that the distribution of stresses and strains in the cartilage is slightly low when the meniscus contains a depth-dependent constitution, but this difference is only modest. Therefore, this study suggests that knee joint mechanics is rather insensitive to the distribution of constitutive components in the cross section of the meniscus, and that the depth-dependent matrix distribution of the meniscus is not essential to be included in axisymmetric computational models of the knee joint.

  16. [Unicondylar replacement of the knee joint.].

    PubMed

    Stedrý, V; Vanecek, L

    1999-01-01

    Twenty-nine unicondylar replacements of the knee joint (UKR) of St. Georg type were implanted in 27 patients at the Orthopaedic Clinic IPVZ in the period between 1985-1994. The average age in case of females was 73 years, in case of men 71 years. The most frequent indication was osteoarthritis of the knee joint of varus type. Two patients (7 %) had to be reoperated on for aseptic loosening of the tibial component, on average 5,5 years after the surgery. Revision surgery for breaking of femoral component was performed in five cases, on average 6 years after the primary implantation. The authores evaluated 16 patients with UKR still in situ. In 8 patients the prosthesis is entirely painless, in 10 joints operated on the radiograph showed a developed femoropatelar osteoarthritis, osteoarthritic changes of the opposite compartment in 2 of them and a radioluscent line up to 1 mm in 3 cases. Despite a high frequency of late complications the authors consider UKR for an alternative to high supratubercular osteotomy of tibia in older patients, for a suitable method of the treatment of osteochondritis dissecans and Ahlbäck disease of the knee joint. The success of this operation is conditioned by a perfect surgical technique and implant of suitable design. Key words: replacement of the knee joint, aseptic loosening, fatique failure of material.

  17. [Knee joint pain with signs of arthrosis].

    PubMed

    Bender, T T A; Marinova, M; Radbruch, L; Conrad, R; Jobst, D; Mücke, M

    2017-03-14

    Chronic pain in the knee joint is most commonly caused by osteoarthritis, especially in elderly patients but can be due to other causes, such as rheumatoid arthritis. The diagnostics include an exact patient medical history and a clinical examination, which often already provide clear indications of the cause of the knee pain. Subsequently, further diagnostics can then be considered, such as radiological procedures and laboratory diagnostics. The treatment is determined by the cause and the individual patient and aims to reduce pain and to preserve the mobility of the joint. Generally, therapy consists of pain management and physiotherapy as well as alternative therapeutic procedures, mostly in combination. Proximal tibial opening wedge osteotomy can be useful; however, partial or total knee arthroplasty should only be considered when conservative treatment options have been exhausted.

  18. The Knee Joint Loose Body as a Source of Viable Autologous Human Chondrocytes

    PubMed Central

    Melrose, J.

    2016-01-01

    Loose bodies are fragments of cartilage or bone present in the synovial fluid. In the present study we assessed if loose bodies could be used as a source of autologous human chondrocytes for experimental purposes. Histochemical examination of loose bodies and differential enzymatic digestions were undertaken, the isolated cells were cultured in alginate bead microspheres and immunolocalisations were undertaken for chondrogenic markers such as aggrecan, and type II collagen. Isolated loose body cells had high viability (≥90% viable), expressed chondrogenic markers (aggrecan, type II collagen) but no type I collagen. Loose bodies may be a useful source of autologous chondrocytes of high viability. PMID:27349321

  19. [Chronic sports injuries of the knee joint].

    PubMed

    Mannil, M; Andreisek, G; Weishaupt, D; Fischer, M A

    2016-05-01

    Chronic sports injuries of the knee joint are common and mainly caused by repetitive (micro) trauma and exertion. Chronic insertion tendinopathies and avulsion fractures and symptoms related to entrapment, friction and impingement can be pathophysiologically distinguished in athletes. In this review, we depict the characteristic magnetic resonance imaging (MRI) findings of the most commonly occurring pathologies.

  20. Bursae around the knee joints

    PubMed Central

    Chatra, Priyank S

    2012-01-01

    A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. PMID:22623812

  1. Review: Modelling of meniscus of knee joint during soccer kicking

    NASA Astrophysics Data System (ADS)

    Azrul Hisham Mohd Adib, Mohd; Firdaus Jaafar, Mohd

    2013-12-01

    Knee is a part of the body that located between thigh and shank is one of the most complicated and largest joints in the human body. The common injuries that occur are ligaments, meniscus or bone fracture. During soccer games, the knee is the most critical part that will easily injure due to the shock from an external impact. Torn meniscus is one of the effects. This study will investigate the effect towards the meniscus within the knee joint during soccer ball kicking. We conduct a literary review of 14 journals that discuss the general view of meniscus and also soccer kicking. The selected topics for this review paper are meniscal function, meniscal movement, meniscal tears and also instep kick. As a finding, statistics show that most meniscal tears (73%) occurred in athletes who were soccer players, basketball players or skiers. The tear is frequently happening at the medial side rather than lateral side with a percentage of 70%.

  2. Elastic properties of an intact and ACL-ruptured knee joint: measurement, mathematical modelling, and haptic rendering.

    PubMed

    Frey, Martin; Riener, Robert; Michas, Christian; Regenfelder, Felix; Burgkart, Rainer

    2006-01-01

    An analytical, dynamic model of the human knee joint has been developed to simulate the unloaded knee joint behaviour in 6 degrees of freedom. It is based on extensive robot-based measurements of the elastic properties of a human cadaver knee joint. The measured data are compared with data from the literature to ensure that a proper database for modelling is used. The analytical modelling of the passive elastic joint properties is done with Local Linear Model Trees. The deduced knee joint model incorporates passive elastic properties of the internal knee joint structures, passive elastic muscle forces, damping forces, gravitational forces, and external forces. There are two sets of parameters, one simulating the movement of the intact knee joint, and a second simulating the knee joint with ruptured anterior cruciate ligament. The dynamic model can be easily processed in real-time. It is implemented in the haptic display of the Munich Knee Joint Simulator (MKS), which enables a person to move a plastic leg driven by a robot manipulator and feel the simulated knee joint force. Orthopaedic physicians judged the performance of the dynamic knee joint model by executing physical knee joint tests at the MKS.

  3. A Novel Approach to the Dissection of the Human Knee

    ERIC Educational Resources Information Center

    Clemente, F. Richard; Fabrizio, Philip A.; Shumaker, Michael

    2009-01-01

    The knee is one of the most frequently injured joints of the human body with injuries affecting the general population and the athletic population of many age groups. Dissection procedures for the knee joint typically do not allow unobstructed visualization of the anterior cruciate or posterior cruciate ligaments without sacrificing the collateral…

  4. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  5. Design and Evaluation of a Prosthetic Knee Joint Using the Geared Five-Bar Mechanism.

    PubMed

    Sun, Yuanxi; Ge, Wenjie; Zheng, Jia; Dong, Dianbiao

    2015-11-01

    This paper presents the mechanical design, dynamics analysis and ankle trajectory analysis of a prosthetic knee joint using the geared five-bar mechanism. Compared with traditional four-bar or six-bar mechanisms, the geared five-bar mechanism is better at performing diverse movements and is easy to control. This prosthetic knee joint with the geared five-bar mechanism is capable of fine-tuning its relative instantaneous center of rotation and ankle trajectory. The centrode of this prosthetic knee joint, which is mechanically optimized according to the centrode of human knee joint, is better in the bionic performance than that of a prosthetic knee joint using the four-bar mechanism. Additionally, the stability control of this prosthetic knee joint during the swing and stance phase is achieved by a motor. By adjusting the gear ratio of this prosthetic knee joint, the ankle trajectories of both unilateral and bilateral amputees show less deviations from expected than that of the four-bar knee joint.

  6. Complex function of the knee joint: the current understanding of the knee.

    PubMed

    Hirschmann, Michael T; Müller, Werner

    2015-10-01

    Since the early years of orthopaedics, it is a well-known fact that anatomy follows function. During the evolution of mankind, the knee has been optimally adapted to the forces and loads acting at and through the knee joint. However, anatomy of the knee joint is variable and the only constant is its complex function. In contrast to the time of open surgery, nowadays the majority of reconstructive knee surgery is done arthroscopically. Keyhole surgery is less invasive, but on the backside, the knee surgeon lacks daily visualisation of the complex open anatomy. As open anatomical knowledge is less present in our daily practice, it is even more important to highlight this complex anatomy and function of the knee. It is the purpose of this review to perform a systematic review of knee anatomy, highlight the complex function of the knee joint and present an overview about recent and current knowledge about knee function. Level of evidence Systematic review, Level IV.

  7. Can generic knee joint models improve the measurement of osteoarthritic knee kinematics during squatting activity?

    PubMed

    Clément, Julien; Dumas, Raphaël; Hagemeister, Nicola; de Guise, Jaques A

    2017-01-01

    Knee joint kinematics derived from multi-body optimisation (MBO) still requires evaluation. The objective of this study was to corroborate model-derived kinematics of osteoarthritic knees obtained using four generic knee joint models used in musculoskeletal modelling - spherical, hinge, degree-of-freedom coupling curves and parallel mechanism - against reference knee kinematics measured by stereo-radiography. Root mean square errors ranged from 0.7° to 23.4° for knee rotations and from 0.6 to 9.0 mm for knee displacements. Model-derived knee kinematics computed from generic knee joint models was inaccurate. Future developments and experiments should improve the reliability of osteoarthritic knee models in MBO and musculoskeletal modelling.

  8. Shea Nut Oil Triterpene Concentrate Attenuates Knee Osteoarthritis Development in Rats: Evidence from Knee Joint Histology

    PubMed Central

    Lin, Sheng-Hsiung; Lai, Chun-Fu; Lin, Yu-Chieh; Kong, Zwe-Ling; Wong, Chih-Shung

    2016-01-01

    Background Shea nut oil triterpene concentrate is considered to have anti-inflammatory and antioxidant properties. Traditionally, it has been used to treat arthritic conditions in humans. This study aimed to investigate the effect of attenuating osteoarthritis (OA)-induced pain and joint destruction in rats by administering shea nut oil triterpene concentrate (SheaFlex75, which is more than 50% triterpenes). Methods An anterior cruciate ligament transaction (ACLT) with medial meniscectomy (MMx) was used to induce OA in male Wistar rats. Different doses of SheaFlex75 (111.6 mg/kg, 223.2 mg/kg, and 446.4 mg/kg) were then intragastrically administered daily for 12 weeks after surgery. Body weight and the width of the knee joint were measured weekly. Additionally, incapacitance tests were performed at weeks 2, 4, 6, 8, 10 and 12 to measure the weight bearing of the hind limbs, and the morphology and histopathology of the medial femoral condyles were examined and were evaluated using the Osteoarthritis Research Society International (OARSI) scoring system. Results This study showed that SheaFlex75 reduced the swelling of the knee joint with OA and rectified its weight bearing after ACLT plus MMx surgery in rats. Treatment with SheaFlex75 also decreased ACLT plus MMx surgery-induced knee joint matrix loss and cartilage degeneration. Conclusion SheaFlex75 relieves the symptoms of OA and protects cartilage from degeneration. SheaFlex75 thus has the potential to be an ideal nutraceutical supplement for joint protection, particularly for injured knee joints. PMID:27583436

  9. Individual muscle contributions to the axial knee joint contact force during normal walking.

    PubMed

    Sasaki, Kotaro; Neptune, Richard R

    2010-10-19

    Muscles are significant contributors to the high joint forces developed in the knee during human walking. Not only do muscles contribute to the knee joint forces by acting to compress the joint, but they also develop joint forces indirectly through their contributions to the ground reaction forces via dynamic coupling. Thus, muscles can have significant contributions to forces at joints they do not span. However, few studies have investigated how the major lower-limb muscles contribute to the knee joint contact forces during walking. The goal of this study was to use a muscle-actuated forward dynamics simulation of walking to identify how individual muscles contribute to the axial tibio-femoral joint force. The simulation results showed that the vastii muscles are the primary contributors to the axial joint force in early stance while the gastrocnemius is the primary contributor in late stance. The tibio-femoral joint force generated by these muscles was at times greater than the muscle forces themselves. Muscles that do not cross the knee joint (e.g., the gluteus maximus and soleus) also have significant contributions to the tibio-femoral joint force through their contributions to the ground reaction forces. Further, small changes in walking kinematics (e.g., knee flexion angle) can have a significant effect on the magnitude of the knee joint forces. Thus, altering walking mechanics and muscle coordination patterns to utilize muscle groups that perform the same biomechanical function, yet contribute less to the knee joint forces may be an effective way to reduce knee joint loading during walking.

  10. Importance of material properties and porosity of bone on mechanical response of articular cartilage in human knee joint--a two-dimensional finite element study.

    PubMed

    Venäläinen, Mikko S; Mononen, Mika E; Jurvelin, Jukka S; Töyräs, Juha; Virén, Tuomas; Korhonen, Rami K

    2014-12-01

    Mechanical behavior of bone is determined by the structure and intrinsic, local material properties of the tissue. However, previously presented knee joint models for evaluation of stresses and strains in joints generally consider bones as rigid bodies or linearly elastic solid materials. The aim of this study was to estimate how different structural and mechanical properties of bone affect the mechanical response of articular cartilage within a knee joint. Based on a cadaver knee joint, a two-dimensional (2D) finite element (FE) model of a knee joint including bone, cartilage, and meniscus geometries was constructed. Six different computational models with varying properties for cortical, trabecular, and subchondral bone were created, while the biphasic fibril-reinforced properties of cartilage and menisci were kept unaltered. The simplest model included rigid bones, while the most complex model included specific mechanical properties for different bone structures and anatomically accurate trabecular structure. Models with different porosities of trabecular bone were also constructed. All models were exposed to axial loading of 1.9 times body weight within 0.2 s (mimicking typical maximum knee joint forces during gait) while free varus-valgus rotation was allowed and all other rotations and translations were fixed. As compared to results obtained with the rigid bone model, stresses, strains, and pore pressures observed in cartilage decreased depending on the implemented properties of trabecular bone. Greatest changes in these parameters (up to -51% in maximum principal stresses) were observed when the lowest modulus for trabecular bone (measured at the structural level) was used. By increasing the trabecular bone porosity, stresses and strains were reduced substantially in the lateral tibial cartilage, while they remained relatively constant in the medial tibial plateau. The present results highlight the importance of long bones, in particular, their mechanical

  11. Intra-Articular Knee Contact Force Estimation During Walking Using Force-Reaction Elements and Subject-Specific Joint Model.

    PubMed

    Jung, Yihwan; Phan, Cong-Bo; Koo, Seungbum

    2016-02-01

    Joint contact forces measured with instrumented knee implants have not only revealed general patterns of joint loading but also showed individual variations that could be due to differences in anatomy and joint kinematics. Musculoskeletal human models for dynamic simulation have been utilized to understand body kinetics including joint moments, muscle tension, and knee contact forces. The objectives of this study were to develop a knee contact model which can predict knee contact forces using an inverse dynamics-based optimization solver and to investigate the effect of joint constraints on knee contact force prediction. A knee contact model was developed to include 32 reaction force elements on the surface of a tibial insert of a total knee replacement (TKR), which was embedded in a full-body musculoskeletal model. Various external measurements including motion data and external force data during walking trials of a subject with an instrumented knee implant were provided from the Sixth Grand Challenge Competition to Predict in vivo Knee Loads. Knee contact forces in the medial and lateral portions of the instrumented knee implant were also provided for the same walking trials. A knee contact model with a hinge joint and normal alignment could predict knee contact forces with root mean square errors (RMSEs) of 165 N and 288 N for the medial and lateral portions of the knee, respectively, and coefficients of determination (R2) of 0.70 and -0.63. When the degrees-of-freedom (DOF) of the knee and locations of leg markers were adjusted to account for the valgus lower-limb alignment of the subject, RMSE values improved to 144 N and 179 N, and R2 values improved to 0.77 and 0.37, respectively. The proposed knee contact model with subject-specific joint model could predict in vivo knee contact forces with reasonable accuracy. This model may contribute to the development and improvement of knee arthroplasty.

  12. [Traumatic vascular lesions of the knee joint].

    PubMed

    Markgraf, E; Clausner, G; Lungershausen, W

    1989-09-01

    The popliteal artery is a "critical" or key-artery, whose sudden occlusion leads to the ischemia-syndrome. The rate of amputation after missing or too late recovery is very high. The real time for the recovery runs to 3-6 hours. The reason for the injury of the vessel is the dorsal luxation of the knee-joint, the fracture of the lower thigh or the fracture of the tibial head with extreme dislocation of the fragments. The management of the diagnosis, the contents and the order of the surgical treatment are reported.

  13. The Relationship between Knee Joint Loading Rate During Walking and Degenerative Changes on Magnetic Resonance Imaging

    PubMed Central

    Morgenroth, David C.; Medverd, Jonathan R.; Seyedali, Mahyo; Czerniecki, Joseph M.

    2014-01-01

    Background While animal study and cadaveric study have demonstrated an association between knee joint loading rate and joint degeneration, the relationship between knee joint loading rate during walking and osteoarthritis has not yet been sufficiently studied in humans. Methods Twenty-eight participants (14 transfemoral amputees and 14 age and body mass matched controls) underwent knee MRI with subsequent assessment using the semiquantitative Whole-Organ Magnetic Resonance Image Score. Each subject also underwent gait analysis in order to determine knee adduction moment loading rate, peak, and impulse and an exploratory measure, knee adduction moment rate*magnitude. Findings Significant correlations were found between medial tibiofemoral joint degeneration and knee adduction moment peak (slope = 0.42 [SE 0.20]; P=.037), loading rate (slope = 12.3 [SE 3.2]; P=.0004), and rate*magnitude (slope = 437 [SE 100]; P<.0001). These relationships continued to be significant after adjusting for body mass or subject type. The relationship between medial knee semiquantitative MRI score and knee adduction moment loading rate and rate*magnitude continued to be significant even after adjusting for peak moment (P<.0001), however, the relationship between medial knee semiquantitative MRI score and peak moment was no longer significant after adjusting for either loading rate or rate*magnitude (P>.2 in both cases). Interpretation This study suggests an independent relationship between knee adduction moment loading rate and medial tibiofemoral joint degeneration. Our results support the hypothesis that rate of loading, represented by the knee adduction moment loading rate, is strongly associated with medial tibiofemoral joint degeneration independent of knee adduction moment peak and impulse. PMID:24820134

  14. Astym® Therapy for the Management of Recalcitrant Knee Joint Stiffness after Total Knee Arthroplasty.

    PubMed

    Bhave, Anil; Corcoran, James; Cherian, Jeffery J; Mont, Michael A

    2016-01-01

    Knee stiffness is a common complication after total knee arthroplasty (TKA). Despite studies published on the surgical management of reduced range of motion (ROM) after TKA, there is limited evidence on the nonoperative management of joint and soft tissue imbalances possibly contributing to reduced knee ROM. This report assesses changes in ROM, pain, function, and patellar tendon length after Astym® joint mobilization use. A 38-year-old male professional skier had a right TKA 3 months before presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of physical therapy with the use of Astym®, patellar mobilization, and tibio-femoral mobilizations with movement. The patient also used a customized knee device at home for prolonged knee extension stretching. The patient was treated for 12 visits, along with home use of customized bracing for knee extension. Significant improvements were seen in pain, function, and ROM. He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free. He also demonstrated resolution of patellar baja radiographically. Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective in restoring knee mobility and reducing pain and activity limitation. A multimodal approach using Astym® treatment, customized knee bracing, and targeted joint mobilization can be effective in resolving knee joint stiffness.

  15. Pathological Knee Joint Motion Analysis By High Speed Cinephotography

    NASA Astrophysics Data System (ADS)

    Baumann, Jurg U.

    1985-02-01

    The use of cinephotography for evaluation of disturbed knee joint function was compared in three groups of patients. While a sampling rate of 50 images per second was adequate for patients with neuromuscular disorders, a higher frequency of around 300 i.p.s. is necessary in osteoarthritis and ligamentous knee joint injuries, but the task of digitizing is prohibitive unless automated.

  16. Knee joint kinematics, fixation and function related to joint area design in total knee arthroplasty.

    PubMed

    Uvehammer, J

    2001-02-01

    The aim was to study the influence of different designs of the joint area on tibial component fixation, kinematics and clinical outcome after a cemented total knee arthroplasty (TKA). The HSS score and a special questionnaire were used at the clinical examination. Conventional radiography was done to record the positioning of the implants and development of radiolucencies. The migration and inducible displacement were evaluated using radiostereometry (RSA). The kinematics of the knee during active extension was studied using dynamic RSA. In randomised and prospective studies 87 knees in 83 patients (28 male, 55 female, age 69, range 50-83) received an AMK (DePuy, Johnson & Johnson) TKA. The patients were divided into two groups. In group 1 the patients had varus/valgus deformities of < or = 5 degrees and the PCL was retained. The PCL was resected in group 2 where the patients had deformities exceeding 5 degrees and/or fixed flexion deformities of more than 10 degrees. In group 1 a flat (F, n = 20) or a concave (C, n = 20) design was implanted (study 3). In group 2 (study 4) the patients received a concave (n = 25) or a posterior-stabilised (PS, n = 22) tibial plateau. The migration of the tibial component, positioning of the prosthesis, development of radiolucencies and the clinical outcome was evaluated after 1 and 2 years. Twenty-two patients (11 F, 11 C) in group 1 (study 1) and 22 knees in 20 patients in group 2 (study 2, 11 C, 11 PS) were examined 1 year post-operatively to evaluate the kinematics of the knee. Eleven normals served as controls. During active extension of the knee the inducible displacements of the tibial component were recorded in 16 knees (15 patients). Based on successful RSA examinations 5 knees (4 F, 1 C) from group 1 and 11 knees (5 C, 6 PS) from group 2 were selected (study 5). Abnormal kinematics and especially increased AP translations compared to normals (p < 0.0005) were recorded in all designs. The concave design showed the widest

  17. A comparative evaluation of the Adaptive knee and Catech knee joints: a preliminary study.

    PubMed

    Jepson, F; Datta, D; Harris, I; Heller, B; Howitt, J; McLean, J

    2008-03-01

    The Adaptive knee joint is a microprocessor-controlled prosthetic knee that incorporates both pneumatic and hydraulic control in one electronic unit. Pneumatic control is said to provide control during swing phase and the hydraulic control during the stance phase of the gait. This hybrid controller is triggered by a computer contained within the knee that responds to input from force, time and angle sensors. The microprocessor then selects an appropriate speed and stability setting. The Catech knee joint is a conventional hydraulic knee joint. The aim of this study was to compare the Adaptive and Catech knee joints in established trans-femoral amputees. The patients meeting the inclusion criteria were all established trans-femoral amputees using the Catech knee joint. The study was carried out by performing gait analysis, assessing energy requirements using the Physiological Cost Index (PCI) and using questionnaires. There was no significant benefit gained from the use of the Adaptive knee over the Catech knee joint in our small study group.

  18. Novel knee joint mechanism of transfemoral prosthesis for stair ascent.

    PubMed

    Inoue, Koh; Wada, Takahiro; Harada, Ryuchi; Tachiwana, Shinichi

    2013-06-01

    The stability of a transfemoral prosthesis when walking on flat ground has been established by recent advances in knee joint mechanisms and their control methods. It is, however, difficult for users of a transfemoral prosthesis to ascend stairs. This difficulty is mainly due to insufficient generation of extension moment around the knee joint of the prosthesis to lift the body to the next step on the staircase and prevent any unexpected flexion of the knee joint in the stance phase. Only a prosthesis with an actuator has facilitated stair ascent using a step-over-step gait (1 foot is placed per step). However, its use has issues associated with the durability, cost, maintenance, and usage environment. Therefore, the purpose of this research is to develop a novel knee joint mechanism for a prosthesis that generates an extension moment around the knee joint in the stance phase during stair ascent, without the use of any actuators. The proposed mechanism is based on the knowledge that the ground reaction force increases during the stance phase when the knee flexion occurs. Stair ascent experiments with the prosthesis showed that the proposed prosthesis can realize stair ascent without any undesirable knee flexion. In addition, the prosthesis is able to generate a positive knee joint moment power in the stance phase even without any power source.

  19. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metallic constrained... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint... knee joint. The device prevents dislocation in more than one anatomic plane and has components that...

  20. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metallic constrained... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint... knee joint. The device prevents dislocation in more than one anatomic plane and has components that...

  1. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metallic constrained... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint... knee joint. The device prevents dislocation in more than one anatomic plane and has components that...

  2. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metallic constrained... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint... knee joint. The device prevents dislocation in more than one anatomic plane and has components that...

  3. Knee osteoarthritis affects the distribution of joint moments during gait.

    PubMed

    Zeni, Joseph A; Higginson, Jill S

    2011-06-01

    Alterations in lower extremity kinetics have been shown to exist in persons with knee osteoarthritis (OA), however few investigations have examined how the intersegmental coordination of the lower extremity kinetic chain varies in the presence of knee joint pathology. The objective of this study was to evaluate how knee OA and walking speed affect total support moment and individual joint contributions to the total support moment. Fifteen healthy subjects and 30 persons with knee OA participated in 3D walking analysis at constrained (1.0 m/s), self-selected and fastest tolerable walking speeds. Individual joint contributions to total support moment were analyzed using separate ANOVAs with one repeated measure (walking speed). Linear regression analysis was used to evaluate the relationship between walking speed and joint contribution. Persons with knee OA reduced the contribution of the knee joint when walking at constrained (p = 0.04) and self-selected walking speeds (p = 0.009). There was a significant increase in the ankle contribution and a significant decrease in the hip contribution when walking speed was increased (p < 0.004), however individual walking speeds were not significantly related to joint contributions. This suggests that the relationship between walking speed and joint contribution is dependent on the individual's control strategy and we cannot estimate the joint contribution solely based on walking speed. The slower gait speed observed in persons with knee OA is not responsible for the reduction in knee joint moments, rather this change is likely due to alterations in the neuromuscular strategy of the lower extremity kinetic chain in response to joint pain or muscle weakness.

  4. Unusual lesions that distend the knee joint: pictorial essay*

    PubMed Central

    de Lima, Luana T. Barros; de Albuquerque Filho, Eolo Santana; Batista, Laecio Leitão; de Moraes, Talita Peixoto; Pereira, Bruno Perez Guedes

    2016-01-01

    The high number of knee imaging exams at radiology clinics, together with the wide variety of knee disorders, calls for expanding the knowledge about the less common lesions seen in routine diagnostic practice. The purpose of this pictorial essay was to illustrate unusual lesions that distend the knee joint, selected by relevance and evaluated with multiple imaging modalities, including X-ray, computed tomography, and magnetic resonance imaging, as well as to perform a brief review of the literature. PMID:27818547

  5. KNEE-JOINT LOADING IN KNEE OSTEOARTHRITIS: INFLUENCE OF ABDOMINAL AND THIGH FAT

    PubMed Central

    Messier, Stephen P.; Beavers, Daniel P.; Loeser, Richard F.; Carr, J. Jeffery; Khajanchi, Shubham; Legault, Claudine; Nicklas, Barbara J.; Hunter, David J.; DeVita, Paul

    2014-01-01

    Purpose Using three separate models that included total body mass, total lean and total fat mass, and abdominal and thigh fat as independent measures, we determined their association with knee-joint loads in older overweight and obese adults with knee osteoarthritis (OA). Methods Fat depots were quantified using computed tomography and total lean and fat mass determined with dual energy x-ray absorptiometry in 176 adults (age = 66.3 yr., BMI = 33.5 kg·m−2) with radiographic knee OA. Knee moments and joint bone-on-bone forces were calculated using gait analysis and musculoskeletal modeling. Results Higher total body mass was significantly associated (p ≤ 0.0001) with greater knee compressive and shear forces, compressive and shear impulses (p < 0.0001), patellofemoral forces (p< 0.006), and knee extensor moments (p = 0.003). Regression analysis with total lean and total fat mass as independent variables revealed significant positive associations of total fat mass with knee compressive (p = 0.0001), shear (p < 0.001), and patellofemoral forces (p = 0.01) and knee extension moment (p = 0.008). Gastrocnemius and quadriceps forces were positively associated with total fat mass. Total lean mass was associated with knee compressive force (p = 0.002). A regression model that included total thigh and total abdominal fat found both were significantly associated with knee compressive and shear forces (p ≤ 0.04). Thigh fat was associated with the knee abduction (p = 0.03) and knee extension moment (p = 0.02). Conclusions Thigh fat, consisting predominately of subcutaneous fat, had similar significant associations with knee joint forces as abdominal fat despite its much smaller volume and could be an important therapeutic target for people with knee OA. PMID:25133996

  6. GSB knee joint: a further possibility, principle, results.

    PubMed

    Gschwend, N

    1978-05-01

    The GSB Knee joint is a nonconstrained hinge joint, which combines the advantages of the so-called condylar or surface prosthesis with those of the constrained hinge joints. This report is of observations on the results and complications in 150 arthroplasties performed over a 5 year period.

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

    PubMed Central

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

    2016-01-01

    The in vivo measurement of articular cartilage deformation is essential to understand how mechanical forces distribute throughout the healthy tissue and change over time in the pathologic joint. Displacements or strain may serve as a functional imaging biomarker for healthy, diseased, and repaired tissues, but unfortunately intratissue cartilage deformation in vivo is largely unknown. Here, we directly quantified for the first time deformation patterns through the thickness of tibiofemoral articular cartilage in healthy human volunteers. Magnetic resonance imaging acquisitions were synchronized with physiologically relevant compressive loading and used to visualize and measure regional displacement and strain of tibiofemoral articular cartilage in a sagittal plane. We found that compression (of 1/2 body weight) applied at the foot produced a sliding, rigid-body displacement at the tibiofemoral cartilage interface, that loading generated subject- and gender-specific and regionally complex patterns of intratissue strains, and that dominant cartilage strains (approaching 12%) were in shear. Maximum principle and shear strain measures in the tibia were correlated with body mass index. Our MRI-based approach may accelerate the development of regenerative therapies for diseased or damaged cartilage, which is currently limited by the lack of reliable in vivo methods for noninvasive assessment of functional changes following treatment. PMID:26752228

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

    NASA Astrophysics Data System (ADS)

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

    2016-01-01

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

  9. Influence of Different Hip Joint Centre Locations on Hip and Knee Joint Kinetics and Kinematics During the Squat

    PubMed Central

    Sinclair, Jonathan; Atkins, Stephen; Vincent, Hayley

    2014-01-01

    Identification of the hip joint centre (HJC) is important in the biomechanical examination of human movement. However, there is yet to be any published information regarding the influence of different HJC locations on hip and knee joint kinetics during functional tasks. This study aimed to examine the influence of four different HJC techniques on 3-D hip and knee joint kinetics/kinematics during the squat. Hip and knee joint kinetics/kinematics of the squat were obtained from fifteen male participants using an eight camera motion capture system. The 3-D kinetics/kinematics of the squat were quantified using four hip joint centre estimation techniques. Repeated measures ANOVAs were used to compare the discrete parameters as a function of each HJC location. The results show that significant differences in joint angles and moment parameters were evident at both the hip and knee joint in the coronal and transverse planes. These observations indicate that when calculating non-sagittal joint kinetics/kinematics during the squat, researchers should carefully consider their HJC method as it may significantly affect the interpretation of their data. PMID:25713661

  10. Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait

    PubMed Central

    Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T.; Li, Guoan; Lewis, Cara L.

    2017-01-01

    Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis. PMID:28339477

  11. Three-dimensional bioprinting of multilayered constructs containing human mesenchymal stromal cells for osteochondral tissue regeneration in the rabbit knee joint.

    PubMed

    Shim, Jin-Hyung; Jang, Ki-Mo; Hahn, Sei Kwang; Park, Ju Young; Jung, Hyuntae; Oh, Kyunghoon; Park, Kyeng Min; Yeom, Junseok; Park, Sun Hwa; Kim, Sung Won; Wang, Joon Ho; Kim, Kimoon; Cho, Dong-Woo

    2016-02-04

    The use of cell-rich hydrogels for three-dimensional (3D) cell culture has shown great potential for a variety of biomedical applications. However, the fabrication of appropriate constructs has been challenging. In this study, we describe a 3D printing process for the preparation of a multilayered 3D construct containing human mesenchymal stromal cells with a hydrogel comprised of atelocollagen and supramolecular hyaluronic acid (HA). This construct showed outstanding regenerative ability for the reconstruction of an osteochondral tissue in the knee joints of rabbits. We found that the use of a mechanically stable, host-guest chemistry-based hydrogel was essential and allowed two different types of extracellular matrix (ECM) hydrogels to be easily printed and stacked into one multilayered construct without requiring the use of potentially harmful chemical reagents or physical stimuli for post-crosslinking. To the best of our knowledge, this is the first study to validate the potential of a 3D printed multilayered construct consisting of two different ECM materials (atelocollagen and HA) for heterogeneous tissue regeneration using an in vivo animal model. We believe that this 3D printing-based platform technology can be effectively exploited for regeneration of various heterogeneous tissues as well as osteochondral tissue.

  12. Is Lifelong Knee Joint Force from Work, Home, and Sport Related to Knee Osteoarthritis?

    PubMed Central

    Ratzlaff, Charles R.; Koehoorn, Mieke; Cibere, Jolanda; Kopec, Jacek A.

    2012-01-01

    Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA). Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation) and dose (frequency, intensity, duration) were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the “cumulative peak force index”, a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio's ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined), and occupational force in men and household force in women were risk factors for knee OA. PMID:22848225

  13. Determining knee joint alignment using digital photographs.

    PubMed

    Schmitt, Holger; Kappel, Hannes; Moser, Michael T; Cardenas-Montemayor, Eloy; Engelleiter, Karoly; Kuni, Benita; Clarius, Michael

    2008-08-01

    The objective of this work is to find out how reliably knee joint alignment can be measured from a standardized photograph and what influence changes in the standing position have on the angles measured. The interrater, intrarater, and test-retest reliability were evaluated. The influence of image-object distance, the distance between the legs and leg rotation on the measured angles was evaluated. In addition to the digital photographs, 10 full-length radiographs were obtained in an upright position to determine whether the measured angles represent the anatomic axis or mechanical axis. There was high correlation between the interrater (ICC 0.997), intrarater (ICC 0.989) and test-retest reliability (ICC 0.904). Only slight deviation was found with the changes in radiograph-object distance (0 degrees -1.8 degrees ). With feet together varus malalignment was greater. Leg rotation showed a strong influence on the measured results (ICC 0.658). The angle measured in the digital photographs reflects the mechanical axis with only slight deviation (0.12 degrees -1.9 degrees ). The measurement of the clinical axis using standardized radiography is highly reliable and can be used for individual follow-up of varus and valgus malalignments.

  14. Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy.

    PubMed

    Oh, Kwang-Jun; Ko, Young Bong; Bae, Ji Hoon; Yoon, Suk Tae; Kim, Jae Gyoon

    2016-11-01

    The aim of this study was to evaluate which lower extremity alignment (knee and ankle joint) parameters affect knee joint line obliquity (KJLO) in the coronal plane after open wedge high tibial osteotomy (OWHTO). Overall, 69 knees of patients that underwent OWHTO were evaluated using radiographs obtained preoperatively and from 6 weeks to 3 months postoperatively. We measured multiple parameters of knee and ankle joint alignment (hip-knee-ankle angle [HKA], joint line height [JLH], posterior tibial slope [PS], femoral condyle-tibial plateau angle [FCTP], medial proximal tibial angle [MPTA], mechanical lateral distal femoral angle [mLDFA], KJLO, talar tilt angle [TTA], ankle joint obliquity [AJO], and the lateral distal tibial ground surface angle [LDTGA]; preoperative [-pre], postoperative [-post], and the difference between -pre and -post values [-Δ]). We categorized patients into two groups according to the KJLO-post value (the normal group [within ± 4 degrees, 56 knees] and the abnormal group [greater than ± 4 degrees, 13 knees]), and compared their -pre parameters. Multiple logistic regression analysis was used to examine the contribution of the -pre parameters to abnormal KJLO-post. The mean HKA-Δ (-9.4 ± 4.7 degrees) was larger than the mean KJLO-Δ (-2.1 ± 3.2 degrees). The knee joint alignment parameters (the HKA-pre, FCTP-pre) differed significantly between the two groups (p < 0.05). In addition, the HKA-pre (odds ratio [OR] = 1.27, p = 0.006) and FCTP-pre (OR = 2.13, p = 0.006) were significant predictors of abnormal KJLO-post. However, -pre ankle joint parameters (TTA, AJO, and LDTGA) did not differ significantly between the two groups and were not significantly associated with the abnormal KJLO-post. The -pre knee joint alignment and knee joint convergence angle evaluated by HKA-pre and FCTP-pre angle, respectively, were significant predictors of abnormal KJLO after OWHTO. However, -pre ankle joint parameters

  15. A multi-scale finite element model for investigation of chondrocyte mechanics in normal and medial meniscectomy human knee joint during walking.

    PubMed

    Tanska, Petri; Mononen, Mika E; Korhonen, Rami K

    2015-06-01

    Mechanical signals experienced by chondrocytes (articular cartilage cells) modulate cell synthesis and cartilage health. Multi-scale modeling can be used to study how forces are transferred from joint surfaces through tissues to chondrocytes. Therefore, estimation of chondrocyte behavior during certain physical activities, such as walking, could provide information about how cells respond to normal and abnormal loading in joints. In this study, a 3D multi-scale model was developed for evaluating chondrocyte and surrounding peri- and extracellular matrix responses during gait loading within healthy and medial meniscectomy knee joints. The knee joint geometry was based on MRI, whereas the input used for gait loading was obtained from the literature. Femoral and tibial cartilages were modeled as fibril-reinforced poroviscoelastic materials, whereas menisci were considered as transversely isotropic. Fluid pressures in the chondrocyte and cartilage tissue increased up to 2MPa (an increase of 30%) in the meniscectomy joint compared to the normal, healthy joint. The elevated level of fluid pressure was observed during the entire stance phase of gait. A medial meniscectomy caused substantially larger (up to 60%) changes in maximum principal strains in the chondrocyte compared to those in the peri- or extracellular matrices. Chondrocyte volume or morphology did not change substantially due to a medial meniscectomy. Current findings suggest that during walking chondrocyte deformations are not substantially altered due to a medial meniscectomy, while abnormal joint loading exposes chondrocytes to elevated levels of fluid pressure and maximum principal strains (compared to strains in the peri- or extracellular matrices). These might contribute to cell viability and the onset of osteoarthritis.

  16. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people

    PubMed Central

    Nakagawa, Kazumasa; Maeda, Misako

    2017-01-01

    [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered. PMID:28356631

  17. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people.

    PubMed

    Nakagawa, Kazumasa; Maeda, Misako

    2017-03-01

    [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered.

  18. [Knee joint distraction: a solution for young patients with osteoarthritis of the knee?

    PubMed

    Piscaer, T M; van der Jagt, O P; Gosens, T

    2016-01-01

    The current treatment for patients with end-stage generalised osteoarthritis of the knee is total knee replacement. In a recent paper in Plos One the authors examined an alternative approach, namely knee joint distraction. On the basis of a model, they claim that this treatment can postpone total knee replacement for about 20 years. This would reduce the costs for the healthcare services and improve quality of life for these patients. Although these claims seem promising, the model is only based on extrapolations of short-term results of small cohort studies. Furthermore, concerns about potential complications, e.g. osteomyelitis following pin-tract infections, are not mentioned. Further high quality studies in knee joint distraction are needed to prove its long-term efficacy and safety before this procedure can be implemented in standard clinical care.

  19. Role of viscosupplementation in osteo-arthritis of knee joint.

    PubMed

    Chandra, Rajesh; Mahajan, Sumit

    2013-05-01

    Osteo-arthritis is the chronic degenerative disease associated with joint pain and loss of joint function. It is caused by 'wear and tear' on a joint. Knee is the most commonly Involved joint. Disease is so crippling that patient is unable to walk independently from bed to bathroom. The major causes of osteo-arthritis are age, gender, obesity, medical condition and hereditary. The signs and symptoms of osteo-arthritis are pain, joint stiffness, joint swelling, and loss of function. No blood tests are helpful in diagnosing osteo-arthritis. Management of osteo-arthritis includes non-pharmacological, pharmacological and surgical. A relatively new procedure is viscosupplementation, in which a preparation of hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid. It acts as a lubricant to enable bones to move smoothly over each other and a shock absorber for joint loads. The decrease in the elastic and viscous properties of synovial fluid in osteo-arthritis results from both a reduced molecular size and a reduced concentration of hyaluronic acid in the synovial fluid. Viscosupplementation may be a therapeutic option for individuals with osteo-arthritis of the knee. Viscosupplementation has been shown to relieve pain in many patients who cannot get relief from non-medicinal measures or analgesic drugs. This article is to know the mechanism of action, patients' selection criteria, rationale and efficacy of viscosupplimentation in the management of osteo-arthritis of knee.

  20. Evaluation of a variable resistance orthotic knee joint.

    PubMed

    Herbert-Copley, Andrew; Lemaire, Edward D; Baddour, Natalie

    2016-08-01

    Knee-ankle-foot orthoses (KAFOs) are full leg braces for individuals with knee extensor weakness, designed to support the person during weight bearing activities by preventing knee flexion. KAFOs typically result in an unnatural gait pattern and are primarily used for level ground walking. A novel variable resistance orthotic knee joint, the Ottawalk-Variable Speed (OWVS), was designed to address these limitations. This paper presents a pilot test to evaluate the OWVS functional performance during walking and stair descent. A carbon-fiber KAFO was adjusted for an able-bodied participant by a certified orthotist, with a standard orthotic single axis knee joint on the medial side and the OWVS on the lateral side. The participant performed level ground walking (stance-control, open, closed) and stair descent tests. The operator was able to manually switch between closed mode in terminal swing to open mode in terminal stance for stance-control walking. Knee angle kinematics were similar between open and stance control modes. For stair descent, resistance settings supported the participant as they lowered their body to the next step, but with smaller range of motion compared to the open setting. The Ottawalk-Variable Speed design successfully controls knee flexion during stance and stair descent, with one lateral control joint. Mode switching was fast and appropriate. This microprocessor controlled SCKAFO has a low profile that fits beneath clothing and the variable resistance design will allow people to negotiate different terrain types.

  1. Abduction dislocation of the knee joint--a case study.

    PubMed

    Wójcik, Krzysztof; Bielecki, Tomasz; Polak, Damian; Skowron, Lukasz

    2013-10-31

    The paper presents a case of untypical, not included in existing classifications, knee joint dislocation in a young man. An MRI scan confirmed a rupture of both cruciate ligaments and damage to the ligamento-capsular complex on the medial side of the knee joint. Two weeks after injury, an arthroscopy was performed with joint lavage followed by repair of the damaged ligamento-capsular complex. A very good functional result was obtained three years after the injury, in spite of the patient not having consented to an elective cruciate ligament reconstruction.

  2. [Studies of the neuromuscular system of the knee joint].

    PubMed

    Börnert, K; Dippold, A

    1990-02-01

    The paper analysis the therapeutic effects of isometric training and electromechanic therapy (EMT) of the quadriceps muscles on subjects. The effects of the training practised with the knee joint bent was to be compared with previous results of training with the knee joint stretched. 36 subjects were trained and the increase in strength was measured with the help of a strain gauge dynamometer. Again a marked superiority of the EMT over sole isometric training could be demonstrated. More over, the results showed that the increase of the isometric maximal strength following an EMT is not influenced by the position of the angle of the joint.

  3. Pigmented Villonodular Synovitis of the Knee Joint: A Case Report

    PubMed Central

    Jhaveri, Maulik; Soni, Rishit; Shah, Malkesh; Rathi, Parth; Golwala, Paresh

    2016-01-01

    Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially locally aggressive and recurrent condition characterized by synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae. It usually affects the large joints such as hip, knee, and ankle. We report a case of PVNS of the knee joint in a young female which was treated by subtotal synovectomy alone without the use of adjuvants. At the 14-month follow-up, the patient was pain free and had no signs of disease recurrence. PMID:27843734

  4. [Empyema of the knee joint in adults: diagnosis and therapy.].

    PubMed

    Mrácek, D

    2000-01-01

    The author presents an overview of the current diagnostic procedures and the scheme used at the author's Department. The article also deals with therapeutical trends including arthroscopic treatment of empyema. Antibiotics necessary for the treatment of the disease are administered empirically. Most often as antibiotics of "the first choice" are recommended penicilin antibiotics with the inhibitor of beta-lactamase. The author points out the necessity of an early and adequate treatment of the empyema of the knee joint as a prevention of serious sequelae on the affected joint. Key words: empyema of the knee joint, diagnosis, therapy.

  5. Computer-aided diagnosis of knee-joint disorders via vibroarthrographic signal analysis: a review.

    PubMed

    Wu, Yunfeng; Krishnan, Sridhar; Rangayyan, Rangaraj M

    2010-01-01

    The knee is the lower-extremity joint that supports nearly the entire weight of the human body. It is susceptible to osteoarthritis and other knee-joint disorders caused by degeneration or loss of articular cartilage. The detection of a knee-joint abnormality at an early stage is important, because it helps increase therapeutic options that may slow down the degenerative process. Imaging-based arthrographic modalities can provide anatomical images of the joint cartilage surfaces, but fail to demonstrate the functional integrity of the cartilage. Knee-joint auscultation, by means of recording the vibroarthrographic (VAG) signal during bending motion of a knee, could be used to develop a noninvasive diagnostic tool. Computer-aided analysis of VAG signals could provide quantitative indices for screening of degenerative conditions of the cartilage surface and staging of osteoarthritis. In addition, the diagnosis of knee-joint pathology by means of VAG signal analysis may reduce the number of semi-invasive diagnostic arthroscopic examinations. This article reviews studies related to VAG signal analysis, first summarizing the pilot studies that demonstrated the diagnostic potential of knee-joint auscultation for the detection of degenerative diseases, and then describing the details of recent progress in analysis of VAG signals using temporal analysis, frequency-domain analysis, time-frequency analysis, and statistical modeling. The decision-making methods used in the related studies are summarized, followed by a comparison of the diagnostic performance achieved by different pattern classifiers. The final section is a perspective on the future and further development of VAG signal analysis.

  6. Effect of BMI on knee joint torques in ergometer rowing.

    PubMed

    Roemer, Karen; Hortobagyi, Tibor; Richter, Chris; Munoz-Maldonado, Yolanda; Hamilton, Stephanie

    2013-12-01

    Although an authoritative panel recommended the use of ergometer rowing as a non-weight-bearing form of exercise for obese adults, the biomechanical characterization of ergometer rowing is strikingly absent. We examined the interaction between body mass index (BMI) relative to the lower extremity biomechanics during rowing in 10 normal weight (BMI 18-25), 10 overweight (BMI 25-30 kg·m⁻²), and 10 obese (BMI > 30 kg·m⁻²) participants. The results showed that BMI affects joint kinematics and primarily knee joint kinetics. The data revealed that high BMI leads to unfavorable knee joint torques, implying increased loads of the medial compartment in the knee joint that could be avoided by allowing more variable foot positioning on future designs of rowing ergometers.

  7. A micromechanical model to predict damage and failure in biological tissues. Application to the ligament-to-bone attachment in the human knee joint.

    PubMed

    Subit, D; Chabrand, P; Masson, C

    2009-02-09

    Computational models are developed in injury biomechanics to assess lesions in biological tissues based on mechanical measurements. The linear mechanics of fracture theory (LMFT) is a common approach to establish injuries based on thresholds (such as force or strain thresholds) which are straightforward to implement and computationally efficient. However, LMFT does not apply to non-linear heterogeneous materials and does not have the ability to predict failure onset. This paper proposes the cohesive zone model theory (CZMT) as an alternative. CZMT focuses on the development of behaviour laws for crack initiation and propagation at an interface that apply within a fibrous material or at the interface between materials. With the view of evaluating CZMT for biological tissues, the model developed by Raous et al. [1999. A consistent model coupling adhesion, friction and unilateral contact. Comput. Methods Appl. Mech. Eng., 177, 383-399] was applied to the ligament-to-bone interface in the human knee joint. This model accounts for adhesion, friction and damage at the interface and provides a smooth transition from total adhesion to complete failure through the intensity of adhesion variable. A 2D finite element model was developed to mimic previous experiments, and the model parameters were determined using a dichotomy method. The model showed good results by its ability to predict damage. The extension to a 3D geometry, with an inverse problem approach, is, however, required to better estimate the model parameters values. Although it is computationally costly, CZMT supplements the improvements achieved in microimaging techniques to support the development of micro/macro approaches in biomechanical modelling.

  8. Blue rubber bleb nevus syndrome with knee joint disorder.

    PubMed

    Doi, Takehiko; Masumoto, Natsuko; Sonoda, Motoshi; Nakayama, Hideki; Mizuno, Yuji

    2016-08-01

    Blue rubber bleb nevus syndrome (BRBNS) involves cutaneous vascular malformation characterized by multiple venous malformations. This commonly affects the skin and gastrointestinal tract. BRBNS is associated with anemia and occasionally involves orthopedic manifestations. A 6-year-old boy was referred to hospital for evaluation of anemia. He presented with a rubber-like soft-tissue mass in the left knee and the right side of the neck, recurrent pain, and fixed flexion contracture of the knee. Blood examination indicated consumption coagulopathy and anemia caused by not only iron-deficiency anemia but also microangiopathy. Endoscopy of the gastrointestinal tract indicated multiple bluish-black sessile venous malformations. Ultrasonography and magnetic resonance imaging of the knee showed intra-articular and intramuscular involvement. Based on these findings, BRBNS with knee joint disorder was diagnosed. With regard to vascular malformations, like other diseases such as inflammatory arthropathy, ultrasonography of the joint may become a new diagnostic approach for evaluating orthopedic manifestations.

  9. Measurement of knee joint motion using digital imaging.

    PubMed

    Bennett, Damien; Hanratty, Brian; Thompson, Neville; Beverland, David

    2009-12-01

    The measurement of joint motion is common practice in many aspects of orthopaedic surgery. A number of techniques and instruments have been developed for this purpose. We describe a method of recording and measuring knee joint motion using digital imaging which demonstrated high inter-observer reliability (r > 0.948) and intra-observer repeatability (r > 0.906). This technique may offer some practical advantages over other methods of measuring joint motion.

  10. Knee Joint Loads and Surrounding Muscle Forces during Stair Ascent in Patients with Total Knee Replacement

    PubMed Central

    Rasnick, Robert; Standifird, Tyler; Reinbolt, Jeffrey A.; Cates, Harold E.

    2016-01-01

    Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis. Unfortunately, difficulty with stair climbing often persists and prolongs the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future healthcare research. Musculoskeletal modeling and simulation approximates joint loading and corresponding muscle forces during a movement. The purpose of this study was to determine if knee joint loadings following TKR are recovered to the level of healthy individuals, and determine the differences in muscle forces causing those loadings. Data from five healthy and five TKR patients were selected for musculoskeletal simulation. Variables of interest included knee joint reaction forces (JRF) and the corresponding muscle forces. A paired samples t-test was used to detect differences between groups for each variable of interest (p<0.05). No differences were observed for peak joint compressive forces between groups. Some muscle force compensatory strategies appear to be present in both the loading and push-off phases. Evidence from knee extension moment and muscle forces during the loading response phase indicates the presence of deficits in TKR in quadriceps muscle force production during stair ascent. This result combined with greater flexor muscle forces resulted in similar compressive JRF during loading response between groups. PMID:27258086

  11. Consideration of equilibrium equations at the hip joint alongside those at the knee and ankle joints has mixed effects on knee joint response during gait.

    PubMed

    Adouni, M; Shirazi-Adl, A

    2013-02-01

    Accurate estimation of muscle forces during daily activities such as walking is critical for a reliable evaluation of loads on the knee joint. To evaluate knee joint muscle forces, the importance of the inclusion of the hip joint alongside the knee and ankle joints when treating the equilibrium equations remains yet unknown. An iterative kinematics-driven finite element model of the knee joint that accounts for the synergy between passive structures and active musculature is employed. The knee joint muscle forces and biomechanical response are predicted and compared with our earlier results that did not account for moment equilibrium equations at the hip joint. This study indicates that inclusion of the hip joint in the optimization along the knee and ankle joints only slightly (<10%) influences total forces in quadriceps, lateral hamstrings and medial hamstrings. As a consequence, even smaller differences are found in predicted ligament forces, contact forces/areas, and cartilage stresses/strains during the stance phase of gait. The distribution of total forces between the uni- and bi-articular muscle components in quadriceps and in lateral hamstrings; however, substantially alter at different stance phases.

  12. Three-dimensional dynamic analysis of knee joint during gait in medial knee osteoarthritis using loading axis of knee.

    PubMed

    Nishino, Katsutoshi; Omori, Go; Koga, Yoshio; Kobayashi, Koichi; Sakamoto, Makoto; Tanabe, Yuji; Tanaka, Masaei; Arakawa, Masaaki

    2015-07-01

    We recently developed a new method for three-dimensional evaluation of mechanical factors affecting knee joint in order to help identify factors that contribute to the progression of knee osteoarthritis (KOA). This study aimed to verify the clinical validity of our method by evaluating knee joint dynamics during gait. Subjects were 41 individuals (14 normal knees; 8 mild KOAs; 19 severe KOAs). The positions of skin markers attached to the body were captured during gait, and bi-planar X-ray images of the lower extremities were obtained in standing position. The positional relationship between the markers and femorotibial bones was determined from the X-ray images. Combining this relationship with gait capture allowed for the estimation of relative movement between femorotibial bones. We also calculated the point of intersection of loading axis of knee on the tibial proximal surface (LAK point) to analyze knee joint dynamics. Knee flexion range in subjects with severe KOA during gait was significantly smaller than that in those with normal knees (p=0.011), and knee adduction in those with severe KOA was significantly larger than in those with mild KOA (p<0.000). LAK point was locally loaded on the medial compartment of the tibial surface as KOA progressed, with LAK point of subjects with severe KOA rapidly shifting medially during loading response. Local loading and medial shear force were applied to the tibial surface during stance phase as medial KOA progressed. Our findings suggest that our method is useful for the quantitative evaluation of mechanical factors that affect KOA progression.

  13. Modeling the Human Knee for Assistive Technologies

    PubMed Central

    Sartori, Massimo; Reggiani, Monica; Pagello, Enrico; Lloyd, David G.

    2013-01-01

    In this paper, we use motion capture technology together with an EMG-driven musculoskeletal model of the knee joint to predict muscle behavior during human dynamic movements. We propose a muscle model based on infinitely stiff tendons and show this allows speeding up 250 times the computation of muscle force and the resulting joint moment calculation with no loss of accuracy with respect to the previously developed elastictendon model. We then integrate our previously developed method for the estimation of 3-D musculotendon kinematics in the proposed EMG-driven model. This new code enabled the creation of a standalone EMG-driven model that was implemented and run on an embedded system for applications in assistive technologies such as myoelectrically controlled prostheses and orthoses. PMID:22911539

  14. Interprofessional approach for teaching functional knee joint anatomy.

    PubMed

    Meyer, Jakob J; Obmann, Markus M; Gießler, Marianne; Schuldis, Dominik; Brückner, Ann-Kathrin; Strohm, Peter C; Sandeck, Florian; Spittau, Björn

    2017-03-01

    Profound knowledge in functional and clinical anatomy is a prerequisite for efficient diagnosis in medical practice. However, anatomy teaching does not always consider functional and clinical aspects. Here we introduce a new interprofessional approach to effectively teach the anatomy of the knee joint. The presented teaching approach involves anatomists, orthopaedists and physical therapists to teach anatomy of the knee joint in small groups under functional and clinical aspects. The knee joint courses were implemented during early stages of the medical curriculum and medical students were grouped with students of physical therapy to sensitize students to the importance of interprofessional work. Evaluation results clearly demonstrate that medical students and physical therapy students appreciated this teaching approach. First evaluations of following curricular anatomy exams suggest a benefit of course participants in knee-related multiple choice questions. Together, the interprofessional approach presented here proves to be a suitable approach to teach functional and clinical anatomy of the knee joint and further trains interprofessional work between prospective physicians and physical therapists as a basis for successful healthcare management.

  15. Knee Joint Dysfunctions That Influence Gait in Cerebrovascular Injury

    PubMed Central

    Lucareli, Paulo Roberto Garcia; Greve, Julia Maria D’Andrea

    2008-01-01

    INTRODUCTION There is still no consensus among different specialists on the subject of kinematic variation during the hemiparetic gait, including the main changes that take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility. One of the most frequently discussed joints is the knee. OBJECTIVES This study aims to evaluate the variables found in the angular kinematics of knee joint, and to describe the alterations found in the hemiparetic gait resulting from cerebrovascular injury. METHODS This study included 66 adult patients of both genders with a diagnosis of either right or left hemiparesis resulting from ischemic cerebrovascular injury. All the participants underwent three-dimensional gait evaluation, an the angular kinematics of the joint knee were selected for analysis. RESULTS The results were distributed into four groups formed based on the median of the gait speed and the side of hemiparesis. CONCLUSIONS The relevant clinical characteristics included the important mechanisms of loading response in the stance, knee hyperextension in single stance, and reduction of the peak flexion and movement amplitude of the knee in the swing phase. These mechanisms should be taken into account when choosing the best treatment. We believe that the findings presented here may aid in preventing the occurrence of the problems found, and also in identifying the origin of these problems. PMID:18719753

  16. Rabbit knee model of post-traumatic joint contractures: the long-term natural history of motion loss and myofibroblasts.

    PubMed

    Hildebrand, Kevin A; Sutherland, Craig; Zhang, Mei

    2004-03-01

    Our objective is to describe the natural history of motion loss with time and myofibroblast numbers in a rabbit knee model of post-traumatic joint contractures. Twenty-eight skeletally mature New Zealand White female rabbits had five-mm-squares of cortical bone removed from the medial and lateral femoral condyles of the right knee. A Kirschner wire (K-wire) was used to immobilize the knee joint in maximum flexion. A second operation was performed 8 weeks later to remove the K-wire. The rabbits were divided into four groups depending on the time of remobilization; 0, 8, 16 or 32 weeks. The average flexion contracture of the experimental knees in the 0-week and 8-week remobilization groups (38 degrees and 33 degrees, respectively) were significantly greater when compared with the values of the unoperated contralateral knees (8 degrees). The average flexion contractures of the experimental knees in the 16-week and 32-week remobilization groups were also greater than the unoperated contralateral knees, although they were not statistically significant. The average flexion contractures of the 16-week and 32-week groups were 19 degrees and 18 degrees, respectively, indicating a stabilization of the motion loss. Myofibroblast numbers in the posterior joint capsules were elevated 4-5x in the knees with contractures when compared to the contralateral knees. The initial decrease in severity followed by stabilization of motion loss and the association of motion loss with myofibroblasts mimics the human scenario of permanent post-traumatic joint contractures.

  17. Three dimensional patient-specific collagen architecture modulates cartilage responses in the knee joint during gait.

    PubMed

    Räsänen, Lasse P; Mononen, Mika E; Lammentausta, Eveliina; Nieminen, Miika T; Jurvelin, Jukka S; Korhonen, Rami K

    2016-01-01

    Site-specific variation of collagen fibril orientations can affect cartilage stresses in knee joints. However, this has not been confirmed by 3-D analyses. Therefore, we present a novel method for evaluation of the effect of patient-specific collagen architecture on time-dependent mechanical responses of knee joint cartilage during gait. 3-D finite element (FE) models of a human knee joint were created with the collagen architectures obtained from T2 mapped MRI (patient-specific model) and from literature (literature model). The effect of accuracy of the implementation of collagen fibril architecture into the model was examined by using a submodel with denser FE mesh. Compared to the literature model, fibril strains and maximum principal stresses were reduced especially in the superficial/middle regions of medial tibial cartilage in the patient-specific model after the loading response of gait (up to -413 and -26%, respectively). Compared to the more coarsely meshed joint model, the patient-specific submodel demonstrated similar strain and stress distributions but increased values particularly in the superficial cartilage regions (especially stresses increased >60%). The results demonstrate that implementation of subject-specific collagen architecture of cartilage in 3-D modulates location- and time-dependent mechanical responses of human knee joint cartilage. Submodeling with more accurate implementation of collagen fibril architecture alters cartilage stresses particularly in the superficial/middle tissue.

  18. Modelling and Simulation of the Knee Joint with a Depth Sensor Camera for Prosthetics and Movement Rehabilitation

    NASA Astrophysics Data System (ADS)

    Risto, S.; Kallergi, M.

    2015-09-01

    The purpose of this project was to model and simulate the knee joint. A computer model of the knee joint was first created, which was controlled by Microsoft's Kinect for Windows. Kinect created a depth map of the knee and lower leg motion independent of lighting conditions through an infrared sensor. A combination of open source software such as Blender, Python, Kinect SDK and NI_Mate were implemented for the creation and control of the simulated knee based on movements of a live physical model. A physical size model of the knee and lower leg was also created, the movement of which was controlled remotely by the computer model and Kinect. The real time communication of the model and the robotic knee was achieved through programming in Python and Arduino language. The result of this study showed that Kinect in the modelling of human kinematics and can play a significant role in the development of prosthetics and other assistive technologies.

  19. Robotic control in knee joint replacement surgery.

    PubMed

    Davies, B L; Rodriguez y Baena, F M; Barrett, A R W; Gomes, M P S F; Harris, S J; Jakopec, M; Cobb, J P

    2007-01-01

    A brief history of robotic systems in knee arthroplasty is provided. The place of autonomous robots is then discussed and compared to more recent 'hands-on' robotic systems that can be more cost effective. The case is made for robotic systems to have a clear justification, with improved benefits compared to those from cheaper navigation systems. A number of more recent, smaller, robot systems for knee arthroplasty are also described. A specific example is given of an active constraint medical robot, the ACROBOT system, used in a prospective randomized controlled trial of unicondylar robotic knee arthroplasty in which the robot was compared to conventional surgery. The results of the trial are presented together with a discussion of the need for measures of accuracy to be introduced so that the efficacy of the robotic surgery can be immediately identified, rather than have to wait for a number of years before long-term clinical improvements can be demonstrated.

  20. Correlation Between Magnetic Resonance Imaging and Arthroscopic Findings in the Knee Joint

    PubMed Central

    Khan, Hayat Ahmad; Ahad, Humayun; Sharma, Pradeep; Bajaj, Pankaj; Hassan, Nazia; Kamal, Younis

    2015-01-01

    Background: The knee joint is the largest and the most complex joint of the human body. It is not covered by any thick muscular covering anteriorly. Objectives: The purpose of this study was to explore the diagnostic capabilities of clinical examination, magnetic resonance imaging (MRI), and arthroscopy in traumatic disorders of the knee joint, to seek correlation between clinical findings, MRI findings and arthroscopic. Patients and Methods: A total of 26 patients with a presentation suggestive of traumatic knee pathology were studied prospectively. A detailed history was taken and relevant clinical examination was done, which was followed by MRI of the knee. The patients were scheduled for arthroscopy under general/spinal anesthesia, whenever indicated. Results: Keeping arthroscopic examination as standard, the correlation between clinical and arthroscopy showed a sensitivity of 80%, specificity of 86%, accuracy of 63.16%, negative predictive value of 93.48%; whereas MRI vs. arthroscopy showed a sensitivity of 74.42%, specificity of 93.10%, accuracy of 84.21%, and negative predictive value of 88.04%. Conclusions: The clinical examination is an important and accurate diagnostic modality for evaluation of traumatic derangement of the knee joint. It is noninvasive, easy, available, and valuable diagnostic modality. The MRI is an accurate diagnostic modality. It can be used whenever there is an uncertain indication for arthroscopy. However, costs have to be kept in mind, especially in patients with low socio-economic status. PMID:25825695

  1. Alpha 5 Integrin Mediates Osteoarthritic Changes in Mouse Knee Joints

    PubMed Central

    Candela, Maria Elena; Wang, Chao; Gunawardena, Aruni T.; Zhang, Kairui; Cantley, Leslie; Yasuhara, Rika; Usami, Yu; Francois, Noelle; Iwamoto, Masahiro; van der Flier, Arjan; Zhang, Yejia; Qin, Ling; Han, Lin; Enomoto-Iwamoto, Motomi

    2016-01-01

    Osteoarthritis (OA) is one of most common skeletal disorders and can affect synovial joints such as knee and ankle joints. α5 integrin, a major fibronectin receptor, is expressed in articular cartilage and has been demonstrated to play roles in synovial joint development and in the regulation of chondrocyte survival and matrix degradation in articular cartilage. We hypothesized that α5 integrin signaling is involved in pathogenesis of OA. To test this, we generated compound mice that conditionally ablate α5 integrin in the synovial joints using the Gdf5Cre system. The compound mice were born normally and had an overall appearance similar to the control mice. However, when the mutant mice received the OA surgery, they showed stronger resistance to osteoarthritic changes than the control. Specifically the mutant knee joints presented lower levels of cartilage matrix and structure loss and synovial changes and showed stronger biomechanical properties than the control knee joints. These findings indicate that α5 integrin may not be essential for synovial joint development but play a causative role in induction of osteoarthritic changes. PMID:27280771

  2. Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis.

    PubMed

    Ju, Sung-Bum; Park, Gi Duck; Kim, Sang-Soo

    2015-08-01

    [Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.

  3. 21 CFR 888.3500 - Knee joint femorotibial metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/composite semi... § 888.3500 Knee joint femorotibial metal/composite semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite semi-constrained cemented prosthesis is a...

  4. 21 CFR 888.3490 - Knee joint femorotibial metal/composite non-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/composite non... § 888.3490 Knee joint femorotibial metal/composite non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite non-constrained cemented prosthesis is a...

  5. 21 CFR 888.3490 - Knee joint femorotibial metal/composite non-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/composite non... § 888.3490 Knee joint femorotibial metal/composite non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite non-constrained cemented prosthesis is a...

  6. 21 CFR 888.3490 - Knee joint femorotibial metal/composite non-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/composite non... § 888.3490 Knee joint femorotibial metal/composite non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite non-constrained cemented prosthesis is a...

  7. 21 CFR 888.3500 - Knee joint femorotibial metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/composite semi... § 888.3500 Knee joint femorotibial metal/composite semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite semi-constrained cemented prosthesis is a...

  8. 21 CFR 888.3500 - Knee joint femorotibial metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/composite semi... § 888.3500 Knee joint femorotibial metal/composite semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite semi-constrained cemented prosthesis is a...

  9. 21 CFR 888.3500 - Knee joint femorotibial metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/composite semi... § 888.3500 Knee joint femorotibial metal/composite semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite semi-constrained cemented prosthesis is a...

  10. 21 CFR 888.3490 - Knee joint femorotibial metal/composite non-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/composite non... § 888.3490 Knee joint femorotibial metal/composite non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite non-constrained cemented prosthesis is a...

  11. 21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/polymer non... § 888.3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer non-constrained cemented prosthesis is a device intended...

  12. 21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/polymer semi... § 888.3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer semi-constrained cemented prosthesis is a device...

  13. 21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/polymer semi... § 888.3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer semi-constrained cemented prosthesis is a device...

  14. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellofemoral polymer/metal semi... § 888.3540 Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis. (a) Identification. A knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis is a...

  15. 21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellofemorotibial metal/polymer... Devices § 888.3565 Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis is a...

  16. 21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellofemorotibial polymer/metal/metal... § 888.3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis. (a) Identification. A knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis is a...

  17. 21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/polymer semi... § 888.3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer semi-constrained cemented prosthesis is a device...

  18. 21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint patellofemorotibial polymer/metal/metal... § 888.3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis. (a) Identification. A knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis is a...

  19. 21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/polymer non... § 888.3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer non-constrained cemented prosthesis is a device intended...

  20. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  1. 21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellofemorotibial metal/polymer... Devices § 888.3565 Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis is a...

  2. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellofemoral polymer/metal semi... § 888.3540 Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis. (a) Identification. A knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis is a...

  3. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellofemoral polymer/metal semi... § 888.3540 Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis. (a) Identification. A knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis is a...

  4. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  5. 21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/polymer non... § 888.3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer non-constrained cemented prosthesis is a device intended...

  6. 21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint patellofemorotibial metal/polymer... Devices § 888.3565 Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis is a...

  7. 21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellofemorotibial metal/polymer... Devices § 888.3565 Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis is a...

  8. 21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/polymer semi... § 888.3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer semi-constrained cemented prosthesis is a device...

  9. 21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/polymer semi... § 888.3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer semi-constrained cemented prosthesis is a device...

  10. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellofemoral polymer/metal semi... § 888.3540 Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis. (a) Identification. A knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis is a...

  11. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  12. 21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellofemorotibial polymer/metal/metal... § 888.3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis. (a) Identification. A knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis is a...

  13. 21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/polymer non... § 888.3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer non-constrained cemented prosthesis is a device intended...

  14. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  15. 21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellofemorotibial metal/polymer... Devices § 888.3565 Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis is a...

  16. 21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellofemorotibial polymer/metal/metal... § 888.3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis. (a) Identification. A knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis is a...

  17. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  18. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint patellofemoral polymer/metal semi... § 888.3540 Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis. (a) Identification. A knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis is a...

  19. 21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/polymer non... § 888.3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer non-constrained cemented prosthesis is a device intended...

  20. 21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellofemorotibial polymer/metal/metal... § 888.3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis. (a) Identification. A knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis is a...

  1. 21 CFR 888.3490 - Knee joint femorotibial metal/composite non-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/composite non... § 888.3490 Knee joint femorotibial metal/composite non-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite non-constrained cemented prosthesis is a...

  2. 21 CFR 888.3500 - Knee joint femorotibial metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/composite semi... § 888.3500 Knee joint femorotibial metal/composite semi-constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/composite semi-constrained cemented prosthesis is a...

  3. Knee joint forces during downhill walking with hiking poles.

    PubMed

    Schwameder, H; Roithner, R; Müller, E; Niessen, W; Raschner, C

    1999-12-01

    The aim of this study was to determine external and internal loads on the knee joint during downhill walking with and without hiking poles. Kinematic, kinetic and electromyographic data were collected from eight males during downhill walking on a ramp declined at 25 degrees. Planar knee joint moments and forces were calculated using a quasi-static knee model. The results were analysed for an entire pole-cycle as well as differentiated between single and double support phases and between each step of a pole-cycle. Significant differences between downhill walking with and without hiking poles were observed for peak and average magnitudes of ground reaction force, knee joint moment, and tibiofemoral compressive and shear forces (12-25%). Similar reductions were found in patellofemoral compressive force, the quadriceps tendon force and the activity of the vastus lateralis; however, because of a high variability, these differences were not significant. The reductions seen during downhill walking with hiking poles compared with unsupported downhill walking were caused primarily by the forces applied to the hiking poles and by a change in posture to a more forward leaning position of the upper body, with the effect of reducing the knee moment arm.

  4. Experimental joint immobilization in guinea pigs. Effects on the knee joint

    NASA Technical Reports Server (NTRS)

    Marcondesdesouza, J. P.; Machado, F. F.; Sesso, A.; Valeri, V.

    1980-01-01

    In young and adult guinea pigs, the aftermath experimentally induced by the immobilization of the knee joint in hyperextended forced position was studied. Joint immobilization which varied from one to nine weeks was attained by plaster. Eighty knee joints were examined macro and microscopically. Findings included: (1) muscular hypotrophy and joint stiffness in all animals, directly proportional to the length of immobilization; (2) haemoarthrosis in the first week; (3) intra-articular fibrous tissue proliferation ending up with fibrous ankylosis; (4) hyaline articular cartilage erosions; (5) various degrees of destructive menisci changes. A tentative explanation of the fibrous tissue proliferation and of the cartilage changes is offered.

  5. Electrical noise to a knee joint stabilizes quiet bipedal stance.

    PubMed

    Kimura, Tetsuya; Kouzaki, Motoki

    2013-04-01

    Studies have shown that a minute, noise-like electrical stimulation (ES) of a lower limb joint stabilizes one-legged standing (OS), possibly due to the noise-enhanced joint proprioception. To demonstrate the practical utility of this finding, we assessed whether the bipedal stance (BS), relatively stable and generally employed in daily activities, is also stabilized by the same ES method. Twelve volunteers maintained quiet BS with or without an unperceivable, noise-like ES of a knee joint. The results showed that the average amplitude, peak-to-peak amplitude, and standard deviation of the foot center of pressure in the anteroposterior direction were significantly attenuated by the ES (P<0.05). These results indicate that the BS also can be stabilized by an unperceivable, noise-like ES of a knee joint.

  6. Elbow and knee joint for hard space suits

    NASA Technical Reports Server (NTRS)

    Vykukal, H. C.

    1986-01-01

    An elbow or knee joint for a hard space suit or similar usage is formed of three serially connected rigid sections which have truncated spherical configurations. The ends of each section form solid geometric angles, and the sections are interconnected by hermetically sealed ball bearings. The outer two sections are fixed together for rotation in a direction opposite to rotation of the center section. A preferred means to make the outer sections track each other in rotation comprises a rotatable continuous bead chain which engages sockets circumferentially spaced on the facing sides of the outer races of the bearings. The joint has a single pivot point and the bearing axes are always contained in a single plane for any articulation of the joint. Thus flexure of the joint simulates the coplanar flexure of the knee or elbow and is not susceptible to lockup.

  7. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury

    PubMed Central

    Wellsandt, Elizabeth; Gardinier, Emily S.; Manal, Kurt; Axe, Michael J.; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2015-01-01

    Background Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Hypothesis Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Study Design Case-control study; Level of evidence, 3. Methods Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Results Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs −0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: −0.001 ± 0.032 N·m·s/kg·m [nonOA] vs −0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs −0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak

  8. Three-dimensional reconstruction of subject-specific knee joint using computed tomography and magnetic resonance imaging image data fusions.

    PubMed

    Dong, Yuefu; Mou, Zhifang; Huang, Zhenyu; Hu, Guanghong; Dong, Yinghai; Xu, Qingrong

    2013-10-01

    Three-dimensional reconstruction of human body from a living subject can be considered as the first step toward promoting virtual human project as a tool in clinical applications. This study proposes a detailed protocol for building subject-specific three-dimensional model of knee joint from a living subject. The computed tomography and magnetic resonance imaging image data of knee joint were used to reconstruct knee structures, including bones, skin, muscles, cartilages, menisci, and ligaments. They were fused to assemble the complete three-dimensional knee joint. The procedure was repeated three times with respect to three different methods of reference landmarks. The accuracy of image fusion in accordance with different landmarks was evaluated and compared with each other. The complete three-dimensional knee joint, which included 21 knee structures, was accurately developed. The choice of external or anatomical landmarks was not crucial to improve image fusion accuracy for three-dimensional reconstruction. Further work needs to be done to explore the value of the reconstructed three-dimensional knee joint for its biomechanics and kinematics.

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

    PubMed

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

    2015-01-01

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

  10. Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis.

    PubMed

    Hunt, Michael A; Bennell, Kim L

    2011-08-01

    Knee joint loading, as measured by the knee adduction moment (KAM), has been implicated in the pathogenesis of knee osteoarthritis (OA). Given that the KAM can only currently be accurately measured in the laboratory setting with sophisticated and expensive equipment, its utility in the clinical setting is limited. This study aimed to determine the ability of a combination of four clinical measures to predict KAM values. Three-dimensional motion analysis was used to calculate the peak KAM at a self-selected walking speed in 47 consecutive individuals with medial compartment knee OA and varus malalignment. Clinical predictors included: body mass; tibial angle measured using an inclinometer; walking speed; and visually observed trunk lean toward the affected limb during the stance phase of walking. Multiple linear regression was performed to predict KAM magnitudes using the four clinical measures. A regression model including body mass (41% explained variance), tibial angle (17% explained variance), and walking speed (9% explained variance) explained a total of 67% of variance in the peak KAM. Our study demonstrates that a set of measures easily obtained in the clinical setting (body mass, tibial alignment, and walking speed) can help predict the KAM in people with medial knee OA. Identifying those patients who are more likely to experience high medial knee loads could assist clinicians in deciding whether load-modifying interventions may be appropriate for patients, whilst repeated assessment of joint load could provide a mechanism to monitor disease progression or success of treatment.

  11. Soft tissue artifact compensation in knee kinematics by multi-body optimization: Performance of subject-specific knee joint models.

    PubMed

    Clément, Julien; Dumas, Raphaël; Hagemeister, Nicola; de Guise, Jaques A

    2015-11-05

    Soft tissue artifact (STA) distort marker-based knee kinematics measures and make them difficult to use in clinical practice. None of the current methods designed to compensate for STA is suitable, but multi-body optimization (MBO) has demonstrated encouraging results and can be improved. The goal of this study was to develop and validate the performance of knee joint models, with anatomical and subject-specific kinematic constraints, used in MBO to reduce STA errors. Twenty subjects were recruited: 10 healthy and 10 osteoarthritis (OA) subjects. Subject-specific knee joint models were evaluated by comparing dynamic knee kinematics recorded by a motion capture system (KneeKG™) and optimized with MBO to quasi-static knee kinematics measured by a low-dose, upright, biplanar radiographic imaging system (EOS(®)). Errors due to STA ranged from 1.6° to 22.4° for knee rotations and from 0.8 mm to 14.9 mm for knee displacements in healthy and OA subjects. Subject-specific knee joint models were most effective in compensating for STA in terms of abduction-adduction, inter-external rotation and antero-posterior displacement. Root mean square errors with subject-specific knee joint models ranged from 2.2±1.2° to 6.0±3.9° for knee rotations and from 2.4±1.1 mm to 4.3±2.4 mm for knee displacements in healthy and OA subjects, respectively. Our study shows that MBO can be improved with subject-specific knee joint models, and that the quality of the motion capture calibration is critical. Future investigations should focus on more refined knee joint models to reproduce specific OA knee geometry and physiology.

  12. Knee Power Is an Important Parameter in Understanding Medial Knee Joint Load in Knee Osteoarthritis

    PubMed Central

    Calder, Kristina M; Acker, Stacey M; Arora, Neha; Beattie, Karen A; Callaghan, Jack P; Adachi, Jonathan D; Maly, Monica R

    2014-01-01

    Objective To determine the extent to which knee extensor strength and power explain variance in knee adduction moment (KAM) peak and impulse in clinical knee osteoarthritis (OA). Methods Fifty-three adults (mean ± SD age 61.6 ± 6.3 years, 11 men) with clinical knee OA participated. The KAM waveform was calculated from motion and force data and ensemble averaged from 5 walking trials. The KAM peak was normalized to body mass (Nm/kg). The mean KAM impulse reflected the mean total medial knee load during stride (Nm × seconds). For strength, the maximum knee extensor moment attained from maximal voluntary isometric contractions (MVIC) was normalized to body mass (Nm/kg). For power, the maximum knee extensor power during isotonic contractions, with the resistance set at 25% of MVIC, was normalized to body mass (W/kg). Covariates included age, sex, knee pain on the Knee Injury and Osteoarthritis Outcome Score, gait speed, and body mass index (BMI). Relationships of the KAM peak and impulse with strength and power were examined using sequential stepwise forward linear regressions. Results Covariates did not explain variance in the KAM peak. While extensor strength did not, peak knee extensor power explained 8% of the variance in the KAM peak (P = 0.02). Sex and BMI explained 24% of the variance in the KAM impulse (P < 0.05). Sex, BMI, and knee extensor power explained 31% of the variance in the KAM impulse (P = 0.02), with power contributing 7% (P < 0.05). Conclusion Knee extensor power was more important than isometric knee strength in understanding medial knee loads during gait. PMID:24920175

  13. Injury tolerance and moment response of the knee joint to combined valgus bending and shear loading.

    PubMed

    Bose, Dipan; Bhalla, Kavi S; Untaroiu, Costin D; Ivarsson, B Johan; Crandall, Jeff R; Hurwitz, Shepard

    2008-06-01

    Valgus bending and shearing of the knee have been identified as primary mechanisms of injuries in a lateral loading environment applicable to pedestrian-car collisions. Previous studies have reported on the structural response of the knee joint to pure valgus bending and lateral shearing, as well as the estimated injury thresholds for the knee bending angle and shear displacement based on experimental tests. However, epidemiological studies indicate that most knee injuries are due to the combined effects of bending and shear loading. Therefore, characterization of knee stiffness for combined loading and the associated injury tolerances is necessary for developing vehicle countermeasures to mitigate pedestrian injuries. Isolated knee joint specimens (n=40) from postmortem human subjects were tested in valgus bending at a loading rate representative of a pedestrian-car impact. The effect of lateral shear force combined with the bending moment on the stiffness response and the injury tolerances of the knee was concurrently evaluated. In addition to the knee moment-angle response, the bending angle and shear displacement corresponding to the first instance of primary ligament failure were determined in each test. The failure displacements were subsequently used to estimate an injury threshold function based on a simplified analytical model of the knee. The validity of the determined injury threshold function was subsequently verified using a finite element model. Post-test necropsy of the knees indicated medial collateral ligament injury consistent with the clinical injuries observed in pedestrian victims. The moment-angle response in valgus bending was determined at quasistatic and dynamic loading rates and compared to previously published test data. The peak bending moment values scaled to an average adult male showed no significant change with variation in the superimposed shear load. An injury threshold function for the knee in terms of bending angle and shear

  14. The minimal effective dose of cis-9-cetylmyristoleate (CMO) in persons presenting with knee joint pain

    PubMed Central

    Lee, Sang Chul; Jin, Hyun Seung; Joo, Young; Kim, Yong Chul; Moon, Jee Youn

    2017-01-01

    Abstract Background: Nutraceuticals containing cis-9-cetylmyristoleate (CMO) are used to improve knee pain despite the lack of placebo-controlled studies in humans. The aim of the study was to explore the minimal effective dose of CMO for relieving knee joint pain. Methods: Twenty-eight subjects with mild degree arthritic knee joint pain were randomized into 4 groups; groups A, B, and C that contained 100%, 80%, and 62.4% of fatty acid component with 12.5% of CMO, and control group D (starch 100%). The pain intensity, functional disability, and the Patient Global Impression of Change (PGIC) were assessed for a 12-week ingestion period. Results: Compared to group D (n = 6), there were significant differences in pain score in group A (n = 7, P = 0.005) and group C (n = 7, P = 0.012), but not significant in group B (n = 6, P = 0.180). Western Ontario and McMaster Universities Arthritis (WOMAC) score decreased significantly in groups A and C. The PGIC was positive in the majority (>50%) in groups A, B, and C, whereas negative in 83.3% in group D (control). Conclusion: CMO is effective in alleviating knee pain in persons with mild degree arthritis of the knee joint, at an effective dose of 62.4%. PMID:28248869

  15. Sex Differences in Proximal Control of the Knee Joint

    PubMed Central

    Mendiguchia, Jurdan; Ford, Kevin R.; Quatman, Carmen E.; Alentorn-Geli, Eduard; Hewett, Timothy E.

    2014-01-01

    Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbopelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries. PMID:21688868

  16. Fatigue Effects on Knee Joint Stability During Two Jump Tasks in Women

    PubMed Central

    Ortiz, Alexis; Olson, Sharon L.; Etnyre, Bruce; Trudelle-Jackson, Elaine E.; Bartlett, William; Venegas-Rios, Heidi L.

    2010-01-01

    Dynamic knee joint stability may be affected by the onset of metabolic fatigue during sports participation that could increase the risk for knee injury. The purpose of this investigation was to determine the effects of metabolic fatigue on knee muscle activation, peak knee joint angles, and peak knee internal moments in young women during 2 jumping tasks. Fifteen women (mean age: 24.6 ± 2.6 years) participated in one nonfatigued session and one fatigued session. During both sessions, peak knee landing flexion and valgus joint angles, peak knee extension and varus/valgus internal moments, electromyographic (EMG) muscle activity of the quadriceps and hamstrings, and quadriceps/hamstring EMG cocontraction ratio were measured. The tasks consisted of a single-legged drop jump from a 40-cm box and a 20-cm, up-down, repeated hop task. The fatigued session included a Wingate anaerobic protocol followed by performance of the 2 tasks. Although participants exhibited greater knee injury–predisposing factors during the fatigued session, such as lesser knee flexion joint angles, greater knee valgus joint angles, and greater varus/valgus internal joint moments for both tasks, only knee flexion during the up-down task was statistically significant (p = 0.028). Metabolic fatigue may perhaps predispose young women to knee injuries by impairing dynamic knee joint stability. Training strength-endurance components and the ability to maintain control of body movements in either rested or fatigued situations might help reduce injuries in young women athletes. PMID:20300024

  17. Fatigue effects on knee joint stability during two jump tasks in women.

    PubMed

    Ortiz, Alexis; Olson, Sharon L; Etnyre, Bruce; Trudelle-Jackson, Elaine E; Bartlett, William; Venegas-Rios, Heidi L

    2010-04-01

    Dynamic knee joint stability may be affected by the onset of metabolic fatigue during sports participation that could increase the risk for knee injury. The purpose of this investigation was to determine the effects of metabolic fatigue on knee muscle activation, peak knee joint angles, and peak knee internal moments in young women during 2 jumping tasks. Fifteen women (mean age: 24.6 +/- 2.6 years) participated in one nonfatigued session and one fatigued session. During both sessions, peak knee landing flexion and valgus joint angles, peak knee extension and varus/valgus internal moments, electromyographic (EMG) muscle activity of the quadriceps and hamstrings, and quadriceps/hamstring EMG cocontraction ratio were measured. The tasks consisted of a single-legged drop jump from a 40-cm box and a 20-cm, up-down, repeated hop task. The fatigued session included a Wingate anaerobic protocol followed by performance of the 2 tasks. Although participants exhibited greater knee injury-predisposing factors during the fatigued session, such as lesser knee flexion joint angles, greater knee valgus joint angles, and greater varus/valgus internal joint moments for both tasks, only knee flexion during the up-down task was statistically significant (p = 0.028). Metabolic fatigue may perhaps predispose young women to knee injuries by impairing dynamic knee joint stability. Training strength-endurance components and the ability to maintain control of body movements in either rested or fatigued situations might help reduce injuries in young women athletes.

  18. [Dynamic loads at knee joint of trans-tibial amputee on different terrains].

    PubMed

    Jia, Xiaohong; Zhang, Ming; Fan, Yubo; Wang, Rencheng

    2005-04-01

    Dynamic loads at knee joint of amputee are fundamental for rehabilitation of knee injury and prosthesis design. In this paper, a 3-D model for calculation of dynamic load at knee joint of trans-tibial amputee was developed. Gait analysis was done on three terrains including normal level walking, upstairs and downstairs. Dynamic loads at knee joint were calculated during one gait cycle. The results show that gait patterns and dynamic loads at knee joint were different among these three terrains. Although the general waveforms were about the same, the motion range of knee joint, ground reaction forces and loads at knee joint when walking upstairs or downstairs were larger than those in a normal level walking. The quantitative findings provide the theoretical basis of gait analysis and prosthesis design for trans-tibial amputee.

  19. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint)

    PubMed Central

    Jethava, Nilesh G.; Dudhamal, Tukaram S.; Gupta, Sanjay Kumar

    2015-01-01

    Introduction: Sandhigata Vata is one of Vata Vyadhi characterized by the symptoms such as Sandhishoola (joint pain) and Sandhishopha (swelling of joint). Osteoarthritis (OA) is degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to Sandhigata Vata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn) is one which gives instant relief from pain by balancing local Vata and Kapha Dosha without any untoward effects. Aim: To evaluate the efficacy of Agnikarma with Rajata and Loha Dhatu Shalaka in the management of Janugata Sandhivata (OA of knee joint). Materials and Methods: A total of 28 diagnosed patients of Janugata Sandhivata were registered and randomly divided into two groups. In Group-A, Agnikarma was done with Rajata Shalaka while in Group-B Agnikarma was performed by Loha Shalaka in four sittings. Assessment in relief of signs and symptoms was done by weekly interval, and Student's t-test was applied for statistical analysis. Results: Group-A provided 76.31% relief in pain while Group-B provided 83.77% relief. Relief from crepitus was observed in 57.13% of patients of Group-A, while 57.92% of patients of Group-B. There was statistically insignificant difference between both the groups. Loha Shalaka provided better result in pain relief than Rajata Shalaka. Conclusion: Agnikarma is effective nonpharmacological, parasurgical procedure for pain management in Sandhigata Vata (OA of knee joint). PMID:26730134

  20. Ultrasonographic evaluation of knee joint cartilage in rheumatoid arthritis patients.

    PubMed

    Batalov, A Z; Kuzmanova, S I; Penev, D P

    2000-01-01

    The non-invasive methods used to study joint cartilage are restricted in their scope. No direct visualization of the joint cartilage is possible in conventional radiology and tomography and the decrease in joint space is only indirect evidence for joint destruction. CT is a radiologic method for direct visualization of joint cartilage but its diagnostic precision in the evaluation of early cartilage lesions is limited because it can not produce an image in a plane other than the transversal plane perpendicular to the direction of the main axis of the body and because it has limited spatial resolution. Other methods for direct visualization of joint cartilage are arthrography and arthroscopy which are little used in clinical practice because of their invasiveness and limited indications. MRI is a promising technique but its usage is limited by the high price and limited accessibility. Our object in the present study was to evaluate the significance of arthro-sonography in the diagnosis of early arthritic lesions of knee cartilage, based on the ultrasonographic assessment of the joint surface and cartilage thickness. Femoral cartilage was our choice for the study as there is statistically well documented high incidence of early arthritic changes in this area; moreover, the area is easily accessible for ultrasound evaluation using a scan perpendicular to the articular surface, incl. the cases with complete flexion of the knee joint, where the pressure areas of the condyles are apositioned to the tibial plateau. Using a 7.5 MHz transducer we managed to measure and document early arthritic changes in joint thickness and the contour of the joint surfaces before they can be detected using routine radiologic methods.

  1. Raman spectroscopy of dried synovial fluid droplets as a rapid diagnostic for knee joint damage

    NASA Astrophysics Data System (ADS)

    Esmonde-White, Karen A.; Mandair, Gurjit S.; Raaii, Farhang; Roessler, Blake J.; Morris, Michael D.

    2008-02-01

    Human synovial fluid droplets were investigated using drop deposition in combination with Raman spectroscopy. Following informed consent, synovial fluid was obtained from forty human patients with various severities of knee pain and/or osteoarthritis at the time of knee arthroscopy or total joint replacement. Synovial fluid was aspirated from the knee joint of each patient and stored at -80°C until examination by near-infrared Raman spectroscopy. Synovial fluid aspirates from the knee joint of each patient were deposited onto a clean fused silica microscope slide and the droplet dried under ambient laboratory conditions. Each droplet was illuminated by a line-focused or a ring-focused 785 nm laser. As the droplet dries, biofluid components segregated based on solubility differences and a deposit that is spatially heterogeneous was made. Spectra taken from the droplet edges and center were dominated by protein bands and showed the presence of at least two protein moieties in the droplet. Band area and band height ratios (1410 cm -1/1450 cm -1) showed the greatest change between specimens from patients with mild/early osteoarthritis compared to those with severe/late stage osteoarthritis. The greatest differences were found in the center of the droplet, which contains more soluble protein components than the edges.

  2. Is it possible to reduce the knee joint compression force during level walking with hiking poles?

    PubMed

    Jensen, S B; Henriksen, M; Aaboe, J; Hansen, L; Simonsen, E B; Alkjaer, T

    2011-12-01

    Walking with hiking poles has become a popular way of exercising. Walking with poles is advocated as a physical activity that significantly reduces the loading of the hip, knee and ankle joints. We have previously observed that pole walking does not lead to a reduction of the load on the knee joint. However, it is unclear whether an increased force transmitted through the poles can reduce the load on the knee joint. Thus, the purpose of the present study was to investigate if an increased load transmitted through the arms to the poles could reduce the knee joint compression force during level walking with poles. We hypothesized that an increased pole force would result in a reduction of the knee joint compression force. Gait analyses from 10 healthy subjects walking with poles were obtained. The pole force was measured simultaneously during the gait analyses. The knee joint compression forces were estimated by using a biomechanical knee joint model. The results showed that the subjects were able to increase the pole force by 2.4 times the normal pole force. However, this did not lead to a reduction in the knee joint compressive force and we rejected our hypothesis. In conclusion, the use of poles during level walking does not seem to reduce knee joint compressive loads. However, it is possible that the use of poles in other populations (e.g. osteoarthritis patients) and in terrain would unload the knee joint. This should be investigated in the future.

  3. Design and evaluation of a quasi-passive knee exoskeleton for investigation of motor adaptation in lower extremity joints.

    PubMed

    Shamaei, Kamran; Cenciarini, Massimo; Adams, Albert A; Gregorczyk, Karen N; Schiffman, Jeffrey M; Dollar, Aaron M

    2014-06-01

    In this study, we describe the mechanical design and control scheme of a quasi-passive knee exoskeleton intended to investigate the biomechanical behavior of the knee joint during interaction with externally applied impedances. As the human knee behaves much like a linear spring during the stance phase of normal walking gait, the exoskeleton implements a spring across the knee in the weight acceptance (WA) phase of the gait while allowing free motion throughout the rest of the gait cycle, accomplished via an electromechanical clutch. The stiffness of the device is able to be varied by swapping springs, and the timing of engagement/disengagement changed to accommodate different loading profiles. After describing the design and control, we validate the mechanical performance and reliability of the exoskeleton through cyclic testing on a mechanical knee simulator. We then describe a preliminary experiment on three healthy adults to evaluate the functionality of the device on both left and right legs. The kinetic and kinematic analyses of these subjects show that the exoskeleton assistance can partially/fully replace the function of the knee joint and obtain nearly invariant moment and angle profiles for the hip and ankle joints, and the overall knee joint and exoskeleton complex under the applied moments of the exoskeleton versus the control condition, implying that the subjects undergo a considerable amount of motor adaptation in their lower extremities to the exoskeletal impedances, and encouraging more in-depth future experiments with the device.

  4. The reliability of knee joint position testing using electrogoniometry

    PubMed Central

    Piriyaprasarth, Pagamas; Morris, Meg E; Winter, Adele; Bialocerkowski, Andrea E

    2008-01-01

    Background The current investigation examined the inter- and intra-tester reliability of knee joint angle measurements using a flexible Penny and Giles Biometric® electrogoniometer. The clinical utility of electrogoniometry was also addressed. Methods The first study examined the inter- and intra-tester reliability of measurements of knee joint angles in supine, sitting and standing in 35 healthy adults. The second study evaluated inter-tester and intra-tester reliability of knee joint angle measurements in standing and after walking 10 metres in 20 healthy adults, using an enhanced measurement protocol with a more detailed electrogoniometer attachment procedure. Both inter-tester reliability studies involved two testers. Results In the first study, inter-tester reliability (ICC[2,10]) ranged from 0.58–0.71 in supine, 0.68–0.79 in sitting and 0.57–0.80 in standing. The standard error of measurement between testers was less than 3.55° and the limits of agreement ranged from -12.51° to 12.21°. Reliability coefficients for intra-tester reliability (ICC[3,10]) ranged from 0.75–0.76 in supine, 0.86–0.87 in sitting and 0.87–0.88 in standing. The standard error of measurement for repeated measures by the same tester was less than 1.7° and the limits of agreement ranged from -8.13° to 7.90°. The second study showed that using a more detailed electrogoniometer attachment protocol reduced the error of measurement between testers to 0.5°. Conclusion Using a standardised protocol, reliable measures of knee joint angles can be gained in standing, supine and sitting by using a flexible goniometer. PMID:18211714

  5. Who should have knee joint replacement surgery for osteoarthritis?

    PubMed

    Dieppe, Paul; Lim, Keith; Lohmander, Stefan

    2011-05-01

    Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10-20% of people who have this surgery are unhappy with the outcome, and have persistent pain. In this article we briefly discuss the variations in utilization of knee joint replacement, and then outline four different approaches to the selection and prioritisation of patients for this procedure. Consensus criteria, including appropriateness criteria are available, but if produced by professionals alone, they may conflict with the views of patients and the public. Databases and cohort studies can be used to attempt relating outcomes to baseline characteristics, but at present we can only account for a small percentage of the variance with this technique. Finally, we propose use of the 'capacity to benefit framework' to attempt providing guidance to both patients and healthcare professionals.

  6. Auditory display of knee-joint vibration signals

    NASA Astrophysics Data System (ADS)

    Krishnan, Sridhar; Rangayyan, Rangaraj M.; Bell, G. Douglas; Frank, Cyril B.

    2001-12-01

    Sounds generated due to rubbing of knee-joint surfaces may lead to a potential tool for noninvasive assessment of articular cartilage degeneration. In the work reported in the present paper, an attempt is made to perform computer-assisted auscultation of knee joints by auditory display (AD) of vibration signals (also known as vibroarthrographic or VAG signals) emitted during active movement of the leg. Two types of AD methods are considered: audification and sonification. In audification, the VAG signals are scaled in time and frequency using a time-frequency distribution to facilitate aural analysis. In sonification, the instantaneous mean frequency and envelope of the VAG signals are derived and used to synthesize sounds that are expected to facilitate more accurate diagnosis than the original signals by improving their aural quality. Auditory classification experiments were performed by two orthopedic surgeons with 37 VAG signals including 19 normal and 18 abnormal cases. Sensitivity values (correct detection of abnormality) of 31%, 44%, and 83%, and overall classification accuracies of 53%, 40%, and 57% were obtained with the direct playback, audification, and sonification methods, respectively. The corresponding d' scores were estimated to be 1.10, -0.36, and 0.55. The high sensitivity of the sonification method indicates that the technique could lead to improved detection of knee-joint abnormalities; however, additional work is required to improve its specificity and achieve better overall performance.

  7. Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

    PubMed

    Ota, Susumu; Nakashima, Takeshi; Morisaka, Ayako; Omachi, Takaaki; Ida, Kunio; Kawamura, Morio

    2010-12-01

    Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.

  8. A Novel Method of Evaluating Knee Joint Stability of Patients with Knee Osteoarthritis: Multiscale Entropy Analysis with A Knee-Aiming Task.

    PubMed

    Zhou, Diange; Zhang, Shijie; Zhang, Hui; Jiang, Long; Zhang, Jue; Fang, Jing

    2017-03-23

    Deteriorating knee stability is a local risk factor that reflects the occurrence and aggregative of osteoarthritis (OA). Despite the many biomechanics-based methods for assessing the structural stability of knee joints in clinics, these methods have many limitations. The stability of the knee joint relies on not only biomechanical factors, but also proprioception and the central nervous system. In this study, we attempt to depict the stability of knee joint from a holistic viewpoint, and a novel index of knee joint stability (IKJS) was thus extracted. We compared the differences of IKJS in 57 healthy volunteers and 55 patients with OA before and after total knee replacement (TKR). Analysis of Variance results demonstrated that there existed significant differences in IKJS among the three participating groups (<0.0001). Also, the IKJS of the operated leg in patients with knee OA increased remarkably after TKR (p < 0.0001). Furthermore, the results of the experiment suggested that the IKJS has sufficient reproducibility (ICC = 0.80). In conclusion, the proposed IKJS that employs the knee-aiming task is feasible for quantitatively determining knee stability. It can provide a potentially valuable and convenient tool to evaluate the effect of postoperative rehabilitation for patients with knee OA.

  9. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry.

    PubMed

    Myles, Christine M; Rowe, Philip J; Walker, Colin R C; Nutton, Richard W

    2002-08-01

    The functional ranges of movement of the knee were investigated in a group of patients with knee osteoarthritis (n = 42, mean age 70 years) before, 4 months and at 18-24 months after total knee arthroplasty and then compared with age matched normal subjects (n = 20, mean age 67 years). Flexible electrogoniometry was used to record the maximum flexion-extension angle, the minimum flexion-extension angle and flexion-extension excursions of both knees during eleven functional activities along with the active and passive knee joint range of motion measured using a manual goniometer. Over the eleven functional activities the patients pre-operatively exhibited 28% less knee joint excursion than normal age matched subjects. By 18-24 months following total knee arthroplasty only 2% of this deficit was recovered. Statistically this recovery was only significant in level walking, slope ascent and slope descent. A greater range of movement was measured in a non-weight bearing position than was used in weight bearing functional activity. It is concluded that total knee arthroplasty gives rise to little improvement in knee motion during functional activities and that functional range of movement of the knee remains limited when compared to normal knee function for a minimum of 18 months following operation.

  10. Interlimb symmetry of dynamic knee joint stiffness and co-contraction is maintained in early stage knee osteoarthritis.

    PubMed

    Collins, A T; Richardson, R T; Higginson, J S

    2014-08-01

    Individuals with knee OA often exhibit greater co-contraction of antagonistic muscle groups surrounding the affected joint which may lead to increases in dynamic joint stiffness. These detrimental changes in the symptomatic limb may also exist in the contralateral limb, thus contributing to its risk of developing knee osteoarthritis. The purpose of this study is to investigate the interlimb symmetry of dynamic knee joint stiffness and muscular co-contraction in knee osteoarthritis. Muscular co-contraction and dynamic knee joint stiffness were assessed in 17 subjects with mild to moderate unilateral medial compartment knee osteoarthritis and 17 healthy control subjects while walking at a controlled speed (1.0m/s). Paired and independent t-tests determined whether significant differences exist between groups (p<0.05). There were no significant differences in dynamic joint stiffness or co-contraction between the OA symptomatic and OA contralateral group (p=0.247, p=0.874, respectively) or between the OA contralateral and healthy group (p=0.635, p=0.078, respectively). There was no significant difference in stiffness between the OA symptomatic and healthy group (p=0.600); however, there was a slight trend toward enhanced co-contraction in the symptomatic knees compared to the healthy group (p=0.051). Subjects with mild to moderate knee osteoarthritis maintain symmetric control strategies during gait.

  11. Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis

    PubMed Central

    2013-01-01

    Background Dynamic joint loading, particularly the external knee adduction moment (KAM), is an important surrogate measure for the medio-lateral distribution of force across the knee joint in people with knee osteoarthritis (OA). Foot motion may alter the load on the medial tibiofemoral joint and hence affect the KAM. Therefore, this study aimed to investigate the relationship between tibia, rearfoot and forefoot motion in the frontal and transverse planes and the KAM in people with medial compartment knee OA. Method Motion of the knee, tibia, rearfoot and forefoot and knee moments were evaluated in 32 patients with clinically and radiographically-confirmed OA, predominantly in the medial compartment. Pearson’s correlation coefficient was used to investigate the association between peak values of tibia, rearfoot and forefoot motion in the frontal and transverse planes and 1st peak KAM, 2nd peak KAM, and the knee adduction angular impulse (KAAI). Results Lateral tilt of the tibia was significantly associated with increased 1st peak KAM (r = 0.60, p < 0.001), 2nd peak KAM (r = 0.67, p = 0.001) and KAAI (r = 0.82, p = 0.001). Increased peak rearfoot eversion was significantly correlated with decreased 2nd peak KAM (r = 0.59, p < 0.001) and KAAI (r = 0.50, p = 0.004). Decreased rearfoot internal rotation was significantly associated with increased 2nd peak KAM (r = −0.44, p = 0.01) and KAAI (r = −0.38, p = 0.02), while decreased rearfoot internal rotation relative to the tibia was significantly associated with increased 2nd peak KAM (r = 0.43, p = 0.01). Significant negative correlations were found between peak forefoot eversion relative to the rearfoot and 2nd peak KAM (r = −0.53, p = 0.002) and KAAI (r = −0.51, p = 0.003) and between peak forefoot inversion and 2nd peak KAM (r = −0.54, p = 0.001) and KAAI (r = −0.48, p = 0.005). Conclusion Increased rearfoot

  12. [Minimally invasive approaches to hip and knee joints for total joint replacement].

    PubMed

    Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F

    2004-11-01

    The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

  13. Type II collagen fragment HELIX-II is a marker for early cartilage lesions but does not predict the progression of cartilage destruction in human knee joint synovial fluid.

    PubMed

    Wei, Xiaochun; Yin, Kun; Li, Pengcui; Wang, Huan; Ding, Juan; Duan, Wangping; Wei, Lei

    2013-07-01

    To determine whether there is a direct correlation between the concentration of type II collagen fragment HELIX-II in synovial fluid and the severity of cartilage damage at the knee joint, 83 patients who had undergone knee arthroscopy or total knee replacement were enrolled in this study (49% women, mean ± SD age 49.5 ± 19). The content of HELIX-II in the synovial fluid samples was measured by enzyme-linked immunosorbent assay (ELISA). Cartilage damage at the knee joint was classified during arthroscopy or direct surgical observation, using the Outerbridge cartilage damage scoring system. The maximum damage score was defined as the highest score among the six areas of the knee joint, and the cumulative score was defined as the sum of the scores of the six areas of the knee joint. The intra-assay and inter-assay variations of the HELIX-II ELISA were lower than 13 and 15%, respectively. The level of HELIX-II in the severely damaged cartilage groups (cumulative scores = 11-24 or maximum score = 2-4) was much higher than in the slightly damaged cartilage groups (cumulative scores = 0-10 or maximum score = 0-1). The level of HELIX-II in cartilage from severely damaged cartilage groups was significantly higher than in the slightly damaged groups, but no significant difference was detected in the level of HELIX-II among the severely damaged cartilage sub-groups. There was a significant correlation between the HELIX-II concentration in the synovial fluid and the cumulative (r = 0.807) and maximum scores (r = 0.794). Thus, elevated HELIX-II level is correlated with early cartilage lesions, but does not have the sensitivity to predict the progression of severity of cartilage damage in the knee joint.

  14. Effects of wearing ankle weight on knee joint repositioning sense in the elderly.

    PubMed

    Kim, Sooyoung; Jung, Daeun; Han, Jintae; Jung, Jaemin

    2016-09-01

    [Purpose] To investigate the effects of different ankle weights on knee joint repositioning sense in elderly individuals. [Subjects and Methods] Twenty-one subjects were divided for assessment as follows: young (20-30 years, n=10) and elderly (60-70 years, n=11). Knee joint repositioning error was measured by asking the subjects to reposition the target angle of their knee joints while wearing different ankle weights (0%, 0.5%, 1%, and 1.5%) in an open kinetic chain. The Hawk Digital System (60 Hz; Motion Analysis, Santa Rosa, CA, USA) was used to measure knee joint repositioning error. Differences in knee joint repositioning error between the young and elderly groups according to ankle weight load were examined by using two-way mixed repeated-measures analysis of variance. [Results] The knee joint repositioning error was lower with than without ankle weights in both groups. The error value was lowest with the 1.0% weight, though not significantly. Knee joint repositioning error was significantly higher in the elderly under all the ankle weight conditions. [Conclusion] Knee joint repositioning sense can be improved in elderly individuals by wearing proper ankle weights. However, weights that are too heavy might disturb knee joint positioning sense.

  15. Effects of wearing ankle weight on knee joint repositioning sense in the elderly

    PubMed Central

    Kim, Sooyoung; Jung, Daeun; Han, Jintae; Jung, Jaemin

    2016-01-01

    [Purpose] To investigate the effects of different ankle weights on knee joint repositioning sense in elderly individuals. [Subjects and Methods] Twenty-one subjects were divided for assessment as follows: young (20–30 years, n=10) and elderly (60–70 years, n=11). Knee joint repositioning error was measured by asking the subjects to reposition the target angle of their knee joints while wearing different ankle weights (0%, 0.5%, 1%, and 1.5%) in an open kinetic chain. The Hawk Digital System (60 Hz; Motion Analysis, Santa Rosa, CA, USA) was used to measure knee joint repositioning error. Differences in knee joint repositioning error between the young and elderly groups according to ankle weight load were examined by using two-way mixed repeated-measures analysis of variance. [Results] The knee joint repositioning error was lower with than without ankle weights in both groups. The error value was lowest with the 1.0% weight, though not significantly. Knee joint repositioning error was significantly higher in the elderly under all the ankle weight conditions. [Conclusion] Knee joint repositioning sense can be improved in elderly individuals by wearing proper ankle weights. However, weights that are too heavy might disturb knee joint positioning sense. PMID:27799664

  16. Focal cartilage defect compromises fluid-pressure dependent load support in the knee joint.

    PubMed

    Dabiri, Yaghoub; Li, LePing

    2015-06-01

    A focal cartilage defect involves tissue loss or rupture. Altered mechanics in the affected joint may play an essential role in the onset and progression of osteoarthritis. The objective of the present study was to determine the compromised load support in the human knee joint during defect progression from the cartilage surface to the cartilage-bone interface. Ten normal and defect cases were simulated with a previously tested 3D finite element model of the knee. The focal defects were considered in both condyles within high load-bearing regions. Fluid pressurization, anisotropic fibril-reinforcement, and depth-dependent mechanical properties were considered for the articular cartilages and menisci. The results showed that a small cartilage defect could cause 25% reduction in the load support of the knee joint due to a reduced capacity of fluid pressurization in the defect cartilage. A partial-thickness defect could cause a fluid pressure decrease or increase in the remaining underlying cartilage depending on the defect depth. A cartilage defect also increased the shear strain at the cartilage-bone interface, which was more significant with a full-thickness defect. The effect of cartilage defect on the fluid pressurization also depended on the defect sites and contact conditions. In conclusion, a focal cartilage defect causes a fluid-pressure dependent load reallocation and a compromised load support in the joint, which depend on the defect depth, site, and contact condition.

  17. Design of a Model of Knee Joint for Educational Purposes

    ERIC Educational Resources Information Center

    Jastaniah, Saddig; Alganmi, Ohud

    2016-01-01

    Uses of models play an important role by simulating the bone, obviating the need to experiment on humans or animals. The aim of the present study was to access local materials as gypsum and wax is to be tested for performing a knee model matching bone in the density also to explore how students can come to understand function through a model-based…

  18. Lower extremity joint position sense in runners with and without a history of knee overuse injury.

    PubMed

    Foch, Eric; Milner, Clare E

    2012-07-01

    Kinematic and kinetic analyses are routinely implemented to determine if gait differences exist between runners with and without a history of knee injury. Hip and knee kinematic differences have been reported between knee injured and non-injured runners. Yet, there is no consensus on whether these differences are the primary variables contributing to knee injury. Furthermore, there may be additional underlying factors that contribute to the development of injury that cannot be determined by gait analysis. The purpose of this investigation was to determine if joint position sense differences exist in runners with and without a history of knee overuse injury. Sagittal plane knee and hip joint position sense was measured in 13 runners with a history of knee overuse injury and 13 runners with no history of knee overuse injury. Absolute joint position replication error was measured during both a weight bearing and a non-weight bearing condition. Joint position replication errors at each joint were compared among groups and task using a two-way ANOVA with joint task as the repeated measure. Knee and hip joint replication errors were similar between both groups. The weight bearing and non-weight bearing tasks resulted in similar joint position replication errors. There were no interaction effects. In conclusion, knee flexion and hip adduction joint position sense is similar in runners with and without a history of knee overuse injury. Therefore, joint position sense measured via weight bearing and non-weight bearing joint position replication tasks may not play an important role in the development of knee overuse injury.

  19. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing.

    PubMed

    Yulou, Si; Yanqin, Xue; Yongjun, Xing

    2015-01-01

    To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients' indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients' flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients' joint recovery.

  20. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing

    PubMed Central

    Yulou, Si; Yanqin, Xue; Yongjun, Xing

    2015-01-01

    To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery. PMID:28352736

  1. Medial knee joint loading increases in those who respond to hyaluronan injection for medial knee osteoarthritis.

    PubMed

    Briem, Kristin; Axe, Michael J; Snyder-Mackler, Lynn

    2009-11-01

    Knee osteoarthritis (OA) is a cause of decline in function and the medial compartment is often affected. Intraarticular injection of hyaluronic acid (HA) is indicated as a symptom modifying treatment with at least 6 months passing between consecutive injection series. The effects of HA injection on gait variables have not been extensively examined. Therefore, our objective was to investigate the effects of HA injection on gait in people with medial knee OA. Twenty-seven subjects were included; each was tested prior to treatment (baseline), no later than 3 weeks following the last injection (post-HA), and again 5 months after treatment ended (follow-up). Responder criteria were defined to identify responders and non-responders. Subjects underwent 3D gait analysis, muscle activity was sampled, and co-contraction indices were calculated. Responders experienced increased peak knee adduction moments post-HA, whereas non-responders did not. Improved self-report scores were associated with increased knee adduction moments and increased medial co-contraction. Pain relief may result in higher loading onto the already vulnerable medial compartment due to changes in lower limb mechanics and muscle activation patterns. Eventually this may result in a more rapid progression of joint deterioration.

  2. Quantitation of articular surface topography and cartilage thickness in knee joints using stereophotogrammetry.

    PubMed

    Ateshian, G A; Soslowsky, L J; Mow, V C

    1991-01-01

    An analytical stereophotogrammetry (SPG) technique has been developed based upon some of the pioneering work of Selvik [Ph.D. thesis, University of Lund, Sweden (1974)] and Huiskes and coworkers [J. Biomechanics 18, 559-570 (1985)], and represents a fundamental step in the construction of biomechanical models of diarthrodial joints. Using this technique, the precise three-dimensional topography of the cartilage surfaces of various diarthrodial joints has been obtained. The system presented in this paper delivers an accuracy of 90 microns in the least favorable conditions with 95% coverage using the same calibration method as Huiskes et al. (1985). In addition, a method has been developed, using SPG, to quantitatively map the cartilage thickness over the entire articular surface of a joint with a precision of 134 microns (95% coverage). In the present study, our SPG system has been used to quantify the topography, including surface area, of the articular surfaces of the patella, distal femur, tibial plateau, and menisci of the human knee. Furthermore, examples of cartilage thickness maps and corresponding thickness data including coefficient of variation, minimum, maximum, and mean cartilage thickness are also provided for the cartilage surfaces of the knee. These maps illustrate significant variations over the joint surfaces which are important in the determination of the stresses and strains within the cartilage during diarthrodial joint function. In addition, these cartilage surface topographies and thickness data are essential for the development of anatomically accurate finite element models of diarthrodial joints.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Proprioceptive impairments associated with knee osteoarthritis are not generalized to the ankle and elbow joints.

    PubMed

    Shanahan, Camille J; Wrigley, Tim V; Farrell, Michael J; Bennell, Kim L; Hodges, Paul W

    2015-06-01

    The mechanisms for proprioceptive changes associated with knee osteoarthritis (OA) remain elusive. Observations of proprioceptive changes in both affected knees and other joints imply more generalized mechanisms for proprioceptive impairment. However, evidence for a generalized effect remains controversial. This study examined whether joint repositioning proprioceptive deficits are localized to the diseased joint (knee) or generalized across other joints (elbow and ankle) in people with knee OA. Thirty individuals with right knee OA (17 female, 66±7 [mean±SD] years) of moderate/severe radiographic disease severity and 30 healthy asymptomatic controls of comparable age (17 female, 65±8years) performed active joint repositioning tests of the knee, ankle and elbow in randomised order in supine. Participants with knee OA had a larger relative error for joint repositioning of the knee than the controls (OA: 2.7±2.1°, control: 1.6±1.7°, p=.03). Relative error did not differ between groups for the ankle (OA: 2.2±2.5°, control: 1.9±1.3°, p=.50) or elbow (OA: 2.5±3.3°, control: 2.9±2.8°, p=.58). These results are consistent with a mechanism for proprioceptive change that is localized to the knee joint. This could be mediated by problems with mechanoreceptors, processing/relay of somatosensory input to higher centers, or joint-specific interference with cognitive processes by pain.

  4. Involvement of the proximal tibiofibular joint in osteoarthritis of the knee.

    PubMed

    Oztuna, Volkan; Yildiz, Altan; Ozer, Caner; Milcan, Abtullah; Kuyurtar, Fehmi; Turgut, Akin

    2003-12-01

    This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

  5. Evaluation of knee joint forces during kneeling work with different kneepads.

    PubMed

    Xu, Hang; Jampala, Sree; Bloswick, Donald; Zhao, Jie; Merryweather, Andrew

    2017-01-01

    The main purpose of this study is to determine knee joint forces resulting from kneeling work with and without kneepads to quantify how different kneepads redistribute force. Eleven healthy males simulated a tile setting task to different locations during six kneepad states (five different kneepad types and without kneepad). Peak and average forces on the anatomical landmarks of both knees were obtained by custom force sensors. The results revealed that kneepad design can significantly modify the forces on the knee joint through redistribution. The Professional Gel design was preferred among the five tested kneepads which was confirmed with both force measurements and participants' responses. The extreme reaching locations induced significantly higher joint forces on left knee or right knee depending on task. The conclusion of this study is that a properly selected kneepad for specific tasks and a more neutral working posture can modify the force distribution on the knees and likely decrease the risk of knee disorders from kneeling work.

  6. In vivo six-degree-of-freedom knee-joint kinematics in overground and treadmill walking following total knee arthroplasty.

    PubMed

    Guan, Shanyuanye; Gray, Hans A; Schache, Anthony G; Feller, Julian; de Steiger, Richard; Pandy, Marcus G

    2016-10-22

    No data are available to describe six-degree-of-freedom (6-DOF) knee-joint kinematics for one complete cycle of overground walking following total knee arthroplasty (TKA). The aims of this study were firstly, to measure 6-DOF knee-joint kinematics and condylar motion for overground walking following TKA; and secondly, to determine whether such data differed between overground and treadmill gait when participants walked at the same speed during both tasks. A unique mobile biplane X-ray imaging system enabled accurate measurement of 6-DOF TKA knee kinematics during overground walking by simultaneously tracking and imaging the joint. The largest rotations occurred for flexion-extension and internal-external rotation whereas the largest translations were associated with joint distraction and anterior-posterior drawer. Strong associations were found between flexion-extension and adduction-abduction (R(2)  = 0.92), joint distraction (R(2)  = 1.00), and anterior-posterior translation (R(2)  = 0.77), providing evidence of kinematic coupling in the TKA knee. Although the measured kinematic profiles for overground walking were grossly similar to those for treadmill walking, several statistically significant differences were observed between the two conditions with respect to temporo-spatial parameters, 6-DOF knee-joint kinematics, and condylar contact locations and sliding. Thus, caution is advised when making recommendations regarding knee implant performance based on treadmill-measured knee-joint kinematic data. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

  7. Design of a knee joint mechanism that adapts to individual physiology.

    PubMed

    Jiun-Yih Kuan; Pasch, Kenneth A; Herr, Hugh M

    2014-01-01

    This paper describes the design of a new knee joint mechanism, called the Adaptive Coupling Joint (ACJ). The new mechanism has an adaptive trajectory of the center of rotations (COR) that automatically matches those of the attached biological joint. The detailed design is presented as well as characterization results of the ACJ. Conventional exoskeleton and assistive devices usually consider limb joints as a one to three degrees of freedom (DOFs) joint synthesized by multiple one-DOF hinge joints in a single plane. However, the biological joints are complex and usually rotate with respect to a changing COR. As a result, the mismatch between limb joint motion and mechanical interface motion can lead to forces that cause undesired ligament and muscle length changes and internal mechanical changes. These undesired changes contribute to discomfort, as well as to the slippage and sluggish interaction between humans and devices. It is shown that the ACJ can transmit planetary torques from either active or passive devices to the limbs without altering the normal biological joint motion.

  8. A new method to measure post-traumatic joint contractures in the rabbit knee.

    PubMed

    Hildebrand, Kevin A; Holmberg, Michael; Shrive, Nigel

    2003-12-01

    A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9 deg +/- 1.5 deg (mean +/- sd) with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6 deg +/- 7.1 deg, and of the four right knees (tested 26 times) was 12.0 deg +/- 10.9 deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint

  9. Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics.

    PubMed

    Lucchetti, L; Cappozzo, A; Cappello, A; Della Croce, U

    1998-11-01

    In three dimensional (3-D) human movement analysis using close-range photogrammetry, surface marker clusters deform and rigidly move relative to the underlying bone. This introduces an important artefact (skin movement artefact) which propagates to bone position and orientation and joint kinematics estimates. This occurs to the extent that those joint attitude components that undergo small variations result in totally unreliable values. This paper presents an experimental and analytical procedure, to be included in a subject-specific movement analysis protocol, which allows for the assessment of skin movement artefacts and, based on this knowledge, for their compensation. The effectiveness of this procedure was verified with reference to knee-joint kinematics and to the artefacts caused by the hip movements on markers located on the thigh surface. Quantitative validation was achieved through experimental paradigms whereby prior reliable information on the target joint kinematics was available. When position and orientation of bones were determined during the execution of a motor task, using a least-squares optimal estimator, but the rigid artefactual marker cluster movement was not dealt with, then knee joint translations and rotations were affected by root mean square errors (r.m.s.) up to 14 mm and 6 degrees, respectively. When the rigid artefactual movement was also compensated for, then r.m.s errors were reduced to less than 4 mm and 3 degrees, respectively. In addition, errors originally strongly correlated with hip rotations, after compensation, lost this correlation.

  10. Septic arthritis caused by Mycobacterium fortuitum and Mycobacterium abscessus in a prosthetic knee joint: case report and review of literature.

    PubMed

    Wang, Shu-Xiang; Yang, Chang-Jen; Chen, Yu-Chuan; Lay, Chorng-Jang; Tsai, Chen-Chi

    2011-01-01

    Nontuberculous mycobacterium (NTM) is an infrequent cause of prosthetic knee joint infections. Simultaneous infection with different NTM species in a prosthetic knee joint has not been previously reported. A case of prosthetic knee joint infection caused by Mycobacterium abscessus and M. fortuitum is described in this report. The patient was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of prosthetic knee joint infection caused by NTM are reviewed.

  11. Intra-articular pressures and joint mechanics: should we pay attention to effusion in knee osteoarthritis?

    PubMed

    Rutherford, Derek James

    2014-09-01

    What factors play a role to ensure a knee joint does what it should given the demands of moving through the physical environment? This paper aims to probe the hypothesis that intra-articular joint pressures, once a topic of interest, have been left aside in contemporary frameworks in which we now view knee joint function. The focus on ligamentous deficiencies and the chondrocentric view of osteoarthritis, while important, have left little attention to the consideration of other factors that can impair joint function across the lifespan. Dynamic knee stability is required during every step we take. While there is much known about the role that passive structures and muscular activation play in maintaining a healthy knee joint, this framework does not account for the role that intra-articular joint pressures may have in providing joint stability during motion and how these factors interact. Joint injuries invariably result in some form of intra-articular fluid accumulation. Ultimately, it may be how the knee mechanically responds to this fluid, of which pressure plays a significant role that provides the mechanisms for continued function. Do joint pressures provide an important foundation for maintaining knee function? This hypothesis is unique and argues that we are missing an important piece of the puzzle when attempting to understand implications that joint injury and disease have for joint function.

  12. Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis

    PubMed Central

    Sugaya, Hisashi; Kubota, Shigeki; Onishi, Mio; Kanamori, Akihiro; Sankai, Yoshiyuki; Yamazaki, Masashi

    2016-01-01

    The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality. PMID:27774330

  13. Quasi-stiffness of the knee joint in flexion and extension during the golf swing.

    PubMed

    Choi, Ahnryul; Sim, Taeyong; Mun, Joung Hwan

    2015-01-01

    Biomechanical understanding of the knee joint during a golf swing is essential to improve performance and prevent injury. In this study, we quantified the flexion/extension angle and moment as the primary knee movement, and evaluated quasi-stiffness represented by moment-angle coupling in the knee joint. Eighteen skilled and 23 unskilled golfers participated in this study. Six infrared cameras and two force platforms were used to record a swing motion. The anatomical angle and moment were calculated from kinematic and kinetic models, and quasi-stiffness of the knee joint was determined as an instantaneous slope of moment-angle curves. The lead knee of the skilled group had decreased resistance duration compared with the unskilled group (P < 0.05), and the resistance duration of the lead knee was lower than that of the trail knee in the skilled group (P < 0.01). The lead knee of the skilled golfers had greater flexible excursion duration than the trail knee of the skilled golfers, and of both the lead and trail knees of the unskilled golfers. These results provide critical information for preventing knee injuries during a golf swing and developing rehabilitation strategies following surgery.

  14. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific.

    PubMed

    Astephen Wilson, Janie L; Dunbar, Michael J; Hubley-Kozey, Cheryl L

    2015-01-01

    The future of total knee arthroplasty (TKA) surgery will involve planning that incorporates more patient-specific characteristics. Despite known biological, morphological, and functional differences between men and women, there has been little investigation into knee joint biomechanical and neuromuscular differences between men and women with osteoarthritis, and none that have examined sex-specific biomechanical and neuromuscular responses to TKA surgery. The objective of this study was to examine sex-associated differences in knee kinematics, kinetics and neuromuscular patterns during gait before and after TKA. Fifty-two patients with end-stage knee OA (28 women, 24 men) underwent gait and neuromuscular analysis within the week prior to and one year after surgery. A number of sex-specific differences were identified which suggest a different manifestation of end-stage knee OA between the sexes.

  15. Designs and performance of microprocessor-controlled knee joints.

    PubMed

    Thiele, Julius; Westebbe, Bettina; Bellmann, Malte; Kraft, Marc

    2014-02-01

    In this comparative study, three transfemoral amputee subjects were fitted with four different microprocessor-controlled exoprosthetic knee joints (MPK): C-Leg, Orion, Plié2.0, and Rel-K. In a motion analysis laboratory, objective gait measures were acquired during level walking at different velocities. Subsequent technical analyses, which involved X-ray computed tomography, identified the functional mechanisms of each device and enabled corroboration of the performance in the gait laboratory by the engineering design of the MPK. Gait measures showed that the mean increase of the maximum knee flexion angle at different walking velocities was closest in value to the unaffected contralateral knee (6.2°/m/s) with C-Leg (3.5°/m/s; Rel-K 17.0°/m/s, Orion 18.3°/m/s, and Plié2.0 28.1°/m/s). Technical analyses corroborated that only with Plié2.0 the flexion resistances were not regulated by microprocessor control at different walking velocities. The muscular effort for the initiation of the swing phase, measured by the minimum hip moment, was found to be lowest with C-Leg (-82.1±14.1 Nm; Rel-K -83.59±17.8 Nm, Orion -88.0±16.3 Nm, and Plié2.0 -91.6±16.5 Nm). Reaching the extension stop at the end of swing phase was reliably executed with both Plié2.0 and C-Leg. Abrupt terminal stance phase extension observed with Plié2.0 and Rel-K could be attributed to the absence of microprocessor control of extension resistance.

  16. Structural Simulation of a Bone-Prosthesis System of the Knee Joint

    PubMed Central

    Andrä, Heiko; Battiato, Sebastiano; Bilotta, Giuseppe; Farinella, Giovanni M.; Impoco, Gaetano; Orlik, Julia; Russo, Giovanni; Zemitis, Aivars

    2008-01-01

    In surgical knee replacement, the damaged knee joint is replaced with artificial prostheses. An accurate clinical evaluation must be carried out before applying knee prosthe-ses to ensure optimal outcome from surgical operations and to reduce the probability of having long-term problems. Useful information can be inferred from estimates of the stress acting onto the bone-prosthesis system of the knee joint. This information can be exploited to tailor the prosthesis to the patient's anatomy. We present a compound system for pre-operative surgical planning based on structural simulation of the bone-prosthesis system, exploiting patient-specific data. PMID:27873848

  17. Tribology studies of the natural knee using an animal model in a new whole joint natural knee simulator.

    PubMed

    Liu, Aiqin; Jennings, Louise M; Ingham, Eileen; Fisher, John

    2015-09-18

    The successful development of early-stage cartilage and meniscus repair interventions in the knee requires biomechanical and biotribological understanding of the design of the therapeutic interventions and their tribological function in the natural joint. The aim of this study was to develop and validate a porcine knee model using a whole joint knee simulator for investigation of the tribological function and biomechanical properties of the natural knee, which could then be used to pre-clinically assess the tribological performance of cartilage and meniscal repair interventions prior to in vivo studies. The tribological performance of standard artificial bearings in terms of anterior-posterior (A/P) shear force was determined in a newly developed six degrees of freedom tribological joint simulator. The porcine knee model was then developed and the tribological properties in terms of shear force measurements were determined for the first time for three levels of biomechanical constraints including A/P constrained, spring force semi-constrained and A/P unconstrained conditions. The shear force measurements showed higher values under the A/P constrained condition (predominantly sliding motion) compared to the A/P unconstrained condition (predominantly rolling motion). This indicated that the shear force simulation model was able to differentiate between tribological behaviours when the femoral and tibial bearing was constrained to slide or/and roll. Therefore, this porcine knee model showed the potential capability to investigate the effect of knee structural, biomechanical and kinematic changes, as well as different cartilage substitution therapies on the tribological function of natural knee joints.

  18. Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players.

    PubMed

    Rozzi, S L; Lephart, S M; Gear, W S; Fu, F H

    1999-01-01

    Anterior cruciate ligament injuries are occurring at a higher rate in female athletes compared with their male counterparts. Research in the area of anterior cruciate ligament injury has increasingly focused on the role of joint proprioception and muscle activity in promoting knee joint stability. We measured knee joint laxity, joint kinesthesia, lower extremity balance, the amount of time required to generate peak torque of the knee flexor and extensor musculature, and electromyographically assessed muscle activity in 34 healthy, collegiate-level athletes (average age, 19.6 +/- 1.5 years) who played soccer or basketball or both. Independent t-tests were used to determine significant sex differences. Results revealed that women inherently possess significantly greater knee joint laxity values, demonstrate a significantly longer time to detect the knee joint motion moving into extension, possess significantly superior single-legged balance ability, and produce significantly greater electromyographic peak amplitude and area of the lateral hamstring muscle subsequent to landing a jump. The excessive joint laxity of women appears to contribute to diminished joint proprioception, rendering the knee less sensitive to potentially damaging forces and possibly at risk for injury. Unable to rely on ligamentous structures, healthy female athletes appear to have adopted compensatory mechanisms of increased hamstring activity to achieve functional joint stabilization.

  19. [Disability due to traumas and diseases of a knee joint].

    PubMed

    Strafun, S S; Kostogryz, O A; Rygan, M M; Ilyin, Yu V; Kostogryz, Yu O; Nechyporenko, R V

    2015-02-01

    The invalidism structure was analyzed for patients, suffering consequences of traumas and diseases of a knee joint (KJ). The primary invalidism level because of traumas and diseases of a KJ have constituted in 2013 yr 12.4%. The cause of invalidism in men is predominantly a one-side gonarthrosis, and in women--a bilateral one--due to concurrent aggravating causes (dishormonal changes, excessive body mass). The invalidism indices enhancement is caused by absence of a dispensary follow-up, insufficient treatment on various stages of the disease course, severity and irreversibility of pathological process in a KJ, socio-economic factors, low rehabilitational potential, prognosticated impossibility to conduct a professional-labour rehabilitation in a prepensionable and pensionable age.

  20. Pulsed Tm:YAG laser ablation of knee joint tissues

    NASA Astrophysics Data System (ADS)

    Shi, Wei-Qiang; Vari, Sandor G.; Duffy, J. T.; Miller, J. M.; Weiss, Andrew B.; Fishbein, Michael C.; Grundfest, Warren S.

    1992-06-01

    We investigated the effect of a free-running 2.01 micron pulsed Tm:YAG laser on bovine knee joint tissues. Ablation rates of fresh fibrocartilage, hyaline cartilage, and bone were measured in saline as a function of laser fluence (160 - 640 J/cm2) and fiber core size (400 and 600 microns). All tissues could be effectively ablated and the ablation rate increased linearly with the increasing fluence. Use of fibers of different core sizes, while maintaining constant energy fluence, did not result in significant difference in ablation rate. Histology analyses of the ablated tissue samples reveal average Tm:YAG radiation induced thermal damage (denatunalization) zones ranging between 130 and 540 microns, depending on the laser parameters and the tissue type.

  1. Altered Tibiofemoral Joint Contact Mechanics and Kinematics in Patients with Knee Osteoarthritis and Episodic Complaints of Joint Instability

    PubMed Central

    Farrokhi, Shawn; Voycheck, Carrie A.; Klatt, Brian A.; Gustafson, Jonathan A.; Tashman, Scott; Fitzgerald, G. Kelley

    2014-01-01

    Background To evaluate knee joint contact mechanics and kinematics during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. Methods Forty-three subjects, 11 with medial compartment knee osteoarthritis and self-reported instability (unstable), 7 with medial compartment knee osteoarthritis but no reports of instability (stable), and 25 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a downhill gait task on a treadmill. Findings The medial compartment contact point excursions were longer in the unstable group compared to the stable (p=0.046) and the control groups (p=0.016). The peak medial compartment contact point velocity was also greater for the unstable group compared to the stable (p=0.047) and control groups (p=0.022). Additionally, the unstable group demonstrated a coupled movement pattern of knee extension and external rotation after heel contact which was different than the coupled motion of knee flexion and internal rotation demonstrated by stable and control groups. Interpretation Our findings suggest that knee joint contact mechanics and kinematics are altered during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. The observed longer medial compartment contact point excursions and higher velocities represent objective signs of mechanical instability that may place the arthritic knee joint at increased risk for disease progression. Further research is indicated to explore the clinical relevance of altered contact mechanics and kinematics during other common daily activities and to assess the efficacy of rehabilitation programs to improve altered joint biomechanics in knee osteoarthritis patients with self-reported instability. PMID:24856791

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. Knee Arthritis Without Other Joint Symptoms in the Elderly With Seronegative Elderly Onset Rheumatoid Arthritis

    PubMed Central

    Mine, Takatomo; Ihara, Koichiro; Kawamura, Hiroyuki; Kuriyama, Ryutaro; Date, Ryo

    2016-01-01

    Elderly onset Rheumatoid arthritis (EORA) has important clinical distinctions when compared with younger onset RA (YORA). In knee arthritis of elderly patients, infection, crystal-induced arthritis or EORA should be suspected if elevation of CRP in the preoperative examination and turbid joint effusion in their knee joint are found. Furthermore, if joint swelling and effusion remain after performing total knee arthroplasty (TKA), the infection after TKA, implant debris-related arthritis and EORA should be considered. However, it is difficult to diagnose patients as EORA if Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are negative. The differential diagnosis is very important. PMID:28217205

  5. Characterisation of a knee-joint energy harvester powering a wireless communication sensing node

    NASA Astrophysics Data System (ADS)

    Kuang, Yang; Zhu, Meiling

    2016-05-01

    Human-based energy harvesters are attractive as sustainable replacements for batteries to power wearable or implantable devices and body sensor networks. In the work presented here, a knee-joint energy harvester (KEH) was introduced to power a customer-built wireless communication sensing node (WCSN). The KEH used a mechanical plucking technique to provide sufficient frequency up-conversion—from a few Hz to the resonant frequency of the KEH—so as to generate the high power required. It was actuated by a knee-joint simulator, which reproduced the knee-joint motion of human gaits at a walking frequency of 0.9 Hz. The energy generated was first stored in a reservoir capacitor and then released to the WCSN in a burst mode with the help of an energy aware interface. The WCSN was deployed with a three-axis accelerometer, a temperature sensor, and a light detector for data sensing. A Jennic microcontroller was utilised to collect and transmit the measured data to a base station placed at a distance of 4 m. The energy generation by the KEH and the energy distribution in the system was characterised in real time by an in-house-built set-up. The results showed that the KEH generated an average power output of 1.76 mW when powering the WCSN. After charging the reservoir capacitor for 28.4 s, the KEH can power the WCSN for a 46 ms period every 1.25 s. The results also clearly illustrated how the energy generated by the KEH was distributed in the system and highlighted the importance of using a high performance power management approach to improve the performance of the whole system.

  6. Therapeutic Experience on Stance Control Knee-Ankle-Foot Orthosis With Electromagnetically Controlled Knee Joint System in Poliomyelitis

    PubMed Central

    Kim, Jung-Hwan; Ji, Sang-Goo; Jung, Kang-Jae

    2016-01-01

    A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern. PMID:27152288

  7. The complexity of human walking: a knee osteoarthritis study.

    PubMed

    Kotti, Margarita; Duffell, Lynsey D; Faisal, Aldo A; McGregor, Alison H

    2014-01-01

    This study proposes a framework for deconstructing complex walking patterns to create a simple principal component space before checking whether the projection to this space is suitable for identifying changes from the normality. We focus on knee osteoarthritis, the most common knee joint disease and the second leading cause of disability. Knee osteoarthritis affects over 250 million people worldwide. The motivation for projecting the highly dimensional movements to a lower dimensional and simpler space is our belief that motor behaviour can be understood by identifying a simplicity via projection to a low principal component space, which may reflect upon the underlying mechanism. To study this, we recruited 180 subjects, 47 of which reported that they had knee osteoarthritis. They were asked to walk several times along a walkway equipped with two force plates that capture their ground reaction forces along 3 axes, namely vertical, anterior-posterior, and medio-lateral, at 1000 Hz. Data when the subject does not clearly strike the force plate were excluded, leaving 1-3 gait cycles per subject. To examine the complexity of human walking, we applied dimensionality reduction via Probabilistic Principal Component Analysis. The first principal component explains 34% of the variance in the data, whereas over 80% of the variance is explained by 8 principal components or more. This proves the complexity of the underlying structure of the ground reaction forces. To examine if our musculoskeletal system generates movements that are distinguishable between normal and pathological subjects in a low dimensional principal component space, we applied a Bayes classifier. For the tested cross-validated, subject-independent experimental protocol, the classification accuracy equals 82.62%. Also, a novel complexity measure is proposed, which can be used as an objective index to facilitate clinical decision making. This measure proves that knee osteoarthritis subjects exhibit more

  8. Mechanical characterization and validation of poly (methyl methacrylate)/multi walled carbon nanotube composite for the polycentric knee joint.

    PubMed

    Arun, S; Kanagaraj, S

    2015-10-01

    Trans femoral amputation is one of the most uncomfortable surgeries in patient׳s life, where the prosthesis consisting of a socket, knee joint, pylon and foot is used to do the walking activities. The artificial prosthetic knee joint imitates the functions of human knee to achieve the flexion-extension for the above knee amputee. The objective of present work is to develop a light weight composite material for the knee joint to reduce the metabolic cost of an amputee. Hence, an attempt was made to study the mechanical properties of multi walled carbon nanotubes (MWCNT) reinforced Poly (methyl methacrylate) (PMMA) prepared through melt mixing technique and optimize the concentration of reinforcement. The PMMA nanocomposites were prepared by reinforcing 0, 0.1, 0.2, 0.25, 0.3 and 0.4 wt% of MWCNT using injection moulding machine via twin screw extruder. It is observed that the tensile and flexural strength of PMMA, which were studied as per ASTM D638 and D790, respectively, were increased by 32.9% and 26.3% till 0.25 wt% reinforcement of MWCNT. The experimental results of strength and modulus were compared with theoretical prediction, where a good correlation was noted. It is concluded that the mechanical properties of PMMA were found to be increased to maximum at 0.25 wt% reinforcement of MWCNT, where the Pukanszky model and modified Halpin-Tsai model are suggested to predict the strength and modulus, respectively, of the PMMA/MWCNT composite, which can be opted as a suitable materiel for the development of polycentric knee joint.

  9. Obesity is not associated with increased knee joint torque and power during level walking.

    PubMed

    DeVita, Paul; Hortobágyi, Tibor

    2003-09-01

    While it is widely speculated that obesity causes increased loads on the knee leading to joint degeneration, this concept is untested. The purpose of the study was to identify the effects of obesity on lower extremity joint kinetics and energetics during walking. Twenty-one obese adults were tested at self-selected (1.29m/s) and standard speeds (1.50m/s) and 18 lean adults were tested at the standard speed. Motion analysis and force platform data were combined to calculate joint torques and powers during the stance phase of walking. Obese participants were more erect with 12% less knee flexion and 11% more ankle plantarflexion in self-selected compared to standard speeds (both p<0.02). Obese participants were still more erect than lean adults with approximately 6 degrees more extension at all joints (p<0.05, for each joint) at the standard speed. Knee and ankle torques were 17% and 11% higher (p<0.034 and p<0.041) and negative knee work and positive ankle work were 68% and 11% higher (p<0.000 and p<0.048) in obese participants at the standard speed compared to the slower speed. Joint torques and powers were statistically identical at the hip and knee but were 88% and 61% higher (both p<0.000) at the ankle in obese compared to lean participants at the standard speed. Obese participants used altered gait biomechanics and despite their greater weight, they had less knee torque and power at their self-selected walking speed and equal knee torque and power while walking at the same speed as lean individuals. We propose that the ability to reorganize neuromuscular function during gait may enable some obese individuals to maintain skeletal health of the knee joint and this ability may also be a more accurate risk indicator for knee osteoarthritis than body weight.

  10. Mechanics of the knee. A study of joint and muscle load with clinical applications.

    PubMed

    Nisell, R

    1985-01-01

    The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m - 1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early

  11. Joint immobilization induced hypoxic and inflammatory conditions in rat knee joints.

    PubMed

    Yabe, Yutaka; Hagiwara, Yoshihiro; Suda, Hideaki; Ando, Akira; Onoda, Yoshito; Tsuchiya, Masahiro; Hatori, Kouki; Itoi, Eiji

    2013-01-01

    The purpose of this study was to examine the hypoxic and inflammatory conditions after immobilization in the joint capsule of rat knees. The unilateral knee joints of adult male rats were immobilized with an internal fixator (Im group) for 1 day, 3 days, and 1, 2, 4, 8, and 16 weeks. Sham-operated animals had holes drilled in the femur and tibia and screws inserted without a plate (control group). The number of cells and blood vessels in the capsule were histologically examined. The hypoxic condition in the capsule was histologically examined with a Hypoxyprobe™-1. The gene expressions related to the hypoxic (hypoxia inducible factor-1α, vascular endothelial growth factor, and fibroblast growth factor 2) and inflammatory conditions [interleukin-6 (IL-6), IL-1α, IL-1β, tumor necrosis factor-α, and tumor necrosis factor-β] were evaluated by quantitative reverse transcription polymerase chain reaction. The number of cells was unchanged at 1 day in the two groups; however, the number significantly increased at 3 days in the Im group. The number of blood vessels in the Im group gradually decreased. Strong immunostaining of Hypoxyprobe™-1 around the blood vessels was observed in the Im group. The gene expressions of hypoxia inducible factor-1α and fibroblast growth factor 2 were significantly higher in the Im group compared with those in the control group. The gene expressions of IL-6, IL-1α, IL-1β, and tumor necrosis factor-β were significantly higher in the Im group compared with those in the control group. These data indicated that joint immobilization induced hypoxic and inflammatory conditions in the joint capsule, which might be an initiating factor for joint contracture.

  12. Immediate effect of Masai Barefoot Technology shoes on knee joint moments in women with knee osteoarthritis.

    PubMed

    Tateuchi, Hiroshige; Taniguchi, Masashi; Takagi, Yui; Goto, Yusuke; Otsuka, Naoki; Koyama, Yumiko; Kobayashi, Masashi; Ichihashi, Noriaki

    2014-01-01

    Footwear modification can beneficially alter knee loading in patients with knee osteoarthritis. This study evaluated the effect of Masai Barefoot Technology shoes on reductions in external knee moments in patients with knee osteoarthritis. Three-dimensional motion analysis was used to examine the effect of Masai Barefoot Technology versus control shoes on the knee adduction and flexion moments in 17 women (mean age, 63.6 years) with radiographically confirmed knee osteoarthritis. The lateral and anterior trunk lean values, knee flexion and adduction angles, and ground reaction force were also evaluated. The influence of the original walking pattern on the changes in knee moments with Masai Barefoot Technology shoes was evaluated. The knee flexion moment in early stance was significantly reduced while walking with the Masai Barefoot Technology shoes (0.25±0.14Nm/kgm) as compared with walking with control shoes (0.30±0.19 Nm/kgm); whereas the knee adduction moment showed no changes. Masai Barefoot Technology shoes did not increase compensatory lateral and anterior trunk lean. The degree of knee flexion moment in the original walking pattern with control shoes was correlated directly with its reduction when wearing Masai Barefoot Technology shoes by multiple linear regression analysis (adjusted R2=0.44, P<0.01). Masai Barefoot Technology shoes reduced the knee flexion moment during walking without increasing the compensatory trunk lean and may therefore reduce external knee loading in women with knee osteoarthritis.

  13. Abdominal muscle activity according to knee joint angle during sit-to-stand

    PubMed Central

    Eom, Juri; Rhee, Min-Hyung; Kim, Laurentius Jongsoon

    2016-01-01

    [Purpose] This study assessed the activity of the abdominal muscles according to the angle of the knee joints during sit-to-stand. [Subjects and Methods] Thirty healthy adult males participated in this study. Subjects initiated sit-to-stand at knee joint angles of 60°, 90°, or 120°. An electromyography system was used to measure the maximum voluntary isometric contraction of the rectus abdominis, external oblique, and internal oblique and transverse abdominis muscles. [Results] Percent contraction differed significantly among the three knee joint angles, most notably for the internal oblique and transverse abdominis muscles. [Conclusion] Wider knee joint angles more effectively activate the abdominal muscles, especially those in the deep abdomen, than do narrower angles. PMID:27390431

  14. Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait

    PubMed Central

    Samaan, Michael A.; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas; Majumdar, Sharmila; Souza, Richard B.

    2015-01-01

    Background Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. Methods A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. Findings The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Interpretation Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. PMID:26298706

  15. Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis.

    PubMed

    Zhang, Shao-Lan; Liu, Hong-Qi; Xu, Xiao-Zu; Zhi, Juan; Geng, Jiao-Jiao; Chen, Jin

    2013-01-01

    The aims of this study were to observe the effect of exercise therapy on the function of the knee joint and the levels of cytokines and cytokine-related genes, specifically tumor necrosis factor-α (TNF-α), high sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinase-3 (MMP-3), in the synovial joints of patients with knee osteoarthritis (KOA) and to explore its mechanism of action. A total of 100 KOA patients were divided into a treatment group (n=50) and a control group (n=50) according to the order of admission. The patients in the treatment group were treated with diclofenac sodium combined with exercise therapy and the patients in the control group were treated with diclofenac sodium only. The function of the knee joint and the therapeutic efficacy was evaluated and the TNF-α, hs-CRP and MMP-3 levels in the synovial fluid were measured following 4 weeks of treatment. The results revealed that the knee joint index score and the TNF-α, hs-CRP and MMP-3 levels in the synovial fluid decreased significantly in the KOA patients of the two groups following treatment (P<0.05). Compared with the control group, the knee joint index score and the TNF-α, hs-CRP and MMP-3 levels in the synovial joints were lower and the therapeutic efficacy was increased in the patients of the treatment group (P<0.05). In brief, exercise therapy may decrease cytokine and cytokine-related gene levels in the synovial fluid and inhibit inflammatory factor-mediated cartilage degradation in KOA patients, thus, effectively improving the clinical symptoms of KOA.

  16. Phantom-based multimodal interactions for medical education and training: the Munich Knee Joint Simulator.

    PubMed

    Riener, Robert; Frey, Martin; Pröll, Thomas; Regenfelder, Felix; Burgkart, Rainer

    2004-06-01

    Simulation environments based on virtual reality technologies can support medical education and training. In this paper, the novel approach of an "interactive phantom" is presented that allows a realistic display of haptic contact information typically generated when touching and moving human organs or segments. The key idea of the haptic interface is to attach passive phantom objects to a mechanical actuator. The phantoms look and feel as real anatomical objects. Additional visualization of internal anatomical and physiological information and sound generated during the interaction with the phantom yield a multimodal approach that can increase performance, didactic value, and immersion into the virtual environment. Compared to classical approaches, this multimodal display is convenient to use, provides realistic tactile properties, and can be partly adjusted to different, e.g., pathological properties. The interactive phantom is exemplified by a virtual human knee joint that can support orthopedic education, especially for the training of clinical knee joint evaluation. It is suggested that the technical principle can be transferred to many other fields of medical education and training such as obstetrics and dentistry.

  17. Synovial haemangioma of the knee joint: an unusual cause of knee pain in a 14-month old girl.

    PubMed

    Wen, D W; Tan, T J; Rasheed, S

    2016-06-01

    We report a histologically proven case of synovial haemangioma of the knee in a 14-month old girl who presented to the emergency department with an acute 1-day history of refusing to weight-bear on the right leg and a preceding 3-week history of a right knee lump. Physical examination revealed a non-tender, soft lump over the lateral infrapatellar region. Radiographs revealed a poorly defined soft tissue density over the infrapatellar fat pad and a suprapatellar joint effusion. Ultrasound was used to confirm the presence of a vascular soft tissue mass compatible with a synovial haemangioma within the infrapatellar fat pad which showed both intra-articular and extra-articular extension. There was good correlation of the ultrasound findings with magnetic resonance imaging (MRI), highlighting the potential clinical utility of ultrasound as an alternative imaging modality in establishing the pre-operative diagnosis and extent of a synovial haemangioma about the knee joint.

  18. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint.

    PubMed

    Shanker, V S; Gadikoppula, S; Loeffler, M D

    1998-03-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint.

  19. The use of a neoprene knee sleeve to compensate the deficit in knee joint position sense caused by muscle fatigue.

    PubMed

    Van Tiggelen, D; Coorevits, P; Witvrouw, E

    2008-02-01

    The importance of good proprioceptive abilities is stressed in many rehabilitation protocols. In contrast, it has been shown that muscle fatigue has a negative influence on proprioception. The objective of this study was to evaluate the effects of a neoprene knee sleeve (NKS) on the joint position sense in a fatigued knee joint. Sixty-four healthy subjects underwent four successive assessments of the same active joint repositioning test (AJRT) in an open kinetic chain setting under different conditions. First, each subject performed the AJRT without brace. One knee was braced during the second assessment. Subjects wore the brace for 6 h and were submitted to a fatigue protocol, followed by the third assessment under the same conditions as the previous one. The fourth and last AJRT was performed immediately after the third one but both knees were non-braced. When the subjects wore an NKS, significant differences in repositioning error were demonstrated between both sides. On the braced side, no significant differences were observed between the baseline assessment and the third assessment. NKS compensate the deficit in joint position sense due to fatigue. The use of NKS could be justified as a preventive measure or treatment in subjects to enhance proprioception.

  20. Footwear affects the gearing at the ankle and knee joints during running.

    PubMed

    Braunstein, Bjoern; Arampatzis, Adamantios; Eysel, Peer; Brüggemann, Gert-Peter

    2010-08-10

    The objective of the study was to investigate the adjustment of running mechanics by wearing five different types of running shoes on tartan compared to barefoot running on grass focusing on the gearing at the ankle and knee joints. The gear ratio, defined as the ratio of the moment arm of the ground reaction force (GRF) to the moment arm of the counteracting muscle tendon unit, is considered to be an indicator of joint loading and mechanical efficiency. Lower extremity kinematics and kinetics of 14 healthy volunteers were quantified three dimensionally and compared between running in shoes on tartan and barefoot on grass. Results showed no differences for the gear ratios and resultant joint moments for the ankle and knee joints across the five different shoes, but showed that wearing running shoes affects the gearing at the ankle and knee joints due to changes in the moment arm of the GRF. During barefoot running the ankle joint showed a higher gear ratio in early stance and a lower ratio in the late stance, while the gear ratio at the knee joint was lower during midstance compared to shod running. Because the moment arms of the counteracting muscle tendon units did not change, the determinants of the gear ratios were the moment arms of the GRF's. The results imply higher mechanical stress in shod running for the knee joint structures during midstance but also indicate an improved mechanical advantage in force generation for the ankle extensors during the push-off phase.

  1. Soldier-relevant body borne loads increase knee joint contact force during a run-to-stop maneuver.

    PubMed

    Ramsay, John W; Hancock, Clifford L; O'Donovan, Meghan P; Brown, Tyler N

    2016-12-08

    The purpose of this study was to understand the effects of load carriage on human performance, specifically during a run-to-stop (RTS) task. Using OpenSim analysis tools, knee joint contact force, grounds reaction force, leg stiffness and lower extremity joint angles and moments were determined for nine male military personnel performing a RTS under three load configurations (light, ~6kg, medium, ~20kg, and heavy, ~40kg). Subject-based means for each biomechanical variable were submitted to repeated measures ANOVA to test the effects of load. During the RTS, body borne load significantly increased peak knee joint contact force by 1.2 BW (p<0.001) and peak vertical (p<0.001) and anterior-posterior (p=0.002) ground reaction forces by 0.6 BW and 0.3 BW, respectively. Body borne load also had a significant effect on hip (p=0.026) posture with the medium load and knee (p=0.046) posture with the heavy load. With the heavy load, participants exhibited a substantial, albeit non-significant increase in leg stiffness (p=0.073 and d=0.615). Increases in joint contact force exhibited during the RTS were primarily due to greater GRFs that impact the soldier with each incremental addition of body borne load. The stiff leg, extended knee and large braking force the soldiers exhibited with the heavy load suggests their injury risk may be greatest with that specific load configuration. Further work is needed to determine if the biomechanical profile exhibited with the heavy load configuration translates to unsafe shear forces at the knee joint and consequently, a higher likelihood of injury.

  2. Effects of Kinesiology Taping on Repositioning Error of the Knee Joint after Quadriceps Muscle Fatigue

    PubMed Central

    Han, Jin Tae; Lee, Jung-hoon

    2014-01-01

    [Purpose] The purpose of this study was to identify the effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue. [Subjects] Thirty healthy adults with no orthopaedic or neurological problems participated in this study. [Methods] The repositioning error of the knee joint was measured using a digital goniometer when the subjects extended their dominant-side knee to a random target angle (30°, 45°, or 60°) with their eyes closed, before and after a quadriceps muscle fatigue protocol, and after application of kinesiology tape. [Results] We found that repositioning errors of the dominant-side knee joint increased after quadriceps fatigue compared with no-fatigue conditions. However, kinesiology taping of the quadriceps muscle and patella after quadriceps fatigue significantly decreased repositioning errors of the knee joint. [Conclusion] These results suggest that quadriceps fatigue increases the repositioning error of the knee joint, whereas application of kinesiology tape decreases fatigue-induced joint repositioning error. PMID:25013297

  3. Knee Kinematics Estimation Using Multi-Body Optimisation Embedding a Knee Joint Stiffness Matrix: A Feasibility Study

    PubMed Central

    Richard, Vincent; Lamberto, Giuliano; Lu, Tung-Wu; Cappozzo, Aurelio; Dumas, Raphaël

    2016-01-01

    The use of multi-body optimisation (MBO) to estimate joint kinematics from stereophotogrammetric data while compensating for soft tissue artefact is still open to debate. Presently used joint models embedded in MBO, such as mechanical linkages, constitute a considerable simplification of joint function, preventing a detailed understanding of it. The present study proposes a knee joint model where femur and tibia are represented as rigid bodies connected through an elastic element the behaviour of which is described by a single stiffness matrix. The deformation energy, computed from the stiffness matrix and joint angles and displacements, is minimised within the MBO. Implemented as a “soft” constraint using a penalty-based method, this elastic joint description challenges the strictness of “hard” constraints. In this study, estimates of knee kinematics obtained using MBO embedding four different knee joint models (i.e., no constraints, spherical joint, parallel mechanism, and elastic joint) were compared against reference kinematics measured using bi-planar fluoroscopy on two healthy subjects ascending stairs. Bland-Altman analysis and sensitivity analysis investigating the influence of variations in the stiffness matrix terms on the estimated kinematics substantiate the conclusions. The difference between the reference knee joint angles and displacements and the corresponding estimates obtained using MBO embedding the stiffness matrix showed an average bias and standard deviation for kinematics of 0.9±3.2° and 1.6±2.3 mm. These values were lower than when no joint constraints (1.1±3.8°, 2.4±4.1 mm) or a parallel mechanism (7.7±3.6°, 1.6±1.7 mm) were used and were comparable to the values obtained with a spherical joint (1.0±3.2°, 1.3±1.9 mm). The study demonstrated the feasibility of substituting an elastic joint for more classic joint constraints in MBO. PMID:27314586

  4. First Case Report of a Late Onset Knee Periprosthetic Joint Infection Caused by Lactococcus garvieae

    PubMed Central

    2016-01-01

    Lactococcus garvieae is known as a Gram-positive, catalase-negative, and facultatively anaerobic fish pathogen. The association between Lactococcus spp. and human infectious diseases is described as being mainly associated with lumbar osteomyelitis, hepatic abscess, and infective endocarditis. In the literature of orthopedic post-prosthetic infections, L. garvieae was associated with a case of hip prosthetic infection in a fishmonger woman. We present the case of a 79-year-old male patient with multiple comorbidities, who is admitted to our center with a 5-day history of pain, swelling, and motility disorder of the right knee by the presence of a bicondylar knee replacement surgery, which was performed due to gonarthrosis 17 years ago. The radiographies of the right knee revealed no signs of displacement or loosening of the prothesis. After multiple radical debridements including VAC therapy and targeted antibiotic therapy we have managed to defeat the infection without exchange arthroplasty. Although we could not demonstrate the source of infection, we can only presume that in our case the source of infection was represented by the ingestion of possibly contaminated food. The patient had a habit of eating Nile perch fish (Lates niloticus) every 4 weeks. We illustrated once more the possibility of a late onset L. garvieae related orthopedic periprosthetic joint infection by multiple comorbidities. PMID:27833769

  5. The effect of sustained static kneeling on kinetic and kinematic knee joint gait parameters.

    PubMed

    Kajaks, Tara; Costigan, Patrick

    2015-01-01

    Despite epidemiological evidence for kneeling as an occupational risk factor for knee osteoarthritis, biomechanical evidence is lacking. Gait knee joint mechanics, a common measure used to study knee osteoarthritis initiation, were used in the present study to investigate the effect of sustained static kneeling on the knee. Ten healthy male subjects (24.1 years ± 3.5) performed ten baseline walking trials, followed by a 30-min kneeling protocol and a second set of walking trials. Knee joint moments and angles were calculated during the stance phase. Within-subject root mean squared differences were compared within and between the pre- and post-kneeling gait trials. Differences were observed between the pre-kneeling and post-kneeling walking trails for flexion and adduction knee moments (0.12 Nm/kg ± 0.03, 0.07 Nm/kg ± 0.02) and angles (3.18° ± 1.22 and 1.64° ± 1.15), indicating that sustained static deep-knee flexion kneeling does acutely alter knee joint gait parameters.

  6. Decision making and experience level influence frontal plane knee joint biomechanics during a cutting maneuver.

    PubMed

    Kipp, Kristof; Brown, Tyler N; McLean, Scott G; Palmieri-Smith, Riann M

    2013-12-01

    The purpose of this study was to examine the combined impact of experience and decision making on frontal plane knee joint biomechanics during a cutting maneuver. Kinematic and kinetic data were collected from 12 recreationally active and 18 NCAA Division I female athletes during execution of anticipated and unanticipated single-leg land-and-cut maneuvers. Knee joint abduction angles and external knee joint abduction torques were calculated and discrete peak stance-phase variables were extracted. Angle and torque time-series data were also submitted to separate functional data analyses. Variables derived from the functional data analyses indicated that decision making influenced knee abduction angle and torque time series in the recreational group only. Specifically, these variables pointed to greater knee abduction at the end of stance as well as a greater, albeit delayed peak in knee abduction torque at the beginning of landing in the recreational athletes during the unanticipated condition. In addition, the recreational athletes displayed greater discrete peak knee abduction angles than the Division I athletes regardless of condition. Discrete peak knee abduction torque did not differ between groups or conditions.

  7. Age-related changes in kinematics of the knee joint during deep squat.

    PubMed

    Fukagawa, Shingo; Leardini, Alberto; Callewaert, Barbara; Wong, Pius D; Labey, Luc; Desloovere, Kaat; Matsuda, Shuichi; Bellemans, Johan

    2012-06-01

    Researchers frequently use the deep knee squat as a motor task in order to evaluate the kinematic performance after total knee arthroplasty. Many authors reported about the kinematics of a normal squatting motion, however, little is known on what the influence of aging is. Twenty-two healthy volunteers in various age groups (range 21-75 years) performed a deep knee squat activity while undergoing motion analysis using an optical tracking system. The influence of aging was evaluated with respect to kinematics of the trunk, hip, knee and ankle joints. Older subjects required significantly more time to perform a deep squat, especially during the descending phase. They also had more knee abduction and delayed peak knee flexion. Older subjects were slower in descend than ascend during the squat. Although older subjects had a trend towards less maximal flexion and less internal rotation of the knee compared to younger subjects, this difference was not significant. Older subjects also showed a trend towards more forward leaning of the trunk, resulting in increased hip flexion and anterior thoracic tilt. This study confirmed that some aspects of squat kinematics vary significantly with age, and that the basic methodology employed here can successfully detect these age-related trends. Older subjects had more abduction of the knee joint, and this may indicate the load distribution of the medial and lateral condyles could be different amongst ages. Age-matched control data are therefore required whenever the performance of an implant is evaluated during a deep knee squat.

  8. Knee joint proprioception in ballet dancers and non-dancers.

    PubMed

    Dieling, Simone; van der Esch, Martin; Janssen, Thomas W J

    2014-01-01

    The aim of this study was to evaluate the influence of upper-leg muscle fatigue on knee joint proprioception in 13 ballet dancers and 13 non-dancer controls. Proprioception acuity, expressed as position and motion sense, was measured with an isokinetic dynamometer. The position and motion sense assessments were prior to and immediately after an isokinetic upper-leg muscle fatigue protocol. Participants wore blindfolds for both tasks to eliminate vision, an inflated air splint on their lower leg to neutralize cutaneous sensation, and headphones with white noise during the motion sense task to eliminate auditory cues. Results showed no significant differences in position and motion sense between dancers and controls in the non-fatigued state. In the fatigued state no significant differences were found in position sense between dancers and controls, while controls increased significantly in motion sense error (p = 0.030) and ballet dancers showed no change in motion sense. It is concluded that position sense and motion sense acuity are not affected by muscle fatigue in dancers, but motion sense is affected by muscle fatigue in non-dancers.

  9. Quantitative analysis of the sympathetic innervation of the rat knee joint

    PubMed Central

    CATRE, MEL G.; SALO, PAUL T.

    1999-01-01

    Retrograde tracing with Fluoro-Gold (FG) was used to identify the complete population of knee joint sympathetic postganglionic efferents in the lumbar sympathetic chain of adult female Wistar rats. In 6 rats, the total number and distribution of FG-labelled neurons in the lumbar sympathetic chain was determined. The rat knee joint is supplied by an average of 187±57 sympathetic afferents with the majority at the L3 and L4 levels. Immunohistochemistry using antibodies specific for tyrosine hydroxylase (TH), somatostatin (SS) or vasoactive intestinal polypeptide (VIP) revealed that 33% of knee joint sympathetic afferents contained TH, 42% contained VIP, and none contained somatostatin. Retrograde tracing with FG provided accurate and reproducible labelling of the joint-innervating subpopulation of sympathetic efferent neurons. This model lends itself to the further study of the molecular responses of this neuronal population in the various disorders and conditions affecting joints. PMID:10337955

  10. Hip rotation angle is associated with frontal plane knee joint mechanics during running.

    PubMed

    Sakaguchi, Masanori; Shimizu, Norifumi; Yanai, Toshimasa; Stefanyshyn, Darren J; Kawakami, Yasuo

    2015-02-01

    Inability to control lower extremity segments in the frontal and transverse planes resulting in large knee abduction angle and increased internal knee abduction impulse has been associated with patellofemoral pain (PFP). However, the influence of hip rotation angles on frontal plane knee joint kinematics and kinetics remains unclear. The purpose of this study was to explore how hip rotation angles are related to frontal plane knee joint kinematics and kinetics during running. Seventy runners participated in this study. Three-dimensional marker positions and ground reaction forces were recorded with an 8-camera motion analysis system and a force plate while subjects ran along a 25-m runway at a speed of 4m/s. Knee abduction, hip rotation and toe-out angles, frontal plane lever arm at the knee, internal knee abduction moment and impulse, ground reaction forces and the medio-lateral distance from the ankle joint center to the center of pressure (AJC-CoP) were quantified. The findings of this study indicate that greater hip external rotation angles were associated with greater toe-out angles, longer AJC-CoP distances, smaller internal knee abduction impulses with shorter frontal plane lever arms and greater knee abduction angles. Thus, there appears to exist a conflict between kinematic and kinetic risk factors of PFP, and hip external rotation angle may be a key factor to control frontal plane knee joint kinematics and kinetics. These results may help provide an appropriate manipulation and/or intervention on running style to reduce the risk of PFP.

  11. Knee and hip joint biomechanics are gender-specific in runners with high running mileage.

    PubMed

    Gehring, D; Mornieux, G; Fleischmann, J; Gollhofer, A

    2014-02-01

    Female runners are reported to be more prone to develop specific knee joint injuries than males. It has been suggested that increased frontal plane joint loading might be related to the incidence of these knee injuries in running. The purpose of this study was to evaluate if frontal plane knee and hip joint kinematics and kinetics are gender-specific in runners with high mileage. 3D-kinematics and kinetics were recorded from 16 female and 16 male runners at a speed of 3 m/s, 4 m/s, and 5 m/s. Frontal plane joint angles and joint moments were ascertained and compared between genders among speed conditions. Across all speed conditions, females showed increased hip adduction and reduced knee adduction angles compared to males (p < 0.003). The initial peak in the hip adduction moment was enhanced in females (p = 0.003). Additionally, the hip adduction impulse showed a trend towards an increase in females at slow running speed (p = 0.07). Hip and knee frontal plane joint kinematics are gender-specific. In addition, there are indications that frontal plane joint loading is increased in female runners. Future research should focus on the relationship of these observations regarding overuse running injuries.

  12. Effects of changing speed on knee and ankle joint load during walking and running.

    PubMed

    de David, Ana Cristina; Carpes, Felipe Pivetta; Stefanyshyn, Darren

    2015-01-01

    Joint moments can be used as an indicator of joint loading and have potential application for sports performance and injury prevention. The effects of changing walking and running speeds on joint moments for the different planes of motion still are debatable. Here, we compared knee and ankle moments during walking and running at different speeds. Data were collected from 11 recreational male runners to determine knee and ankle joint moments during different conditions. Conditions include walking at a comfortable speed (self-selected pacing), fast walking (fastest speed possible), slow running (speed corresponding to 30% slower than running) and running (at 4 m · s(-1) ± 10%). A different joint moment pattern was observed between walking and running. We observed a general increase in joint load for sagittal and frontal planes as speed increased, while the effects of speed were not clear in the transverse plane moments. Although differences tend to be more pronounced when gait changed from walking to running, the peak moments, in general, increased when speed increased from comfortable walking to fast walking and from slow running to running mainly in the sagittal and frontal planes. Knee flexion moment was higher in walking than in running due to larger knee extension. Results suggest caution when recommending walking over running in an attempt to reduce knee joint loading. The different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes.

  13. The test-retest reliability of knee joint center location techniques.

    PubMed

    Sinclair, Jonathan; Hebron, Jack; Taylor, Paul J

    2015-04-01

    The principal source of measurement error in three-dimensional analyses is the definition of the joint center about which segmental rotations occur. The hip joint has received considerable attention in three-dimensional modeling analyses yet the reliability of the different techniques for the definition of the knee joint center has yet to be established. This study investigated the reliability of five different knee joint center estimation techniques: femoral epicondyle, femoral condyle, tibial ridge, plugin- gait, and functional. Twelve male participants walked at 1.25 m·s-1 and three-dimensional kinetics/kinematics of the knee and ankle were collected. The knee joint center was defined twice using each technique (test-and-retest) and the joint kinetic/kinematic data were applied to both. Wilcoxon rank tests and intraclass correlation coefficients (ICCs) were used to compare test and retest angular parameters and kinematic waveforms. The results show significant differences in coronal and transverse planes angulation using the tibial ridge, plug-in-gait, and functional methods. The strongest test-retest ICCs were observed for the femoral epicondyle and femoral condyle configurations. The findings from the current investigation advocate that the femoral epicondyle and femoral condyle techniques for the estimation of the knee joint center are currently the most reliable techniques.

  14. Controlled trial of synovectomy of knee and metacarpophalangeal joints in rheumatoid arthritis

    PubMed Central

    1976-01-01

    Arthritis and Rheumatism Council and British Orthopaedic Association (1976).Annals of the Rheumatic Diseases, 35, 437-442. Controlled trial of synovectomy of knee and metacarpophalangeal joints in rheumatoid arthritis. In a multicentre study patients with rheumatoid arthritis judged by prevailing criteria to be suitable for synovectomy of the knee or metacarpophalangeal (MCP) joints were randomly allocated to one of two groups. One group had the operation, the other was observed without operation from a notional corresponding date. 3 years later the outcome of synovectomy was compared with that of observation without synovectomy. Synovectomy of the knee was followed by significantly less pain and tenderness, smaller effusions, and smaller and less frequent erosions and geodes. By contrast, MCP joints were no better clinically or radiographically than those treated conservatively. The results have been compared with those of two other controlled trials, one concerned with the knee and MCP joints, the other only with MCP joints. In the present trial results were more favourable in the knee but comparable in the MCP joints with those reported in the first of these two trials but less favourable in the MCP joints than those observed in the second. PMID:1234410

  15. Primary and secondary restraints of human and ovine knees for simulated in vivo gait kinematics.

    PubMed

    Nesbitt, Rebecca J; Herfat, Safa T; Boguszewski, Daniel V; Engel, Andrew J; Galloway, Marc T; Shearn, Jason T

    2014-06-27

    Knee soft tissue structures are frequently injured, leading to the development of osteoarthritis even with treatment. Understanding how these structures contribute to knee function during activities of daily living (ADLs) is crucial in creating more effective treatments. This study was designed to determine the role of different knee structures during a simulated ADL in both human knees and ovine stifle joints. A six degree-of-freedom robot was used to reproduce each species' in vivo gait while measuring three-dimensional joint forces and torques. Using a semi-randomized selective cutting method, we determined the primary and secondary structures contributing to the forces and torques along and about each anatomical axis. In both species, the bony interaction, ACL, and medial meniscus provided most of the force contributions during stance, whereas the ovine MCL, human bone, and ACLs of both species were the key contributors during swing. This study contributes to our overarching goal of establishing functional tissue engineering parameters for knee structures by further validating biomechanical similarities between the ovine model and the human to provide a platform for measuring biomechanics during an in vivo ADL. These parameters will be used to develop more effective treatments for knee injuries to reduce or eliminate the incidence of osteoarthritis.

  16. Knee joint angle affects EMG-force relationship in the vastus intermedius muscle.

    PubMed

    Saito, Akira; Akima, Hiroshi

    2013-12-01

    It is not understood how the knee joint angle affects the relationship between electromyography (EMG) and force of four individual quadriceps femoris (QF) muscles. The purpose of this study was to examine the effect of the knee joint angle on the EMG-force relationship of the four individual QF muscles, particularly the vastus intermedius (VI), during isometric knee extensions. Eleven healthy men performed 20-100% of maximal voluntary contraction (MVC) at knee joint angles of 90°, 120° and 150°. Surface EMG of the four QF synergists was recorded and normalized by the root mean square during MVC. The normalized EMG of the four QF synergists at a knee joint angle of 150° was significantly lower than that at 90° and 120° (P < 0.05). Comparing the normalized EMG among the four QF synergists, a significantly lower normalized EMG was observed in the VI at 150° as compared with the other three QF muscles (P < 0.05). These results suggest that the EMG-force relationship of the four QF synergists shifted downward at an extended knee joint angle of 150°. Furthermore, the neuromuscular activation of the VI was the most sensitive to change in muscle length among the four QF synergistic muscles.

  17. Whole-body vibration does not influence knee joint neuromuscular function or proprioception.

    PubMed

    Hannah, R; Minshull, C; Folland, J P

    2013-02-01

    This study examined the acute effects of whole-body vibration (WBV) on knee joint position sense and indices of neuromuscular function, specifically strength, electromechanical delay and the rate of force development. Electromyography and electrically evoked contractions were used to investigate neural and contractile responses to WBV. Fourteen healthy males completed two treatment conditions on separate occasions: (1) 5 × 1 min of unilateral isometric squat exercise on a synchronous vibrating platform [30 Hz, 4 mm peak-to-peak amplitude] (WBV) and (2) a control condition (CON) of the same exercise without WBV. Knee joint position sense (joint angle replication task) and quadriceps neuromuscular function were assessed pre-, immediately-post and 1 h post-exercise. During maximum voluntary knee extensions, the peak force (PF(V)), electromechanical delay (EMD(V)), rate of force development (RFD(V)) and EMG of the quadriceps were measured. Twitch contractions of the knee extensors were electrically evoked to assess EMD(E) and RFD(E). The results showed no influence of WBV on knee joint position, EMD(V), PF(V) and RFD(V) during the initial 50, 100 or 150 ms of contraction. Similarly, electrically evoked neuromuscular function and neural activation remained unchanged following the vibration exercise. A single session of unilateral WBV did not influence any indices of thigh muscle neuromuscular performance or knee joint proprioception.

  18. Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces.

    PubMed

    Gerus, Pauline; Sartori, Massimo; Besier, Thor F; Fregly, Benjamin J; Delp, Scott L; Banks, Scott A; Pandy, Marcus G; D'Lima, Darryl D; Lloyd, David G

    2013-11-15

    Estimating tibiofemoral joint contact forces is important for understanding the initiation and progression of knee osteoarthritis. However, tibiofemoral contact force predictions are influenced by many factors including muscle forces and anatomical representations of the knee joint. This study aimed to investigate the influence of subject-specific geometry and knee joint kinematics on the prediction of tibiofemoral contact forces using a calibrated EMG-driven neuromusculoskeletal model of the knee. One participant fitted with an instrumented total knee replacement walked at a self-selected speed while medial and lateral tibiofemoral contact forces, ground reaction forces, whole-body kinematics, and lower-limb muscle activity were simultaneously measured. The combination of generic and subject-specific knee joint geometry and kinematics resulted in four different OpenSim models used to estimate muscle-tendon lengths and moment arms. The subject-specific geometric model was created from CT scans and the subject-specific knee joint kinematics representing the translation of the tibia relative to the femur was obtained from fluoroscopy. The EMG-driven model was calibrated using one walking trial, but with three different cost functions that tracked the knee flexion/extension moments with and without constraint over the estimated joint contact forces. The calibrated models then predicted the medial and lateral tibiofemoral contact forces for five other different walking trials. The use of subject-specific models with minimization of the peak tibiofemoral contact forces improved the accuracy of medial contact forces by 47% and lateral contact forces by 7%, respectively compared with the use of generic musculoskeletal model.

  19. Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces

    PubMed Central

    Gerus, Pauline; Sartori, Massimo; Besier, Thor F.; Fregly, Benjamin J.; Delp, Scott L.; Banks, Scott A.; Pandy, Marcus G.; D’Lima, Darryl D.; Lloyd, David G.

    2013-01-01

    Estimating tibiofemoral joint contact forces is important for understanding the initiation and progression of knee osteoarthritis. However, tibiofemoral contact force predictions are influenced by many factors including muscle forces and anatomical representations of the knee joint. This study aimed to investigate the influence of subject-specific geometry and knee joint kinematics on the prediction of tibiofemoral contact forces using a calibrated EMG-driven neuromusculoskeletal model of the knee. One participant fitted with an instrumented total knee replacement walked at a self-selected speed while medial and lateral tibiofemoral contact forces, ground reaction forces, whole-body kinematics, and lower-limb muscle activity were simultaneously measured. The combination of generic and subject-specific knee joint geometry and kinematics resulted in four different OpenSim models used to estimate muscle-tendon lengths and moment arms. The subject-specific geometric model was created from CT scans and the subject-specific knee joint kinematics representing the translation of the tibia relative to the femur was obtained from fluoroscopy. The EMG-driven model was calibrated using one walking trial, but with three different cost functions that tracked the knee flexion/extension moments with and without constraint over the estimated joint contact forces. The calibrated models then predicted the medial and lateral tibiofemoral contact forces for five other different walking trials. The use of subject-specific models with minimization of the peak tibiofemoral contact forces improved the accuracy of medial contact forces by 47% and lateral contact forces by 7%, respectively compared with the use of generic musculoskeletal model. PMID:24074941

  20. Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females.

    PubMed

    Delahunt, Eamonn; Prendiville, Anna; Sweeney, Lauren; Chawke, Mark; Kelleher, Judy; Patterson, Matt; Murphy, Katie

    2012-08-01

    Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P<0.05) and transverse plane (P<0.05) kinematic profiles, as well as knee joint frontal plane (P<0.05) and sagittal plane (P<0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

  1. Biomechanical comparison of frontal plane knee joint moment arms during normal and Tai Chi walking.

    PubMed

    Jagodinsky, Adam; Fox, John; Decoux, Brandi; Weimar, Wendi; Liu, Wei

    2015-09-01

    [Purpose] Medial knee osteoarthritis, a degenerative joint disease, affects adults. The external knee adduction moment, a surrogate knee-loading measure, has clinical implications for knee osteoarthritis patients. Tai Chi is a promising intervention for pain alleviation in knee osteoarthritis; however, the characteristics of external knee adduction moment during Tai Chi have not been established. [Subjects and Methods] During normal and Tai Chi walking, a gait analysis was performed to compare the external knee adduction moment moment-arm characteristics and paired t-tests to compare moment-arm magnitudes. [Results] A significant difference was observed in the average lateral direction of moment-arm magnitude during Tai Chi walking (-0.0239 ± 0.011 m) compared to that during normal walking (-0.0057 ± 0.004 m). No significant difference was found between conditions in average medial direction of moment-arm magnitude (normal walking: 0.0143 ± 0.010 m; Tai Chi walking: 0.0098 ± 0.014 m). [Conclusion] Tai Chi walking produced a larger peak lateral moment-arm value than normal walking during the stance phase, whereas Tai Chi walking and normal walking peak medial moment-arm values were similar, suggesting that medial knee joint loading may be avoided during Tai Chi walking.

  2. Effect of the Japanese herbal medicine, Boiogito, on the osteoarthritis of the knee with joint effusion

    PubMed Central

    2012-01-01

    Background Boiogito (Japanese herbal medicine, Tsumura Co. Tokyo, Japan) contains sinomenin which inhibits inflammatory reactions. Since sinomenine is a principle component of the Boiogito, there is a possibility of it being effective on osteoarthritis (OA) of the knee with joint effusion. However, there is no report concerning the effectiveness of Boiogito on knee OA. The objective of the present study is to investigate the therapeutic effect of Boiogito on OA of the knee associated with joint effusion in a comparative study among randomly assigned groups. Methods Study was performed using 50 patients who were diagnosed with primary osteoarthritis of the knee with joint effusion. The patients were randomly assigned to two groups: one group (25 patients) using both loxoprofen (2-{4-[(2-oxocyclopentyl) methyl]} propanoic acid) and Boiogito and the other group (25 patients) using loxoprofen, and were evaluated during a 12 week observation period. The assessment parameters including knee scores in the Knee Society Rating System including Knee score and Functional scores, amount of joint effusion by joint puncture in clinically detected cases, the 36-items short form of the Medical Outcome Study Questionnaire (SF-36) as a measurement of health related quality of life were used. Results The knee scores based on the Knee Society Rating System were improved in both groups. The staircase climbing up and down ability in the Knee society rating system functional score was significantly improved in the group using Boiogito and loxoprofen compared to the loxoprofen group. In the evaluation using SF-36, significant improvements were found in the scores in both groups in physical functioning after 12 weeks. The amount of joint fluid was significantly decreased at 4, 8 and 12 weeks compared to pre-administration baseline in the group using Boiogito and loxoprofen. A side effect of Boiogito, dry mouth, was found in one case. The symptom was mild and improved immediately after

  3. Failed Radiation Synovectomy in Diseased Knee Joint with Missed Tuberculous Synovitis

    PubMed Central

    Sood, Ashwani; Sharma, Aman; Chouhan, Devendra Kumar; Gupta, Kirti; Parghane, Rahul; Shukla, Jaya; Mittal, Bhagwant Rai

    2016-01-01

    The authors in this case report highlight the poor outcome of radiation synovectomy (RSV) for repeated knee joint effusion in a patient with histopathologically proven nonspecific arthritis. There was partial response initially following RSV but later follow-up showed recurrence in joint effusion with limited and painful mobility of the knee joint. Subsequent surgical synovectomy and histopathological examination showed it to be tubercular in origin. Thus in a country endemic for tuberculosis, an alternative infective etiology should also be kept in mind before subjecting the patient to RSV. PMID:27651744

  4. Joint space narrowing after partial medial meniscectomy in the anterior cruciate ligament-intact knee.

    PubMed

    Shelbourne, K Donald; Dickens, Jonathan F

    2007-09-01

    Osteoarthritis of the knee is common after total medial meniscectomy. In anterior cruciate ligament-intact knees, the reported outcomes of partial medial meniscectomy are variable. Radiographic assessment using a posteroanterior weight-bearing view is a reliable tool for detecting minor medial joint space narrowing, which may be an early sign of osteoarthritis. Studies that assessed the effect of partial medial meniscectomy found a low percentage of patients with >50% joint narrowing at 10 to 15 years after surgery. Digital radiography, using a posteroanterior weight-bearing view, is a highly sensitive method for observing minor joint space narrowing in the involved knee. A recent study showed that 88% of patients who underwent partial medial meniscectomy had joint space narrowing of <2 mm, and none had narrowing >or=2 mm, at a mean follow-up of 12 years. Subjective results after partial medial meniscectomy are favorable, with 88% to 95% of patients reporting good to excellent results.

  5. Effect studies of Uyghur sand therapy on the hemodynamics of the knee-joint arteries.

    PubMed

    Fu, Rongchang; Mahemut, Dilinaer; Tiyipujiang, Rexiati; Aihemaiti, Kuwahan; Ainiwaierjiang, Nuerya

    2014-01-01

    This paper studies the effect of Uyghur sand therapy on dynamics of arterial flow of knee joints via experiments and numerical simulations. Experiments have been carried out on 30 volunteers, with their diameter and flow rate of arteries of knee joints measured before and after Uyghur sand therapy. It has been found that Uyghur sand therapy will increase the inner diameter of knee arteries and speed up the blood flow. Experimental results show that Uyghur sand therapy can help relieve obstacles in local blood flow. By choosing one volunteer for CT scanning, three-dimensional reconstruction of knee-joint arteries via MIMICS software is achieved. Calculation model is the established with numerical calculations performed by ANSYS software. According to the calculations, the blood flow of the knee arteries speeds up and the uniform distribution of velocity enlarges after Uyghur sand therapy, which further confirms the experimental results. Besides, the research also suggests that Uyghur sand therapy has stronger effect on blood flow of knee-joint arteries than the inner diameter.

  6. Measurement of Resistive Torques in Major Human Joints

    DTIC Science & Technology

    1979-04-01

    Joints Knee Joint Resistive Torques Hip Joint Resistive Moments Elbow Joint Ankle Joint 20. ABSTRACT (Continue on reverse side if necessary and...applications. The major articulating Joints which are considered are the shoulder, knee, hip, elbow and ankle. Due DD I J 1473 EDITION OF I NOV 65 IS OBSOLETE...47 Force is being applied by means of the GFA on the subject’s lower arm for the elbow joint resistive force and moment data collection

  7. Sagittal knee joint kinematics and energetics in response to different landing heights and techniques.

    PubMed

    Yeow, C H; Lee, P V S; Goh, J C H

    2010-03-01

    Single-leg and double-leg landing techniques are common athletic maneuvers typically performed from various landing heights during intensive sports activities. However, it is still unclear how the knee joint responds in terms of kinematics and energetics to the combined effects of different landing heights and techniques. We hypothesized that the knee displays greater flexion angles and angular velocities, joint power and work in response to the larger peak ground reaction force from 0.6-m height, compared to 0.3-m height. We further hypothesized that the knee exhibits elevated flexion angles and angular velocities, joint power and work during double-leg landing, relative to single-leg landing. Ground reaction force, knee joint kinematics and energetics data were obtained from 10 subjects performing single-leg and double-leg landing from 0.3-m to 0.6-m heights, using motion-capture system and force-plates. Higher peak ground reaction force (p<0.05) was observed during single-leg landing and/or at greater landing height. We found greater knee flexion angles and angular velocities (p<0.05) during double-leg landing and/or at greater landing height. Elevated knee joint power and work were noted (p<0.05) during double-leg landing and/or at greater landing height. The knee joint is able to respond more effectively in terms of kinematics and energetics to a larger landing impact from an elevated height during double-leg landing, compared to single-leg landing. This allows better shock absorption and thus minimizes the risk of sustaining lower extremity injuries.

  8. Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees.

    PubMed

    Silverman, Anne K; Neptune, Richard R

    2014-08-22

    Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis.

  9. The Influence of Task Complexity on Knee Joint Kinetics Following ACL Reconstruction

    PubMed Central

    Schroeder, Megan J.; Krishnan, Chandramouli; Dhaher, Yasin Y.

    2015-01-01

    Background Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. Methods In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. Findings The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft-specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. Interpretation The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint

  10. The use of focal knee joint cryotherapy to improve functional outcomes after total knee arthroplasty: review article.

    PubMed

    Ewell, Melvin; Griffin, Christopher; Hull, Jason

    2014-08-01

    The purpose of this study was to review and synthesize available evidence on the effect of focal knee joint cryotherapy on quadriceps arthrogenic muscle inhibition and to discuss the implications of the findings regarding the use of this modality for patients after a total knee arthroplasty. An electronic literature search that targeted peer reviewed journals was completed by using the PubMed, CINAHL, ScienceDirect, and OvidSP databases. An article was included when it was determined that the article was relevant to the topic of focal knee joint cryotherapy and its effect on quadriceps muscle function. There were 6 studies that met the inclusion criteria. Of the reviewed studies, effect sizes for quadriceps activation ranged from very small to large. Five of the 6 studies observed medium to large effects. Effect sizes for quadriceps torque and force production ranged from no effect to a large effect. Two of the 5 studies with outcome measurements related to quadriceps torque or force production observed medium and large effects. Analysis of this evidence suggests that focal joint cooling of the knee shows the potential to improve quadriceps activation as well as quadriceps torque and force production in patients with arthrogenic muscle inhibition. Arthrogenic muscle inhibition of the quadriceps is an impairment commonly observed in patients after a total knee arthroplasty. Analysis of the evidence uncovered in this review suggests that this patient population may be positively impacted by the use of this modality to improve quadriceps activation as well as quadriceps torque and force production.

  11. Soft tissue balance changes depending on joint distraction force in total knee arthroplasty.

    PubMed

    Nagai, Kanto; Muratsu, Hirotsugu; Matsumoto, Tomoyuki; Miya, Hidetoshi; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-03-01

    The influence of joint distraction force on intraoperative soft tissue balance was evaluated using Offset Repo-Tensor® for 78 knees that underwent primary posterior-stabilized total knee arthroplasty. The joint center gap and varus ligament balance were measured between osteotomized surfaces using 20, 40 and 60 lbs of joint distraction force. These values were significantly increased at extension and flexion as the distraction force increased. Furthermore, lateral compartment stiffness was significantly lower than medial compartment stiffness. Thus, larger joint distraction forces led to larger varus ligament balance and joint center gap, because of the difference in soft tissue stiffness between lateral and medial compartments. These findings indicate the importance of the strength of joint distraction force in the assessment of soft tissue balance, especially when using gap-balancing technique.

  12. Imaging osteoarthritis in the knee joints using x-ray guided diffuse optical tomography

    NASA Astrophysics Data System (ADS)

    Zhang, Qizhi; Yuan, Zhen; Sobel, Eric S.; Jiang, Huabei

    2010-02-01

    In our previous studies, near-infrared (NIR) diffuse optical tomography (DOT) had been successfully applied to imaging osteoarthritis (OA) in the finger joints where significant difference in optical properties of the joint tissues was evident between healthy and OA finger joints. Here we report for the first time that large joints such as the knee can also be optically imaged especially when DOT is combined with x-ray tomosynthesis where the 3D image of the bones from x-ray is incorporated into the DOT reconstruction as spatial a priori structural information. This study demonstrates that NIR light can image large joints such as the knee in addition to finger joints, which will drastically broaden the clinical utility of our x-ray guided DOT technique for OA diagnosis.

  13. Acceleration-based joint stability parameters for total knee arthroplasty that correspond with patient-reported instability.

    PubMed

    Roberts, Dustyn; Khan, Humera; Kim, Joo H; Slover, James; Walker, Peter S

    2013-10-01

    There is no universally accepted definition of human joint stability, particularly in nonperiodic general activities of daily living. Instability has proven to be a difficult parameter to define and quantify, since both spatial and temporal measures need to be considered to fully characterize joint stability. In this preliminary study, acceleration-based parameters were proposed to characterize the joint stability. Several time-statistical parameters of acceleration and jerk were defined as potential stability measures, since anomalous acceleration or jerk could be a symptom of poor control or stability. An inertial measurement unit attached at the level of the tibial tubercle of controls and patients following total knee arthroplasty was used to determine linear acceleration of the knee joint during several activities of daily living. The resulting accelerations and jerks were compared with patient-reported instability as determined through a standard questionnaire. Several parameters based on accelerations and jerks in the anterior/posterior direction during the step-up/step-down activity were significantly different between patients and controls and correlated with patient reports of instability in that activity. The range of the positive to negative peak acceleration and infinity norm of acceleration, in the anterior/posterior direction during the step-up/step-down activity, proved to be the best indicators of instability. As time derivatives of displacement, these acceleration-based parameters represent spatial and temporal information and are an important step forward in developing a definition and objective quantification of human joint stability that can complement the subjective patient report.

  14. Knee Joint Contact Mechanics during Downhill Gait and its Relationship with Varus/Valgus Motion and Muscle Strength in Patients with Knee Osteoarthritis

    PubMed Central

    Farrokhi, Shawn; Voycheck, Carrie A.; Gustafson, Jonathan A.; Fitzgerald, G. Kelley; Tashman, Scott

    2015-01-01

    Objective The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Methods Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Group differences in contact mechanics and frontal-plane motion excursions were compared using analysis of covariance with adjustments for body mass index. Differences in strength were compared using independent sample t-tests. Additionally, linear associations between contact mechanics with frontal-plane knee motion and muscle strength were evaluated using Pearson's correlation coefficients. Results Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p<0.02) and greater heel-strike joint contact point velocities (p<0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p=0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p<0.01) and greater quadriceps and hip abductor muscle weakness (p=0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p<0.04) but not with quadriceps or hip abductor strength. Conclusion Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with

  15. Influences of Alignment and Obesity on Knee Joint Loading in Osteoarthritic Gait

    PubMed Central

    Messier, Stephen P.; Pater, Mackenzie; Beavers, Daniel P.; Legault, Claudine; Loeser, Richard F.; Hunter, David J.; DeVita, Paul

    2014-01-01

    Objective To determine the influences of frontal plane knee alignment and obesity on knee joint loads in older, overweight and obese adults with knee osteoarthritis. Methods Cross-sectional investigation of alignment and obesity on knee joint loads using community dwelling older adults (age ≥ 55 yrs.; 27 kg·m−2 ≥ BMI ≤ 41 kg·m−2; 69% female) with radiographic knee osteoarthritis that were a subset of participants (157 out of 454) enrolled in the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial. Results A higher BMI was associated with greater (p = 0.0006) peak knee compressive forces [overweight, 2411 N (2182, 2639), class 1 obesity, 2772 N (2602, 2943), class 2+ obesity, 2993 N (2796, 3190)] and greater (p = 0.004) shear forces [overweight, 369 N (322, 415), class 1 obesity, 418 N (384, 453), class 2+ obesity, 472 N (432, 513)], independent of alignment, and varus alignment was associated (p < 0.0001) with greater peak external knee adduction moments, independent of BMI [valgus, 18.7 Nm (15.1, 22.4), neutral, 27.7 Nm (24.0, 31.4), varus, 37.0 Nm (34.4, 39.7)]. Conclusion BMI and alignment were associated with different joint loading measures; alignment was more closely associated with the asymmetry or imbalance of loads across the medial and lateral knee compartments as reflected by the frontal plane external adduction moment, while BMI was associated with the magnitude of total tibio-femoral force. These data may be useful in selecting treatment options for knee osteoarthritis patients (e.g., diet to reduce compressive loads or bracing to change alignment). PMID:24857973

  16. Remobilization does not restore immobilization-induced adhesion of capsule and restricted joint motion in rat knee joints.

    PubMed

    Ando, Akira; Suda, Hideaki; Hagiwara, Yoshihiro; Onoda, Yoshito; Chimoto, Eiichi; Itoi, Eiji

    2012-01-01

    Joint immobilization, which is used in orthopaedic treatments and observed in bedridden people, usually causes restricted joint motion. Decreased joint motion diminishes activities of daily living and increases burden of nursing-care. The purpose of this study was to clarify the reversibility of immobilization-induced capsular changes and restricted joint motion in rat knee joints. The unilateral knee joints of adult male rats were immobilized with an internal fixator for 1, 2, 4, 8, and 16 weeks as a model of immobilization after surgery or disuse of the joint. After the fixation devices were removed, the rats were allowed to move freely for 16 weeks. Sham-operated rats were used as controls. Sagittal sections at medial midcondylar regions were made and assessed with histological, histomorphometric, and immunohistochemical methods. Joint motion was measured using a custom-made device under x-ray control after removal of the periarticular muscles. In the 1/16-week and 2/16-week immobilization-remobilization (Im-Rm) groups, cord-like structures connecting the superior and inferior portions of the posterior capsule (partial adhesion) were observed without restricted joint motion. In the 4/16-, 8/16-, and 16/16-week Im-Rm groups, global adhesion of the posterior capsule and restricted joint motion were observed. The restricted joint motion was not completely restored after incision of the posterior capsule. These data indicate that immobilization alone causes irreversible capsular changes and arthrogenic restricted joint motion. Besides the joint capsule, other arthrogenic factors such as ligaments might influence the restricted joint motion. Prolonged immobilization over 4 weeks should be avoided to prevent irreversible joint contracture.

  17. Prediction of knee joint moment changes during walking in response to wedged insole interventions.

    PubMed

    Lewinson, Ryan T; Stefanyshyn, Darren J

    2016-04-01

    Wedged insoles are prescribed for medial knee osteoarthritis to reduce the knee adduction moment; however, it is currently not possible to predict which patients will in fact experience reduced moments. The purpose of this study was to identify a simple method using two-dimensional data for predicting the expected change in knee adduction moments with wedged insoles. Knee adduction moments during walking were determined for healthy individuals (n = 15) and individuals with medial knee osteoarthritis (n = 19) while wearing their own shoe without an insole (control), with a 6-mm medial wedge and with a 6-mm lateral wedge. The percent changes relative to control were determined. Then, participants completed single-step trials with each footwear condition where only the changes in mediolateral positions of the knee joint center, shank center of mass, ankle joint center, and foot center of mass relative to control were determined. These variables were used as predictors in regression equations where the change in knee adduction moment during walking was the dependent variable. The change in mediolateral positions of the lower extremity during a single step significantly predicted the change in knee adduction moment during walking for the lateral wedge in both the healthy (R(2) = 0.72, p = 0.008) and knee osteoarthritis (R(2) = 0.52, p = 0.026) groups, and also for the medial wedge in both the healthy (R(2) = 0.67, p = 0.016) and knee osteoarthritis (R(2) = 0.54, p = 0.020) groups. The method of using mediolateral position data from a single-step movement to predict walking biomechanics was successful. These data are relatively simple to collect and analyze, offering the possibility for future incorporation into a wedge prediction system.

  18. Design and energetic evaluation of a prosthetic knee joint actuator with a lockable parallel spring.

    PubMed

    Geeroms, J; Flynn, L; Jimenez-Fabian, R; Vanderborght, B; Lefeber, D

    2017-02-03

    There are disadvantages to existing damping knee prostheses which cause an asymmetric gait and higher metabolic cost during level walking compared to non-amputees. Most existing active knee prostheses which could benefit the amputees use a significant amount of energy and require a considerable motor. In this work, a novel semi-active actuator with a lockable parallel spring for a prosthetic knee joint has been developed and tested. This actuator is able to provide an approximation of the behavior of a healthy knee during most of the gait cycle of level walking. This actuator is expanded with a series-elastic actuator to mimic the full gait cycle and enable its use in other functional tasks like stair climbing and sit-to-stance. The proposed novel actuator reduces the energy consumption for the same trajectory with respect to a compliant or directly-driven prosthetic active knee joint and improves the approximation of healthy knee behavior during level walking compared to passive or variable damping knee prostheses.

  19. Effects of childhood obesity on three-dimensional knee joint biomechanics during walking.

    PubMed

    Gushue, David L; Houck, Jeff; Lerner, Amy L

    2005-01-01

    Despite the increasing percentages of children who are overweight, few studies have investigated their gait patterns. The purpose of this study was to quantify the three-dimensional knee joint kinematics and kinetics during walking in children of varying body mass and to identify effects associated with obesity. Three-dimensional kinematics and kinetics were collected from children of normal weight and overweight during normal gait using surface-mounted infrared emitting diodes and a force plate. The overweight group walked with a significantly lower peak knee flexion angle during early stance, and no significant differences in peak internal knee extension moments were found between groups. However, the overweight group showed a significantly higher peak internal knee abduction moment during early stance. These data suggest that although overweight children may develop a gait adaptation to maintain a similar knee extensor load, they may not be able to compensate for alterations in the frontal plane, which may lead to increased medial compartment joint loads. Therefore, assuming that the development of varus angular deformities of the knee joint and, in the longer term, medial compartment osteoarthritis are influenced by cumulative stress, this study supports the understanding that childhood obesity may impart a greater risk for the development of these diseases.

  20. Hierarchical imaging of the human knee

    NASA Astrophysics Data System (ADS)

    Schulz, Georg; Götz, Christian; Deyhle, Hans; Müller-Gerbl, Magdalena; Zanette, Irene; Zdora, Marie-Christine; Khimchenko, Anna; Thalmann, Peter; Rack, Alexander; Müller, Bert

    2016-10-01

    Among the clinically relevant imaging techniques, computed tomography (CT) reaches the best spatial resolution. Sub-millimeter voxel sizes are regularly obtained. For investigations on true micrometer level lab-based μCT has become gold standard. The aim of the present study is the hierarchical investigation of a human knee post mortem using hard X-ray μCT. After the visualization of the entire knee using a clinical CT with a spatial resolution on the sub-millimeter range, a hierarchical imaging study was performed using a laboratory μCT system nanotom m. Due to the size of the whole knee the pixel length could not be reduced below 65 μm. These first two data sets were directly compared after a rigid registration using a cross-correlation algorithm. The μCT data set allowed an investigation of the trabecular structures of the bones. The further reduction of the pixel length down to 25 μm could be achieved by removing the skin and soft tissues and measuring the tibia and the femur separately. True micrometer resolution could be achieved after extracting cylinders of several millimeters diameters from the two bones. The high resolution scans revealed the mineralized cartilage zone including the tide mark line as well as individual calcified chondrocytes. The visualization of soft tissues including cartilage, was arranged by X-ray grating interferometry (XGI) at ESRF and Diamond Light Source. Whereas the high-energy measurements at ESRF allowed the simultaneous visualization of soft and hard tissues, the low-energy results from Diamond Light Source made individual chondrocytes within the cartilage visual.

  1. The effect of angle and moment of the hip and knee joint on iliotibial band hardness.

    PubMed

    Tateuchi, Hiroshige; Shiratori, Sakiko; Ichihashi, Noriaki

    2015-02-01

    Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness.

  2. Ankle, knee, and hip joint contribution to body support during gait

    PubMed Central

    Fukui, Tsutomu; Ueda, Yasuhisa; Kamijo, Fumiko

    2016-01-01

    [Purpose] Support moment was defined as the sum of ankle plantar flexion, knee and hip extension moments. There are some mechanical relationships among the 3 joints. If these relationships were understood, it might be possible to determine which joint should be strengthened to improve gait. The aims of this study were to examine the mutual relationship among kinetic variables of the 3 joints during different phases. [Subjects and Methods] Twenty-five healthy subjects volunteered for this study. They were asked to walk on a platform at a self-selected speed. Correlation coefficients between support moment and vertical ground reaction force were calculated for each subject. Pearson correlation analysis was performed among the 3 joint moments and between each joint moment and vertical ground reaction force. [Results] Knee and hip extension moments showed negative correlation throughout the stance. Ankle moment had a positive with hip but a negative correlation with knee moment except in the initial contact and pre-swing. Hip moment in the initial contact, knee moment in the loading response, and ankle moment from the terminal stance to pre-swing had a high correlation with vertical ground reaction force. [Conclusion] The results may indicate which joint should be strengthened to improve gait pattern. PMID:27821945

  3. Effect of patient positions on measurement errors of the knee-joint space on radiographs

    NASA Astrophysics Data System (ADS)

    Gilewska, Grazyna

    2001-08-01

    Osteoarthritis (OA) is one of the most important health problems these days. It is one of the most frequent causes of pain and disability of middle-aged and old people. Nowadays the radiograph is the most economic and available tool to evaluate changes in OA. Error of performance of radiographs of knee joint is the basic problem of their evaluation for clinical research. The purpose of evaluation of such radiographs in my study was measuring the knee-joint space on several radiographs performed at defined intervals. Attempt at evaluating errors caused by a radiologist of a patient was presented in this study. These errors resulted mainly from either incorrect conditions of performance or from a patient's fault. Once we have information about size of the errors, we will be able to assess which of these elements have the greatest influence on accuracy and repeatability of measurements of knee-joint space. And consequently we will be able to minimize their sources.

  4. Sock systems to prevent foot blisters and the impact on overuse injuries of the knee joint.

    PubMed

    Van Tiggelen, Damien; Wickes, Simon; Coorevits, Pascal; Dumalin, Mich; Witvrouw, Erik

    2009-02-01

    The incidence of foot blisters and other overuse injuries of the lower limb is very high during basic military training (BMT). One hundred and eighty-nine subjects were divided into two intervention groups wearing alternative sock systems and one control group. Overall, 57% of the 173 recruits who completed the training, developed foot blisters. Binary logistic regression revealed the type of sock, race, previous hiking or military experience, and known orthopedic foot conditions to be predictive variables for foot blisters. Fifty-three percent of the 173 recruits also developed another overuse injury of the lower limb (25.4% related to the knee joint). Previous military or hiking experience and the association of foot blisters revealed to be predictive for the overuse injuries of the knee joint. The results of the present study suggest associated foot blisters are also an important factor in the development of overuse injuries of the knee joint during BMT.

  5. Staphylococcus aureus-dependent septic arthritis in murine knee joints: local immune response and beneficial effects of vaccination

    PubMed Central

    Corrado, Alessia; Donato, Paolo; Maccari, Silvia; Cecchi, Raffaella; Spadafina, Tiziana; Arcidiacono, Letizia; Tavarini, Simona; Sammicheli, Chiara; Laera, Donatello; Manetti, Andrea Guido Oreste; Ruggiero, Paolo; Galletti, Bruno; Nuti, Sandra; De Gregorio, Ennio; Bertholet, Sylvie; Seubert, Anja; Bagnoli, Fabio; Bensi, Giuliano; Chiarot, Emiliano

    2016-01-01

    Staphylococcus aureus is the major cause of human septic arthritis and osteomyelitis, which deserve special attention due to their rapid evolution and resistance to treatment. The progression of the disease depends on both bacterial presence in situ and uncontrolled disruptive immune response, which is responsible for chronic disease. Articular and bone infections are often the result of blood bacteremia, with the knees and hips being the most frequently infected joints showing the worst clinical outcome. We report the development of a hematogenous model of septic arthritis in murine knees, which progresses from an acute to a chronic phase, similarly to what occurs in humans. Characterization of the local and systemic inflammatory and immune responses following bacterial infection brought to light specific signatures of disease. Immunization of mice with the vaccine formulation we have recently described (4C-Staph), induced a strong antibody response and specific CD4+ effector memory T cells, and resulted in reduced bacterial load in the knee joints, a milder general inflammatory state and protection against bacterial-mediated cellular toxicity. Possible correlates of protection are finally proposed, which might contribute to the development of an effective vaccine for human use. PMID:27901071

  6. Longitudinal changes in knee joint biomechanics during level walking following anterior cruciate ligament reconstruction surgery.

    PubMed

    Webster, Kate E; Feller, Julian A; Wittwer, Joanne E

    2012-06-01

    Following anterior cruciate ligament reconstruction (ACL) patients have altered movement patterns in the reconstructed knee during walking. There is limited information about these alterations over an extended period of time. This study was designed to present a longitudinal analysis of gait patterns following ACL reconstruction surgery. Assessments of level walking were undertaken in 16 participants at a mean 10 months (initial assessment) and again at 3 years (follow-up assessment) after ACL reconstruction surgery. Kinematic and kinetic variables were analysed using a two factor (time, limb) repeated measures ANOVA. Kinematic data showed that patients were able to achieve greater extension about the reconstructed knee at follow-up than at initial assessment. The reconstructed knee was significantly less internally rotated than the contralateral knee at the initial assessment but not at follow-up. Kinetic data showed a significant increase in the external knee extension moment for the reconstructed limb over time. There were also significant increases in the external knee adduction moment for both limbs at the follow-up assessment. The external knee adduction moment was however smaller in the reconstructed knee than the contralateral knee at both assessments. The results indicate that gait variables do change over time and that measurement at a single time point may not reflect the long term outcome of ACL reconstruction surgery. The changes were however small and may not be clinically relevant. However, the consistently reduced external knee adduction moment seen about the reconstructed knee in this study may suggest that factors other than joint moments influence degenerative change over time.

  7. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist.

    PubMed

    Adouni, M; Shirazi-Adl, A; Marouane, H

    2016-01-01

    Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics-kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°-90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.

  8. Measurement of force sense reproduction in the knee joint: application of a new dynamometric device

    PubMed Central

    Zavieh,, Minoo Khalkhali; Amirshakeri,, Bahram; Rezasoltani,, Asghar; Talebi,, Ghadam Ali; Kalantari,, Khosro Khademi; Nedaey,, Vahab; Baghban,, Alireza Akbarzadeh

    2016-01-01

    [Purpose] The aim of this study was to determine the reliability of a newly designed dynamometric device for use in frequent force producing/reproducing tasks on the knee joint. [Subjects and Methods] In this cross-sectional study (Development & Reliability), 30 young healthy males and females (age 23.4 ± 2.48 years) were selected among students of Tabriz University of Medical Sciences by simple randomized selection. The study instrument was designed to measure any isometric contraction force exerted by the knee joint flexor/extensor muscles, known as the ipsilateral and contralateral methods. Participant knees were fixed in 60° flexion, and each participant completed the entire set of measurements twice, 72 hours apart. [Results] The findings showed a good intraclass correlation coefficient of 0.73 to 0.81 for all muscle groups. The standard error of measurement and smallest detectable difference for flexor muscle groups were 0.37 and 1.02, respectively, while the values increased to standard error of measurement=0.38 and smallest detectable difference=1.05 for extensor muscle groups. [Conclusion] The device designed could quantify the forces producing/reproducing tasks on the knee joint with a high rate of reliability, and can probably be applied for outcome measurements in proprioceptive assessment of the knee joint. PMID:27630421

  9. Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression.

    PubMed

    Marouane, H; Shirazi-Adl, A; Adouni, M

    2015-01-01

    Knee joints are subject to large compression forces in daily activities. Due to artefact moments and instability under large compression loads, biomechanical studies impose additional constraints to circumvent the compression position-dependency in response. To quantify the effect of compression on passive knee moment resistance and stiffness, two validated finite element models of the tibiofemoral (TF) joint, one refined with depth-dependent fibril-reinforced cartilage and the other less refined with homogeneous isotropic cartilage, are used. The unconstrained TF joint response in sagittal and frontal planes is investigated at different flexion angles (0°, 15°, 30° and 45°) up to 1800 N compression preloads. The compression is applied at a novel joint mechanical balance point (MBP) identified as a point at which the compression does not cause any coupled rotations in sagittal and frontal planes. The MBP of the unconstrained joint is located at the lateral plateau in small compressions and shifts medially towards the inter-compartmental area at larger compression forces. The compression force substantially increases the joint moment-bearing capacities and instantaneous angular rigidities in both frontal and sagittal planes. The varus-valgus laxities diminish with compression preloads despite concomitant substantial reductions in collateral ligament forces. While the angular rigidity would enhance the joint stability, the augmented passive moment resistance under compression preloads plays a role in supporting external moments and should as such be considered in the knee joint musculoskeletal models.

  10. Effect of compensatory trunk movements on knee and hip joint loading during gait in children with different orthopedic pathologies.

    PubMed

    Stief, Felix; Böhm, Harald; Ebert, Carsten; Döderlein, Leonhard; Meurer, Andrea

    2014-03-01

    Ipsilateral trunk lean toward the affected stance limb has been identified as a compensatory mechanism to unload the hip joint. However, this altered gait pattern increases the lever arm around the knee joint by shifting the ground reaction vector more lateral to the knee joint center, which could be sufficient to deform the lateral compartment of the knee. The purpose of the present study was to show the effect of ipsilateral trunk lean on hip and knee joint moments in the frontal plane in 132 young patients with different orthopedic diagnosis. Linear correlations between ipsilateral trunk lean and the external knee and/or hip adduction moment were detected for patients with Legg-Calvé-Perthes disease (LCPD), arthrogryposis multiplex congenita, myelomeningocele, and unilateral cerebral palsy (CP). In contrast, children with bilateral CP did not show such a relationship due to an increased internal foot placement. In comparison to the hip joint, the effect of ipsilateral trunk lean in patients with LCPD is obviously more pronounced in the knee joint. The valgus thrust of the knee could initiate degenerative changes by placing altered loads on regions of the articular cartilage that were previously conditioned for different load levels. The results suggest that the ipsilateral trunk lean should not be considered and recommended as unloading mechanism for the hip joint on its own but also as a potential increased joint loading of the lateral knee compartment. Therefore, an acceptable therapy concept for limping patients should aim for an inconspicuous gait pattern with a reduced trunk movement.

  11. 21 CFR 888.3560 - Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis. 888.3560 Section 888.3560 Food and Drugs FOOD AND DRUG... Devices § 888.3560 Knee joint patellofemorotibial polymer/metal/polymer semi-constrained...

  12. 21 CFR 888.3560 - Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis. 888.3560 Section 888.3560 Food and Drugs FOOD AND DRUG... Devices § 888.3560 Knee joint patellofemorotibial polymer/metal/polymer semi-constrained...

  13. 21 CFR 888.3535 - Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .../polymer porous-coated uncemented prosthesis. 888.3535 Section 888.3535 Food and Drugs FOOD AND DRUG... Devices § 888.3535 Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint femorotibial (uni-compartmental) metal/polymer...

  14. 21 CFR 888.3535 - Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .../polymer porous-coated uncemented prosthesis. 888.3535 Section 888.3535 Food and Drugs FOOD AND DRUG... Devices § 888.3535 Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis. (a) Identification. A knee joint femorotibial (uni-compartmental) metal/polymer...

  15. 21 CFR 888.3560 - Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis. 888.3560 Section 888.3560 Food and Drugs FOOD AND DRUG... Devices § 888.3560 Knee joint patellofemorotibial polymer/metal/polymer semi-constrained...

  16. 21 CFR 888.3560 - Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis. 888.3560 Section 888.3560 Food and Drugs FOOD AND DRUG... Devices § 888.3560 Knee joint patellofemorotibial polymer/metal/polymer semi-constrained...

  17. 21 CFR 888.3560 - Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellofemorotibial polymer/metal/polymer semi-constrained cemented prosthesis. 888.3560 Section 888.3560 Food and Drugs FOOD AND DRUG... Devices § 888.3560 Knee joint patellofemorotibial polymer/metal/polymer semi-constrained...

  18. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint

    PubMed Central

    Shanker, V. S.; Gadikoppula, S.; Loeffler, M. D.

    1998-01-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint. 




 PMID:9562171

  19. The ligaments and sesamoid bones of knee joint in New Zealand rabbits.

    PubMed

    Orhan, I O; Haziroglu, R M; Gultiken, M E

    2005-04-01

    This study has been conducted on the knee joints of the New Zealand rabbits. A total of 20 knee joints from 10 (five female, five male) adult New Zealand rabbits were studied in the study. Fourteen ligaments and four sesamoid bones including the patellar bone, the infrapatellar adipose body, and the suprapatellar cartilage specifically present in rabbits were grossly observed. The caudal meniscotibial ligaments of the lateral meniscus were noted to be lacking in these rabbits. Moreover, the medial collateral ligament did not have a capsular character in nature. Thus, adipose tissue was determined at a point where the suprapatellar cartilage and patella fused.

  20. Measuring the effect of femoral malrotation on knee joint biomechanics for total knee arthroplasty using computational simulation

    PubMed Central

    Kang, K-T.; Koh, Y-G.; Son, J.; Kwon, O-R.; Baek, C.; Jung, S. H.

    2016-01-01

    Objectives Malrotation of the femoral component can result in post-operative complications in total knee arthroplasty (TKA), including patellar maltracking. Therefore, we used computational simulation to investigate the influence of femoral malrotation on contact stresses on the polyethylene (PE) insert and on the patellar button as well as on the forces on the collateral ligaments. Materials and Methods Validated finite element (FE) models, for internal and external malrotations from 0° to 10° with regard to the neutral position, were developed to evaluate the effect of malrotation on the femoral component in TKA. Femoral malrotation in TKA on the knee joint was simulated in walking stance-phase gait and squat loading conditions. Results Contact stress on the medial side of the PE insert increased with internal femoral malrotation and decreased with external femoral malrotation in both stance-phase gait and squat loading conditions. There was an opposite trend in the lateral side of the PE insert case. Contact stress on the patellar button increased with internal femoral malrotation and decreased with external femoral malrotation in both stance-phase gait and squat loading conditions. In particular, contact stress on the patellar button increased by 98% with internal malrotation of 10° in the squat loading condition. The force on the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) increased with internal and external femoral malrotations, respectively. Conclusions These findings provide support for orthopaedic surgeons to determine a more accurate femoral component alignment in order to reduce post-operative PE problems. Cite this article: K-T. Kang, Y-G. Koh, J. Son, O-R. Kwon, C. Baek, S. H. Jung, K. K. Park. Measuring the effect of femoral malrotation on knee joint biomechanics for total knee arthroplasty using computational simulation. Bone Joint Res 2016;5:552–559. DOI: 10.1302/2046-3758.511.BJR-2016-0107.R1. PMID:28094763

  1. Arthroscopic-assisted Arthrodesis of the Knee Joint With the Ilizarov Technique: A Case Report and Literature Review.

    PubMed

    Waszczykowski, Michal; Niedzielski, Kryspin; Radek, Maciej; Fabis, Jaroslaw

    2016-01-01

    Arthrodesis of the knee joint is a mainly a salvage surgical procedure performed in cases of infected total knee arthroplasty, tumor, failed knee arthroplasty or posttraumatic complication.The authors report the case of 18-year-old male with posttraumatic complication of left knee because of motorbike accident 1 year before. He was treated immediately after the injury in the local Department of Orthopaedics and Traumatology. The examination in the day of admission to our department revealed deformation of the left knee, massive scar tissue adhesions to the proximal tibial bone and multidirectional instability of the knee. The plain radiographs showed complete lack of lateral compartment of the knee joint and patella. The patient complained of severe instability and pain of the knee and a consecutive loss of supporting function of his left limb. The authors decided to perform an arthroscopic-assisted fusion of the knee with Ilizarov external fixator because of massive scar tissue in the knee region and the prior knee infection.In the final follow-up after 54 months a complete bone fusion, good functional and clinical outcome were obtained.This case provides a significant contribution to the development and application of low-invasive techniques in large and extensive surgical procedures in orthopedics and traumatology. Moreover, in this case fixation of knee joint was crucial for providing good conditions for the regeneration of damaged peroneal nerve.

  2. The Waist Width of Skis Influences the Kinematics of the Knee Joint in Alpine Skiing.

    PubMed

    Zorko, Martin; Nemec, Bojan; Babič, Jan; Lešnik, Blaz; Supej, Matej

    2015-09-01

    Recently alpine skis with a wider waist width, which medially shifts the contact between the ski edge and the snow while turning, have appeared on the market. The aim of this study was to determine the knee joint kinematics during turning while using skis of different waist widths (65mm, 88mm, 110mm). Six highly skilled skiers performed ten turns on a predefined course (similar to a giant slalom course). The relation of femur and tibia in the sagital, frontal and coronal planes was captured by using an inertial motion capture suit, and Global Navigation Satellite System was used to determine the skiers' trajectories. With respect of the outer ski the knee joint flexion, internal rotation and abduction significantly decreased with the increase of the ski waist width for the greatest part of the ski turn. The greatest abduction with the narrow ski and the greatest external rotation (lowest internal rotation) with the wide ski are probably the reflection of two different strategies of coping the biomechanical requirements in the ski turn. These changes in knee kinematics were most probably due to an active adaptation of the skier to the changed biomechanical conditions using wider skis. The results indicated that using skis with large waist widths on hard, frozen surfaces could bring the knee joint unfavorably closer to the end of the range of motion in transversal and frontal planes as well as potentially increasing the risk of degenerative knee injuries. Key pointsThe change in the skis' waist width caused a change in the knee joint movement strategies, which had a tendency to adapt the skier to different biomechanical conditions.The use of wider skis or, in particular, skis with a large waist width, on a hard or frozen surface, could unfavourably bring the knee joint closer to the end of range of motion in transversal and frontal planes as well as may potentially increase the risk of degenerative knee injuries.The overall results of the abduction and internal

  3. The Waist Width of Skis Influences the Kinematics of the Knee Joint in Alpine Skiing

    PubMed Central

    Zorko, Martin; Nemec, Bojan; Babič, Jan; Lešnik, Blaz; Supej, Matej

    2015-01-01

    Recently alpine skis with a wider waist width, which medially shifts the contact between the ski edge and the snow while turning, have appeared on the market. The aim of this study was to determine the knee joint kinematics during turning while using skis of different waist widths (65mm, 88mm, 110mm). Six highly skilled skiers performed ten turns on a predefined course (similar to a giant slalom course). The relation of femur and tibia in the sagital, frontal and coronal planes was captured by using an inertial motion capture suit, and Global Navigation Satellite System was used to determine the skiers’ trajectories. With respect of the outer ski the knee joint flexion, internal rotation and abduction significantly decreased with the increase of the ski waist width for the greatest part of the ski turn. The greatest abduction with the narrow ski and the greatest external rotation (lowest internal rotation) with the wide ski are probably the reflection of two different strategies of coping the biomechanical requirements in the ski turn. These changes in knee kinematics were most probably due to an active adaptation of the skier to the changed biomechanical conditions using wider skis. The results indicated that using skis with large waist widths on hard, frozen surfaces could bring the knee joint unfavorably closer to the end of the range of motion in transversal and frontal planes as well as potentially increasing the risk of degenerative knee injuries. Key points The change in the skis’ waist width caused a change in the knee joint movement strategies, which had a tendency to adapt the skier to different biomechanical conditions. The use of wider skis or, in particular, skis with a large waist width, on a hard or frozen surface, could unfavourably bring the knee joint closer to the end of range of motion in transversal and frontal planes as well as may potentially increase the risk of degenerative knee injuries. The overall results of the abduction and

  4. Knee joint loading during lineman-specific movements in American football players.

    PubMed

    Lambach, Rebecca L; Young, Jay W; Flanigan, David C; Siston, Robert A; Chaudhari, Ajit M

    2015-06-01

    Linemen are at high risk for knee cartilage injuries and osteoarthritis. High-intensity movements from squatting positions (eg, 3-point stance) may produce high joint loads, increasing the risk for cartilage damage. We hypothesized that knee moments and joint reaction forces during lineman-specific activities would be greater than during walking or jogging. Data were collected using standard motion analysis techniques. Fifteen NCAA linemen (mean ± SD: height = 1.86 ± 0.07 m, mass = 121.45 ± 12.78 kg) walked, jogged, and performed 3 unloaded lineman-specific blocking movements from a 3-point stance. External 3-dimensional knee moments and joint reaction forces were calculated using inverse dynamics equations. MANOVA with subsequent univariate ANOVA and post hoc Tukey comparisons were used to determine differences in peak kinetic variables and the flexion angles at which they occurred. All peak moments and joint reaction forces were significantly higher during jogging than during all blocking drills (all P < .001). Peak moments occurred at average knee flexion angles > 70° during blocking versus < 44° in walking or jogging. The magnitude of moments and joint reaction forces when initiating movement from a 3-point stance do not appear to increase risk for cartilage damage, but the high flexion angles at which they occur may increase risk on the posterior femoral condyles.

  5. In vitro method for assessing the biomechanics of the patellofemoral joint following total knee arthroplasty.

    PubMed

    Coles, L G; Gheduzzi, S; Miles, A W

    2014-12-01

    The patellofemoral joint is a common site of pain and failure following total knee arthroplasty. A contributory factor may be adverse patellofemoral biomechanics. Cadaveric investigations are commonly used to assess the biomechanics of the joint, but are associated with high inter-specimen variability and often cannot be carried out at physiological levels of loading. This study aimed to evaluate the suitability of a novel knee simulator for investigating patellofemoral joint biomechanics. This simulator specifically facilitated the extended assessment of patellofemoral joint biomechanics under physiological levels of loading. The simulator allowed the knee to move in 6 degrees of freedom under quadriceps actuation and included a simulation of the action of the hamstrings. Prostheses were implanted on synthetic bones and key soft tissues were modelled with a synthetic analogue. In order to evaluate the physiological relevance and repeatability of the simulator, measurements were made of the quadriceps force and the force, contact area and pressure within the patellofemoral joint using load cells, pressure-sensitive film, and a flexible pressure sensor. The results were in agreement with those previously reported in the literature, confirming that the simulator is able to provide a realistic physiological loading situation. Under physiological loading, average standard deviations of force and area measurements were substantially lower and comparable to those reported in previous cadaveric studies, respectively. The simulator replicates the physiological environment and has been demonstrated to allow the initial investigation of factors affecting patellofemoral biomechanics following total knee arthroplasty.

  6. Therapeutic effects of segmental resection and decompression combined with joint prosthesis on continuous knee osteoarthritis

    PubMed Central

    Xue, Junlai; Wang, Changhong; Liu, Peng; Xie, Xiangchun; Qi, Shan

    2014-01-01

    Objective: To observe the therapeutic effects of segmental resection and decompression combined with joint prosthesis on continuous knee osteoarthritis (OA). Methods: A total of 130 patients with knee OA were selected and randomly divided into an observation group and a control group (n=65). The control group was treated by segmental resection in combination with joint prosthesis, and the observation group was treated by segmental resection and decompression combined with joint prosthesis. They were followed-up for three months. Results: All patients underwent successful surgeries during which no severe complications occurred. During the follow-up period, the overall effective rates of the observation group and the control group were 93.8% and 78.5% respectively, which were not statistically significantly different (p < 0.05). The observation group was significantly less prone to patellar instability, infection and deep vein thrombosis compared with the control group (P < 0.05). On the same day after surgery, the knee joint scores and functional scores of the two groups were similar, which evidently increased three months later, with significant intra-group and inter-group differences (p < 0.05). Conclusion: Combining segmental resection and decompression with joint prosthesis gave rise to satisfactory short-term prognosis by effectively improving the flexion and extension of injured knee and by decreasing complications, thus being worthy of promotion in clinical practice. PMID:25674115

  7. Functional assessments of the knee joint biomechanics by using pendulum test in adults with Down syndrome

    PubMed Central

    Casabona, Antonino; Valle, Maria Stella; Pisasale, Mariangela; Pantò, Maria Rosita

    2012-01-01

    In this study, we assessed kinematics and viscoelastic features of knee joint in adults with Down syndrome (DS) by means of the Wartenberg pendulum test. This test allows the measuring of the kinematics of the knee joint during passive pendular motion of leg under the influence of gravity. In addition, by a combination of kinematic and anthropometric data, pendulum test provides estimates of joint viscoelastic properties by computing damping and stiffness coefficients. To monitor the occurrences of muscle activation, the surface electromyogram (EMG) of muscle rectus femoris was recorded. The experimental protocol was performed in a group of 10 adults with DS compared with 10 control adults without DS. Joint motion amplitude, velocity, and acceleration of the leg during the first knee flexion significantly decreased in persons with DS with respect to those without DS. This behavior was associated with the activation of rectus femoris in subjects with DS that resulted in increasing of joint resistance shortly after the onset of the first leg flexion. The EMG bursts mostly occurred between 50 and 150 ms from the leg flexion onset. During the remaining cycles of pendular motion, persons with DS exhibited passive leg oscillations with low tonic EMG activity and reduced damping coefficient compared with control subjects. These results suggest that adults with DS might perform preprogrammed contractions to increase joint resistance and compensate for inherent joint instability occurring for quick and unpredictable perturbations. The reduction of damping coefficients observed during passive oscillations could be a predictor of muscle hypotonia. PMID:22995394

  8. [Bypass spanning the knee joint with synthetic prosthesis].

    PubMed

    Müller-Wiefel, H

    1989-01-01

    Synthetic tubes are the second choice for below-knee bypass materials. The ring-reinforced thin-walled Goretex-PTFE graft is an approved material which was tested in a multicenter study. The primary 3 years patency for below-knee femoral-popliteal bypass was 64%, for crural bypass 39%. A total of 195 grafts have been implanted. Long-term patency depends very much on the run-off conditions (81% in good and 43% in bad cases). The over-all limb salvage rate was 80% after 3 years.

  9. The Effects of a Lateral Wedge Insole on Knee and Ankle Joints During Slope Walking.

    PubMed

    Uto, Yuki; Maeda, Tetsuo; Kiyama, Ryoji; Kawada, Masayuki; Tokunaga, Ken; Ohwatashi, Akihiko; Fukudome, Kiyohiro; Ohshige, Tadasu; Yoshimoto, Yoichi; Yone, Kazunori

    2015-12-01

    The purpose of this study was to determine whether a lateral wedge insole reduces the external knee adduction moment during slope walking. Twenty young, healthy subjects participated in this study. Subjects walked up and down a slope using 2 different insoles: a control flat insole and a 7° lateral wedge insole. A three-dimensional motion analysis system and force plate were used to examine the knee adduction moment, the ankle valgus moment, and the moment arm of the ground reaction force to the knee joint center in the frontal plane. The lateral wedge insole significantly decreased the moment arm of the ground reaction force, resulting in a reduction of the knee adduction moment during slope walking, similar to level walking. The reduction ratio of knee adduction moment by the lateral wedge insole during the early stance of up-slope walking was larger than that of level walking. Conversely, the lateral wedge insole increased the ankle valgus moment during slope walking, especially during the early stance phase of up-slope walking. Clinicians should examine the utilization of a lateral wedge insole for knee osteoarthritis patients who perform inclined walking during daily activity, in consideration of the load on the ankle joint.

  10. The association between antagonist hamstring coactivation and episodes of knee joint shifting and buckling

    PubMed Central

    Segal, N.A.; Nevitt, M.C.; Welborn, R.D.; Nguyen, U.-S.D.T.; Niu, J.; Lewis, C.E.; Felson, D.T.; Frey-Law, L.

    2016-01-01

    SUMMARY Objective Hamstring coactivation during quadriceps activation is necessary to counteract the quadriceps pull on the tibia, but coactivation can be elevated with symptomatic knee osteoarthritis (OA). To guide rehabilitation to attenuate risk for mobility limitations and falls, this study evaluated whether higher antagonistic open kinetic chain hamstring coactivation is associated with knee joint buckling (sudden loss of support) and shifting (a sensation that the knee might give way). Design At baseline, median hamstring coactivation was assessed during maximal isokinetic knee extensor strength testing and at baseline and 24-month follow-up, knee buckling and shifting was self-reported. Associations between tertiles of co-activation and knee (1) buckling, (2) shifting and (3) either buckling or shifting were assessed using logistic regression, adjusted for age, sex, knee OA and pain. Results 1826 participants (1089 women) were included. Mean ± SD age was 61.7 ± 7.7 years, BMI was 30.3 ± 5.5 kg/m2 and 38.2% of knees had OA. There were no consistent statistically significant associations between hamstring coactivation and ipsilateral prevalent or incident buckling or the combination of buckling and shifting. The odds ratios for incident shifting in the highest in comparison with the lowest tertile of coactivation had similar magnitudes in the combined and medial hamstrings, but only reached statistical significance for lateral hamstring coactivation, OR(95%CI) 1.53 (0.99, 2.36). Conclusions Hamstring coactivation during an open kinetic chain quadriceps exercise was not consistently associated with prevalent or incident self-reported knee buckling or shifting in older adults with or at risk for knee OA. PMID:25765501

  11. Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry)

    PubMed Central

    Aslani, Hamidreza; Nourbakhsh, Seyed Taghi; Lahiji, Farivar A.; Heydarian, Keykavoos; Jabalameli, Mahmood; Ghazavi, Mohammad Taghi; Tahmasebi, Mohammad Naghi; Fayyaz, Mahmoud Reza; Sazegari, Mohammad Ali; Mohaddes, Maziar; Rajabpour, Mojtaba; Emami, Mohammad; Jazayeri, Seyyed Mohammad; Madadi, Firooz; Farahini, Hossein; Mirzatoloee, Fardin; Gharahdaghi, Mohammad; Ebrahimzadeh, Mohammad Hossein; Ebrahimian, Mohammadreza; Mirvakili, Hossein; Bashti, Kaveh; Almasizadeh, Mohtasham; Abolghasemian, Mansour; Taheriazam, Afshin; Motififard, Mehdi; Yazdi, Hamidreza; Mobarakeh, Mahmood Karimi; Shayestehazar, Masoud; Moghtadae, Mehdi; Siavashi, Babak; Sajjadi, Mohammadreza M.; Rasi, Alireza Manafi; Chabok, Seyyed Kazem; Zafarani, Zohreh; Salehi, Shahin; Ahmadi, Monireh; Mohammadi, Amin; Shahsavand, Mohammad Ebrahim

    2016-01-01

    Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran’s Ministry of Health and Education. PMID:27200403

  12. Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry).

    PubMed

    Aslani, Hamidreza; Nourbakhsh, Seyed Taghi; Lahiji, Farivar A; Heydarian, Keykavoos; Jabalameli, Mahmood; Ghazavi, Mohammad Taghi; Tahmasebi, Mohammad Naghi; Fayyaz, Mahmoud Reza; Sazegari, Mohammad Ali; Mohaddes, Maziar; Rajabpour, Mojtaba; Emami, Mohammad; Jazayeri, Seyyed Mohammad; Madadi, Firooz; Farahini, Hossein; Mirzatoloee, Fardin; Gharahdaghi, Mohammad; Ebrahimzadeh, Mohammad Hossein; Ebrahimian, Mohammadreza; Mirvakili, Hossein; Bashti, Kaveh; Almasizadeh, Mohtasham; Abolghasemian, Mansour; Taheriazam, Afshin; Motififard, Mehdi; Yazdi, Hamidreza; Mobarakeh, Mahmood Karimi; Shayestehazar, Masoud; Moghtadae, Mehdi; Siavashi, Babak; Sajjadi, Mohammadreza M; Rasi, Alireza Manafi; Chabok, Seyyed Kazem; Zafarani, Zohreh; Salehi, Shahin; Ahmadi, Monireh; Mohammadi, Amin; Shahsavand, Mohammad Ebrahim

    2016-04-01

    Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.

  13. A comparison between dynamic implicit and explicit finite element simulations of the native knee joint.

    PubMed

    Naghibi Beidokhti, Hamid; Janssen, Dennis; Khoshgoftar, Mehdi; Sprengers, Andre; Perdahcioglu, Emin Semih; Van den Boogaard, Ton; Verdonschot, Nico

    2016-10-01

    The finite element (FE) method has been widely used to investigate knee biomechanics. Time integration algorithms for dynamic problems in finite element analysis can be classified as either implicit or explicit. Although previously both static/dynamic implicit and dynamic explicit method have been used, a comparative study on the outcomes of both methods is of high interest for the knee modeling community. The aim of this study is to compare static, dynamic implicit and dynamic explicit solutions in analyses of the knee joint to assess the prediction of dynamic effects, potential convergence problems, the accuracy and stability of the calculations, the difference in computational time, and the influence of mass-scaling in the explicit formulation. The heel-strike phase of fast, normal and slow gait was simulated for two different body masses in a model of the native knee. Our results indicate that ignoring the dynamic effect can alter joint motion. Explicit analyses are suitable to simulate dynamic loading of the knee joint in high-speed simulations, as this method offers a substantial reduction of the computational time with a similar prediction of cartilage stresses and meniscus strains. Although mass-scaling can provide even more gain in computational time, it is not recommended for high-speed activities, in which inertial forces play a significant role.

  14. Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study.

    PubMed

    Diraçoğlu, Demirhan; Alptekin, Kerem; Teksöz, Bahar; Yağci, Ilker; Ozçakar, Levent; Aksoy, Cihan

    2009-09-01

    This paper aims to compare the results of single-joint knee vs hip hyaluronic acid (HA) injections in patients with osteoarthritis (OA) involving both the knee and hip joints. Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled. Patients were divided into two groups to receive HA injection three times at 1-week intervals either to the hip or knee joints. Pain level during activities and rest was measured by using visual analog scale (VAS). Western Ontario and McMaster University Osteoarthritis Index (WOMAC 5-point Likert 3.0) was also used prior to the injections and 1 month after the 3rd injection. In the knee injection group, the intragroup analysis revealed significant improvements in VAS activity pain, VAS rest pain, and WOMAC pain values following injection when compared with preinjection values, while no significant difference was detected in WOMAC stiffness, WOMAC physical function, and WOMAC total values. In the hip injection group, VAS activity pain, VAS rest pain, WOMAC pain, WOMAC stiffness, WOMAC physical function, and WOMAC total values showed significant improvement after the injection when compared with preinjection values. Although statistically not significant (p > 0.05), the comparison of the differences (preinjection-postinjection) between the groups demonstrated higher values in the hip injection group. We imply that intra-articular single-joint HA injections either to the knee or hip joints in OA patients with involvement of both of these joints are effective with regard to pain and functional status.

  15. [Deep Relief sonophoresis in degenerative changes of the knee joint].

    PubMed

    Zjuzin, Nada; Muftić, Mirsad; Avdić, Dijana; Zubcević, Haris; Stefanovski, Mihajlo; Stefanovski, Gordana; Lukać, Tamara; Hotić, Asia; Halilbegović, Emir; Kapidzić, Nedima

    2004-01-01

    We analysed 130 persons with osteoarthritis of knee and compared efficiency Deep Relief gel with sonophoresis and ultrasound with standard gel. Deep Relief has significant better effect for less pain and better improvement of functional capacity in comparison with ultrasound. Results of examination are statistic significant.

  16. Multiple osteochondroses of bilateral knee joints: a case report.

    PubMed

    Franceschi, Francesco; Barnaba, Simona Angela; Rojas, Mario; Gualdi, Giancarlo; Rizzello, Giacomo; Papalia, Rocco; Denaro, Vincenzo

    2007-04-01

    Knee injuries in young athletes include not only the typical adult bone injuries, ligament and cartilage, but also the growth plate lesions. Osteochondroses are idiopathic, self-limited disturbance of enchondral ossification in which a rapid growth spurt is present. The patella could be affected by two different kinds of osteochondroses: Kohler syndrome and Sinding-Larsen-Johansson. Here we are reporting the first case of simultaneous location of osteochondroses of the two ossification centers of both patella. A 9-year-old boy, competitive skater, presented a history of anterior knee pain involving both knees. Standard X-rays, axial patellar view, MRI and arthro-MR were performed. In order to follow the natural history of the pathology and the evolution of the healing, examinations at 2 years were repeated. We proposed the young skater a medical and a physiotherapeutic treatment based on unloading, isometric exercises, NSAID. As the symptoms improve a gradual return to competitive sports activity was allowed. The case mentioned above can be considered an atypical case because the patient suffered for a bilateral knee osteochondroses, involving simultaneously the primary ossification centre (Kohler syndrome) and the secondary ossification centre (Larsen syndrome) of the patella.

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

    PubMed Central

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

    2011-01-01

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

  18. Defining the knee joint flexion-extension axis for purposes of quantitative gait analysis: an evaluation of methods.

    PubMed

    Schache, Anthony G; Baker, Richard; Lamoreux, Larry W

    2006-08-01

    Minimising measurement variability associated with hip axial rotation and avoiding knee joint angle cross-talk are two fundamental objectives of any method used to define the knee joint flexion-extension axis for purposes of quantitative gait analysis. The aim of this experiment was to compare three different methods of defining this axis: the knee alignment device (KAD) method, a method based on the transepicondylar axis (TEA) and an alternative numerical method (Dynamic). The former two methods are common approaches that have been applied clinically in many quantitative gait analysis laboratories; the latter is an optimisation procedure. A cohort of 20 subjects performed three different functional tasks (normal gait; squat; non-weight bearing knee flexion) on repeated occasions. Three-dimensional hip and knee angles were computed using the three alternative methods of defining the knee joint flexion-extension axis. The repeatability of hip axial rotation measurements during normal gait was found to be significantly better for the Dynamic method (p<0.01). Furthermore, both the variance in the knee varus-valgus kinematic profile and the degree of knee joint angle cross-talk were smallest for the Dynamic method across all functional tasks. The Dynamic method therefore provided superior results in comparison to the KAD and TEA-based methods and thus represents an attractive solution for orientating the knee joint flexion-extension axis for purposes of quantitative gait analysis.

  19. Gender differences in hip and ankle joint kinematics on knee abduction during running.

    PubMed

    Sakaguchi, Masanori; Ogawa, Haruna; Shimizu, Norifumi; Kanehisa, Hiroaki; Yanai, Toshimasa; Kawakami, Yasuo

    2014-01-01

    The knee is the most common site of running injuries, particularly prevalent in females. The purpose of this study was to clarify gender differences in the lower extremity kinematics during running, with a specific emphasis on the relationships between the distal and proximal factors and the knee joint kinematics. Eleven female and 11 male runners participated in this study. Three-dimensional marker positions were recorded with a motion analysis system while the subjects ran along a 25 m runway at a speed of 3.5 m/s. Kinematic variables were analyzed for the stance phase of the right leg. Female runners demonstrated significantly greater peak knee abduction (P<0.05), hip adduction (P<0.01) and internal rotation (P<0.05), whereas male runners demonstrated significantly greater peak rearfoot eversion (P<0.01). The knee abduction angles were positively correlated with hip adduction angles (r=0.49, P<0.05) and negatively correlated with rearfoot eversion (r= -0.69, P<0.001). There was no significant difference in normalised step width between genders (P>0.05). Smaller rearfoot eversion and greater hip adduction related closely to the greater knee abduction as the distal and proximal factors, respectively. These relationships are thought to be the compensatory joint motions in the frontal plane, because there was no significant difference in the normalised step width between females and males. The current results suggest that if the step width is identical, the subjects with greater knee abduction had smaller rearfoot eversion to compensate for greater hip adduction, which were more apparent in females. This explains greater knee abduction found in female runners, which can be linked to a high risk of knee injury.

  20. Evaluation of the gait performance of above-knee amputees while walking with 3R20 and 3R15 knee joints

    PubMed Central

    Taheri, AliReza; Karimi, Mohammad Taghi

    2012-01-01

    Background: The performance of the subjects with above-knee amputation is noticeably poorer than normal subjects. Various types of components have been designed to compensate their performance. Among various prosthetic components, the knee joint has great influence on the function. Two types of knee joints (3R15, 3R20) have been used broadly for above-knee prostheses. However, there is not enough research to highlight the influence of these joints on the gait performance of the subjects. Therefore, an aim of this research was to investigate the performance of the above-knee amputees while walking with 3R15 and 3R20 knee joints. Materials and Methods: 7 above-knee amputees were recruited in this research study. They were asked to walk with a comfortable speed to investigate the gait function of the subjects with 3 cameras 3D motion analysis system (Kinematrix system). The difference between the performances of the subjects with these joints was compared by use of paired t-test. Results: The results of this study showed that, the performances of the subjects with 3R20 were better than that with 3R15. The walking speed of the subjects with 3R20 was 66.7 m/min compared to 30.4 m/min (P-value = 0.045). Moreover; the symmetry of walking with 3R20 was more than that with 3R15, based on the spatio- temporal gait parameters values (P-value <0.05). Conclusion: The difference between the performances of the subjects with 3R20 and 3R15 knee joints was related to the walking speed, which improved while walking with 3R20 joint. PMID:23267378

  1. Quantifying in vivo laxity in the anterior cruciate ligament and individual knee joint structures.

    PubMed

    Westover, L M; Sinaei, N; Küpper, J C; Ronsky, J L

    2016-11-01

    A custom knee loading apparatus (KLA), when used in conjunction with magnetic resonance imaging, enables in vivo measurement of the gross anterior laxity of the knee joint. A numerical model was applied to the KLA to understand the contribution of the individual joint structures and to estimate the stiffness of the anterior-cruciate ligament (ACL). The model was evaluated with a cadaveric study using an in situ knee loading apparatus and an ElectroForce test system. A constrained optimization solution technique was able to predict the restraining forces within the soft-tissue structures and joint contact. The numerical model presented here allowed in vivo prediction of the material stiffness parameters of the ACL in response to applied anterior loading. Promising results were obtained for in vivo load sharing within the structures. The numerical model overestimated the ACL forces by 27.61-92.71%. This study presents a novel approach to estimate ligament stiffness and provides the basis to develop a robust and accurate measure of in vivo knee joint laxity.

  2. [Follow-up results of reconstructing the knee joint with ligaments of Lavasan (author's transl)].

    PubMed

    Mironova, S S

    1978-01-01

    Recommendation of synthetic material for reconstructing the knee joint ligaments. 15 years experience in 262 patients (sportsmen, ballet dancers, circus artistis,. The Lavasan implant was used in isolated as well as in combined injuries of the ligaments. The long-term results (13 years) yielded satisfactory results in 91%.

  3. Listeria monocytogenes infection in a prosthetic knee joint in rheumatoid arthritis.

    PubMed Central

    Booth, L V; Walters, M T; Tuck, A C; Luqmani, R A; Cawley, M I

    1990-01-01

    The prosthetic knee joint of a 64 year old woman with severe rheumatoid arthritis was found to be infected with Listeria monocytogenes. After treatment with intravenous antibiotics, symptoms gradually resolved. She subsequently received prolonged treatment with oral co-trimoxazole and 18 months later remained well. PMID:2310230

  4. Arthrosonography of hip and knee joints in the follow up of juvenile rheumatoid arthritis

    PubMed Central

    Frosch, M; Foell, D; Ganser, G; Roth, J

    2003-01-01

    Methods: Twenty eight patients with JRA with active disease at entry in 15 hips and 38 knee joints were followed up three times in intervals of 4–6 weeks. Sonographic, clinical, and laboratory findings were documented at the same time in clinically active and inactive disease. As controls of the sonographic variables 10 children without a history of arthritis were examined by ultrasound. Results: In active arthritis of the hip joint 19/31 (61%) examinations showed a pathological widening of the synovial joint space. There was no significant correlation between sonographic and clinical measures of disease activity in coxitis. Marked effusion within the suprapatellar pouch was seen in 87% and thickening of the synovial membrane in 92% of cases of active gonarthritis in patients with JRA. There was a significant difference in the number of patients with joint effusion and in the mean joint effusion between patients with clinically active gonarthritis at entry and inactive arthritis at follow up (p<0.001). In contrast, synovial thickening persisted in about 80% after induction of clinical remission. Conclusion: The data confirm the high sensitivity of arthrosonography in imaging changes in hip and knee joints of patients with JRA. Sonographic effusion of the knee provided the highest correlation with measures of clinical disease activity. Further prospective studies should evaluate whether persistent thickening of the synovial membrane detected by ultrasound in clinically inactive arthritis indicates residual inflammatory activity and an increased risk of relapse. PMID:12594110

  5. Deformation of articular cartilage during static loading of a knee joint--experimental and finite element analysis.

    PubMed

    Halonen, K S; Mononen, M E; Jurvelin, J S; Töyräs, J; Salo, J; Korhonen, R K

    2014-07-18

    Novel conical beam CT-scanners offer high resolution imaging of knee structures with i.a. contrast media, even under weight bearing. With this new technology, we aimed to determine cartilage strains and meniscal movement in a human knee at 0, 1, 5, and 30 min of standing and compare them to the subject-specific 3D finite element (FE) model. The FE model of the volunteer׳s knee, based on the geometry obtained from magnetic resonance images, was created to simulate the creep. The effects of collagen fibril network stiffness, nonfibrillar matrix modulus, permeability and fluid flow boundary conditions on the creep response in cartilage were investigated. In the experiment, 80% of the maximum strain in cartilage developed immediately, after which the cartilage continued to deform slowly until the 30 min time point. Cartilage strains and meniscus movement obtained from the FE model matched adequately with the experimentally measured values. Reducing the fibril network stiffness increased the mean strains substantially, while the creep rate was primarily influenced by an increase in the nonfibrillar matrix modulus. Changing the initial permeability and preventing fluid flow through noncontacting surfaces had a negligible effect on cartilage strains. The present results improve understanding of the mechanisms controlling articular cartilage strains and meniscal movements in a knee joint under physiological static loading. Ultimately a validated model could be used as a noninvasive diagnostic tool to locate cartilage areas at risk for degeneration.

  6. Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants

    PubMed Central

    Kutzner, Ines; Dymke, Jörn; Damm, Philipp; Duda, Georg N.; Günzl, Reiner; Bergmann, Georg

    2017-01-01

    Aquatic exercises are widely used for rehabilitation or preventive therapies in order to enable mobilization and muscle strengthening while minimizing joint loading of the lower limb. The load reducing effect of water due to buoyancy is a main advantage compared to exercises on land. However, also drag forces have to be considered that act opposite to the relative motion of the body segments and require higher muscle activity. Due to these opposing effects on joint loading, the load-reducing effect during aquatic exercises remains unknown. The aim of this study was to quantify the joint loads during various aquatic exercises and to determine the load reducing effect of water. Instrumented knee and hip implants with telemetric data transfer were used to measure the resultant joint contact forces in 12 elderly subjects (6x hip, 6x knee) in vivo. Different dynamic, weight-bearing and non-weight-bearing activities were performed by the subjects on land and in chest-high water. Non-weight-bearing hip and knee flexion/extension was performed at different velocities and with additional Aquafins. Joint forces during aquatic exercises ranged between 32 and 396% body weight (BW). Highest forces occurred during dynamic activities, followed by weight-bearing and slow non-weight-bearing activities. Compared to the same activities on land, joint forces were reduced by 36–55% in water with absolute reductions being greater than 100%BW during weight-bearing and dynamic activities. During non-weight-bearing activities, high movement velocities and additional Aquafins increased the joint forces by up to 59% and resulted in joint forces of up to 301%BW. This study confirms the load reducing effect of water during weight-bearing and dynamic exercises. Nevertheless, high drag forces result in increased joint contact forces and indicate greater muscle activity. By the choice of activity, movement velocity and additional resistive devices joint forces can be modulated individually in

  7. Registration of knee joint surfaces for the in vivo study of joint injuries based on magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Cheng, Rita W. T.; Habib, Ayman F.; Frayne, Richard; Ronsky, Janet L.

    2006-03-01

    In-vivo quantitative assessments of joint conditions and health status can help to increase understanding of the pathology of osteoarthritis, a degenerative joint disease that affects a large population each year. Magnetic resonance imaging (MRI) provides a non-invasive and accurate means to assess and monitor joint properties, and has become widely used for diagnosis and biomechanics studies. Quantitative analyses and comparisons of MR datasets require accurate alignment of anatomical structures, thus image registration becomes a necessary procedure for these applications. This research focuses on developing a registration technique for MR knee joint surfaces to allow quantitative study of joint injuries and health status. It introduces a novel idea of translating techniques originally developed for geographic data in the field of photogrammetry and remote sensing to register 3D MR data. The proposed algorithm works with surfaces that are represented by randomly distributed points with no requirement of known correspondences. The algorithm performs matching locally by identifying corresponding surface elements, and solves for the transformation parameters relating the surfaces by minimizing normal distances between them. This technique was used in three applications to: 1) register temporal MR data to verify the feasibility of the algorithm to help monitor diseases, 2) quantify patellar movement with respect to the femur based on the transformation parameters, and 3) quantify changes in contact area locations between the patellar and femoral cartilage at different knee flexion angles. The results indicate accurate registration and the proposed algorithm can be applied for in-vivo study of joint injuries with MRI.

  8. 3D reconstruction of bony elements of the knee joint and finite element analysis of total knee prosthesis obtained from the reconstructed model

    PubMed Central

    Djoudi, Farid

    2013-01-01

    Two separate themes are presented in this paper. Aims The first theme is to present a graphical modeling approach of human anatomical structures namely, the femur and the tibia. The second theme involves making a finite element analysis of stresses, displacements and deformations in prosthetic implants (the femoral implant and the polyethylene insert). Objectives The graphical modeling approach comes in two parts. The first is the segmentation of MRI scanned images, retrieved in DICOM format for edge detection. In the second part, 3D-CAD models are generated from the results of the segmentation stage. The finite element analysis is done by first extracting the prosthetic implants from the reconstructed 3D-CAD model, then do a finite element analysis of these implants under objectively determined conditions such as; forces, allowed displacements, the materials composing implant, and the coefficient of friction. Conclusion The objective of this work is to implement an interface for exchanging data between 2D MRI images obtained from a medical diagnosis of a patient and the 3D-CAD model used in various applications, such as; the extraction of the implants, stress analysis at the knee joint and can serve as an aid to surgery, also predict the behavior of the prosthetic implants vis-a-vis the forces acting on the knee joints. PMID:24396234

  9. Influence of a Full Body Compression Suit on Trunk Positioning and Knee Joint Mechanics During Lateral Movements.

    PubMed

    Mornieux, Guillaume; Weltin, Elmar; Pauls, Monika; Rott, Franz; Gollhofer, Albert

    2017-02-09

    Trunk positioning has been shown to be associated with knee joint loading during athletic tasks, especially changes of direction. The purpose of the present study was to test whether a full body compression suit (FBCS) would improve trunk positioning and knee joint control during lateral movements. Twelve female athletes performed lateral reactive jumps (LRJ) and unanticipated cuttings with and without the customized FBCS, while 3D kinematics and kinetics were measured. FBCS did not influence trunk positioning during LRJ and led to increased trunk lateral lean during cuttings (P < .001). However, while wearing FBCS, knee joint abduction and internal rotation angles were reduced during LRJ (P < .001 and P = .013, respectively), whereas knee joint moments were comparable during cuttings. FBCS cannot support the trunk segment during unanticipated dynamic movements. But increased trunk lateral lean during cutting maneuvers was not high enough to elicit increased knee joint moments. On the contrary, knee joint abduction and internal rotation were reduced during LRJ, speaking for a better knee joint alignment with FBCS. Athletes seeking to improve trunk positioning may not benefit from a full body compression suit.

  10. An extended dynamometer setup to improve the accuracy of knee joint moment assessment.

    PubMed

    Van Campen, Anke; De Groote, Friedl; Jonkers, Ilse; De Schutter, Joris

    2013-05-01

    This paper analyzes an extended dynamometry setup that aims at obtaining accurate knee joint moments. The main problem of the standard setup is the misalignment of the joint and the dynamometer axes of rotation due to nonrigid fixation, and the determination of the joint axis of rotation by palpation. The proposed approach 1) combines 6-D registration of the contact forces with 3-D motion capturing (which is a contribution to the design of the setup); 2) includes a functional axis of rotation in the model to describe the knee joint (which is a contribution to the modeling); and 3) calculates joint moments by a model-based 3-D inverse dynamic analysis. Through a sensitivity analysis, the influence of the accuracy of all model parameters is evaluated. Dynamics resulting from the extended setup are quantified, and are compared to those provided by the dynamometer. Maximal differences between the 3-D joint moment resulting from the inverse dynamics and measured by the dynamometer were 16.4 N ·m (16.9%) isokinetically and 18.3 N ·m (21.6%) isometrically. The calculated moment is most sensitive to the orientation and location of the axis of rotation. In conclusion, more accurate experimental joint moments are obtained using a model-based 3-D inverse dynamic approach that includes a good estimate of the pose of the joint axis.

  11. Knee Joint Loading during Gait in Healthy Controls and Individuals with Knee Osteoarthritis

    PubMed Central

    Kumar, Deepak; Manal, Kurt T.; Rudolph, Katherine S.

    2013-01-01

    Objective People with knee osteoarthritis (OA) are thought to walk with high loads at the knee which are yet to be quantfied using modeling techniques that account for subject specific EMG patterns, kinematics and kinetics. The objective was to estimate medial and lateral loading for people with knee OA and controls using an approach that is sensitive to subject specific muscle activation patterns. Methods 16 OA and 12 control (C) subjects walked while kinematic, kinetic and EMG data were collected. Muscle forces were calculated using an EMG-Driven model and loading was calculated by balancing the external moments with internal muscle and contact forces Results OA subjects walked slower and had greater laxity, static and dynamic varus alignment, less flexion and greater knee adduction moment (KAM). Loading (normalized to body weight) was no different between the groups but OA subjects had greater absolute medial load than controls and maintained a greater %total load on the medial compartment. These patterns were associated with body mass, sagittal and frontal plane moments, static alignment and close to signficance for dynamic alignment. Lateral compartment unloading during mid-late stance was observed in 50% of OA subjects. Conclusions Loading for control subjects was similar to data from instrumented prostheses. Knee OA subjects had high medial contact loads in early stance and half of the OA cohort demonstared lateral compartment lift-off. Results suggest that interventions aimed at reducing body weight and dynamic malalignment might be effective in reducing medial compartment loading and establishing normal medio-lateral load sharing patterns. PMID:23182814

  12. [Development of a testing device for knee joint kinematics parameters of patients with strokes].

    PubMed

    Xu, Xiulin; Ji, Xuefei; Xu, Xijiao; Zhao, Hongyao

    2013-04-01

    This article is aimed to present a design of a testing device for knee joint kinematics parameters of patients with strokes. We used Auto CAD to design the knee joint sensor device, and applied multifunction data acquisition card to collect sensor data. Then we transferred the data to the computer to quantitatively detect and analyze the joint angle, angular velocity and other parameters. The software system used Visual C+ + MFC frame and shared database Access, and used ADO technology to realize the collection between the software system and patient information system. After a preliminary test of 20 healthy subjects, the result showed that intraclass correlation coefficient (ICC) was more than 0.8, indicating a good reliability of the instrument.

  13. [Anatomy and biomechanics of the patellofemoral joint: physiological conditions and changes after total knee arthroplasty].

    PubMed

    Steinbrück, A; Milz, S; Woiczinski, M; Schröder, C; Utzschneider, S; Jansson, V; Fottner, A

    2011-10-01

    The patellofemoral joint constitutes a complex anatomical and functional entity. The tensile force of the quadriceps femoris muscle is transmitted through the patella and patellar ligament onto the tibial tuberosity. This particular three-dimensional arrangement increases the torsional moment acting on the knee joint. Dynamic alignment of the patella is determined by trochlear geometry and is supported by active muscular and passive connective tissue stabilizers. In addition to the retinaculum of the patella, the medial patellofemoral ligament is attracting increasing clinical attention. Multidirectional motion of the patella is closely connected to retropatellar pressure distribution which can be modulated by moving the patellar ligament insertion. Implantation of a knee endoprosthesis changes the joint surface geometry and consequently patella kinematics and retropatellar pressure distribution. Finite element analysis provides the possibility to assess retropatellar pressure distribution before and after implantation of prostheses.

  14. Lateral wedges alter mediolateral load distributions at the knee joint in obese individuals.

    PubMed

    Russell, Elizabeth M; Miller, Ross H; Umberger, Brian R; Hamill, Joseph

    2013-05-01

    Obesity is the primary risk factor for knee osteoarthritis (OA). Greater external knee adduction moments, surrogate measures for medial compartment loading, are present in Obese individuals and may predispose them to knee OA. Laterally wedged insoles decrease the magnitude of the external adduction moment in Obese individuals but it is unknown how they alter the center of pressure on the tibial plateau. A gait analysis was performed on 14 Obese (avg. 29.3 years; BMI range: 30.3-51.6 kg/m(2) ) and 14 lean women (avg. 26.1 years; BMI range: 20.9-24.6 kg/m(2) ) with and without a full-length, wedged insole. Computed joint angles, joint moments, and knee extensor strength values were input into a musculoskeletal model to estimate center of pressure of the contact force on the tibial plateau. Statistical significance was assessed using a two-way ANOVA to compare the main effects of group and insole condition (α = 0.05). The insole resulted in a significant (p < 0.01) lateral shift in the center of pressure location in both the Obese and Control groups (mean: 2.9 ± 0.7 and 1.5 ± 0.7 mm, respectively). The insole also significantly reduced the peak external knee adduction moment 1.88 ± 1.82 N m in the Control group (p < 0.01) and 3.62 ± 3.90 N m in the Obese group (p < 0.01). The results of this study indicate the effects of a prophylactic wedged insole for reducing the magnitude of the load on the knee's medial compartment in Obese women who are at risk for knee OA development.

  15. Minimization of the knee shear joint load in leg-extension equipment.

    PubMed

    Biscarini, A

    2008-10-01

    We developed an analytical biomechanical model for leg-extension equipment and the associated knee-extension/flexion exercises. The shear component, phi(t), of the tibiofemoral joint load was calculated taking into account all the fundamental elements of the equipment mechanics (resistance pad placement, cam/pulley system geometry, selected weight stack, etc.) and the instantaneous values of the relevant kinematical parameters (knee-flexion angle (theta(f)), angular velocity, and angular acceleration). The optimal distance (a(R))(OPT) between the knee-flexion/extension axis and the resistance pad placement point was derived by minimizing phi(t). (a(R))(OPT) is nearly independent of joint angular velocity and, for appreciably high resistance torques, becomes nearly independent of resistance level and cam/pulley geometry: for theta(f)>40 degrees , phi(t) is minimized by placing the resistance pad distally along the lower leg; for theta(f)knee-extension phase and distally during knee-flexion phase (0.17 mknee angular accelerations and hamstrings co-contractions, not predictable in advance, the value of (a(R))(OPT) obtained neglecting these effects still represents a good compromise for joint protection. This work establishes the rational basis for the design and clinical use of a leg-extension equipment that minimizes phi(t).

  16. [Modelling of the knee joint loading conditions in the view of mechanics].

    PubMed

    Pustovoĭt, K B; Karpins'kyĭ, M Iu

    2013-02-01

    The results of mathematic modelling of work of femoropatellar joint in normal conditions and in the presence of dysplastic deformity were adduced. There was established, that a knee joint (KJ) by its external appearance and function constitutes a classic cam mechanism. Biomechanical scheme of interaction between the femoral bone processus and patella was elaborated. In accordance to scheme of cam mechanism its experimental roentgenometric investigations were performed. According to statistical analysis performed, in conditions of dysplasia in femoropatellar joint the changes in the KJ occur, which may cause its blockade; the patella position in the KJ depends on peculiarities of anatomical structure of the femoral bone processuses.

  17. A viscoelastic poromechanical model of the knee joint in large compression.

    PubMed

    Kazemi, M; Li, L P

    2014-08-01

    The elastic response of the knee joint in various loading and pathological conditions has been investigated using anatomically accurate geometry. However, it is still challenging to predict the poromechanical response of the knee in realistic loading conditions. In the present study, a viscoelastic, poromechanical model of the knee joint was developed for soft tissues undergoing large deformation. Cartilages and menisci were modeled as fibril-reinforced porous materials and ligaments were considered as fibril-reinforced hyperelastic solids. Quasi-linear viscoelasticty was formulated for the collagen network of these tissues and nearly incompressible Neo-Hookean hyperelasticity was used for the non-fibrillar matrix. The constitutive model was coded with a user defined FORTRAN subroutine, in order to use ABAQUS for the finite element analysis. Creep and stress relaxation were investigated with large compression of the knee in full extension. The contact pressure distributions were found similar in creep and stress relaxation. However, the load transfer in the joint was completely different in these two loading scenarios. During creep, the contact pressure between cartilages decreased but the pressure between cartilage and meniscus increased with time. This led to a gradual transfer of some loading from the central part of cartilages to menisci. During stress relaxation, however, both contact pressures decreased monotonically.

  18. A Case of Penicillin-Resistant Veillonella Prosthetic Joint Infection of the Knee

    PubMed Central

    Peterson, Joy H.; Brodersen, Mark P.; Huff, Tamara

    2016-01-01

    Veillonella sp. and V. dispar are emerging pathogens. This is the third case of a monomicrobial Veillonella sp. prosthetic joint infection (PJI) among knees and hips; this is the second prosthetic knee infection described. The infection was treated with a 2-stage procedural approach combined with 6 weeks of ceftriaxone with excellent clinical response. There was no relapse in 2 years of follow-up care. This case exemplifies the importance of incubating anaerobic cultures for at least 7 days to grow some anaerobic pathogens. PMID:28050296

  19. The relationship between serum relaxin and knee joint laxity in female athletes.

    PubMed

    Arnold, Christopher; Van Bell, Craig; Rogers, Vincent; Cooney, Timothy

    2002-06-01

    Gravidity studies have intimated a relationship between serum relaxin levels and joint laxity. To assess its applicability to eumenorrheic athletes, weekly serum relaxin and knee arthrometry measurements were obtained in 57 collegiate women and 5 men for 4 consecutive weeks. The former included athletes, ACL-injured athletes, and nonathletes, while the latter formed an a priori hormonal control. Analysis of variance revealed a significant change in weekly serum relaxin levels in females but not in anterior translation. Regression analysis failed to disclose a relationship between these variables. Therefore, we conclude relaxin does not affect knee laxity.

  20. Development and validation of a 3-D model to predict knee joint loading during dynamic movement.

    PubMed

    McLean, S G; Su, A; van den Bogert, A J

    2003-12-01

    The purpose of this study was to develop a subject-specific 3-D model of the lower extremity to predict neuromuscular control effects on 3-D knee joint loading during movements that can potentially cause injury to the anterior cruciate ligament (ACL) in the knee. The simulation consisted of a forward dynamic 3-D musculoskeletal model of the lower extremity, scaled to represent a specific subject. Inputs of the model were the initial position and velocity of the skeletal elements, and the muscle stimulation patterns. Outputs of the model were movement and ground reaction forces, as well as resultant 3-D forces and moments acting across the knee joint. An optimization method was established to find muscle stimulation patterns that best reproduced the subject's movement and ground reaction forces during a sidestepping task. The optimized model produced movements and forces that were generally within one standard deviation of the measured subject data. Resultant knee joint loading variables extracted from the optimized model were comparable to those reported in the literature. The ability of the model to successfully predict the subject's response to altered initial conditions was quantified and found acceptable for use of the model to investigate the effect of altered neuromuscular control on knee joint loading during sidestepping. Monte Carlo simulations (N = 100,000) using randomly perturbed initial kinematic conditions, based on the subject's variability, resulted in peak anterior force, valgus torque and internal torque values of 378 N, 94 Nm and 71 Nm, respectively, large enough to cause ACL rupture. We conclude that the procedures described in this paper were successful in creating valid simulations of normal movement, and in simulating injuries that are caused by perturbed neuromuscular control.

  1. Prediction of medial and lateral contact force of the knee joint during normal and turning gait after total knee replacement.

    PubMed

    Purevsuren, Tserenchimed; Dorj, Ariunzaya; Kim, Kyungsoo; Kim, Yoon Hyuk

    2016-04-01

    The computational modeling approach has commonly been used to predict knee joint contact forces, muscle forces, and ligament loads during activities of daily living. Knowledge of these forces has several potential applications, for example, within design of equipment to protect the knee joint from injury and to plan adequate rehabilitation protocols, although clinical applications of computational models are still evolving and one of the limiting factors is model validation. The objective of this study was to extend previous modeling technique and to improve the validity of the model prediction using publicly available data set of the fifth "Grand Challenge Competition to Predict In Vivo Knee Loads." A two-stage modeling approach, which combines conventional inverse dynamic analysis (the first stage) with a multi-body subject-specific lower limb model (the second stage), was used to calculate medial and lateral compartment contact forces. The validation was performed by direct comparison of model predictions and experimental measurement of medial and lateral compartment contact forces during normal and turning gait. The model predictions of both medial and lateral contact forces showed strong correlations with experimental measurements in normal gait (r = 0.75 and 0.71) and in turning gait trials (r = 0.86 and 0.72), even though the current technique over-estimated medial compartment contact forces in swing phase. The correlation coefficient, Sprague and Geers metrics, and root mean squared error indicated that the lateral contact forces were predicted better than medial contact forces in comparison with the experimental measurements during both normal and turning gait trials.

  2. Dissecting the contribution of knee joint NGF to spinal nociceptive sensitization in a model of OA pain in the rat

    PubMed Central

    Sagar, D.R.; Nwosu, L.; Walsh, D.A.; Chapman, V.

    2015-01-01

    Summary Objective Although analgesic approaches targeting nerve growth factor (NGF) for the treatment of osteoarthritis (OA) pain remain of clinical interest, neurophysiological mechanisms by which NGF contribute to OA pain remain unclear. We investigated the impact of local elevation of knee joint NGF on knee joint, vs remote (hindpaw), evoked responses of spinal neurones in a rodent model of OA pain. Design In vivo spinal electrophysiology was carried out in anaesthetised rats with established pain behaviour and joint pathology following intra-articular injection of monosodium iodoacetate (MIA), vs injection of saline. Neuronal responses to knee joint extension and flexion, mechanical punctate stimulation of the peripheral receptive fields over the knee and at a remote site (ipsilateral hind paw) were studied before, and following, intra-articular injection of NGF (10 μg/50 μl) or saline. Results MIA-injected rats exhibited significant local (knee joint) and remote (lowered hindpaw withdrawal thresholds) changes in pain behaviour, and joint pathology. Intra-articular injection of NGF significantly (P < 0.05) increased knee extension-evoked firing of spinal neurones and the size of the peripheral receptive fields of spinal neurones (100% increase) over the knee joint in MIA rats, compared to controls. Intra-articular NGF injection did not significantly alter responses of spinal neurones following noxious stimulation of the ipsilateral hind paw in MIA-injected rats. Conclusion The facilitatory effects of intra-articular injection of NGF on spinal neurones receiving input from the knee joint provide a mechanistic basis for NGF mediated augmentation of OA knee pain, however additional mechanisms may contribute to the spread of pain to remote sites. PMID:25623624

  3. Wearable Goniometer and Accelerometer Sensory Fusion for Knee Joint Angle Measurement in Daily Life

    PubMed Central

    Tognetti, Alessandro; Lorussi, Federico; Carbonaro, Nicola; de Rossi, Danilo

    2015-01-01

    Human motion analysis is crucial for a wide range of applications and disciplines. The development and validation of low cost and unobtrusive sensing systems for ambulatory motion detection is still an open issue. Inertial measurement systems and e-textile sensors are emerging as potential technologies for daily life situations. We developed and conducted a preliminary evaluation of an innovative sensing concept that combines e-textiles and tri-axial accelerometers for ambulatory human motion analysis. Our sensory fusion method is based on a Kalman filter technique and combines the outputs of textile electrogoniometers and accelerometers without making any assumptions regarding the initial accelerometer position and orientation. We used our technique to measure the flexion-extension angle of the knee in different motion tasks (monopodalic flexions and walking at different velocities). The estimation technique was benchmarked against a commercial measurement system based on inertial measurement units and performed reliably for all of the various tasks (mean and standard deviation of the root mean square error of 1.96 and 0.96∘, respectively). In addition, the method showed a notable improvement in angular estimation compared to the estimation derived by the textile goniometer and accelerometer considered separately. In future work, we will extend this method to more complex and multi-degree of freedom joints. PMID:26569249

  4. Wearable Goniometer and Accelerometer Sensory Fusion for Knee Joint Angle Measurement in Daily Life.

    PubMed

    Tognetti, Alessandro; Lorussi, Federico; Carbonaro, Nicola; de Rossi, Danilo

    2015-11-11

    Human motion analysis is crucial for a wide range of applications and disciplines. The development and validation of low cost and unobtrusive sensing systems for ambulatory motion detection is still an open issue. Inertial measurement systems and e-textile sensors are emerging as potential technologies for daily life situations. We developed and conducted a preliminary evaluation of an innovative sensing concept that combines e-textiles and tri-axial accelerometers for ambulatory human motion analysis. Our sensory fusion method is based on a Kalman filter technique and combines the outputs of textile electrogoniometers and accelerometers without making any assumptions regarding the initial accelerometer position and orientation. We used our technique to measure the flexion-extension angle of the knee in different motion tasks (monopodalic flexions and walking at different velocities). The estimation technique was benchmarked against a commercial measurement system based on inertial measurement units and performed reliably for all of the various tasks (mean and standard deviation of the root mean square error of 1:96 and 0:96, respectively). In addition, the method showed a notable improvement in angular estimation compared to the estimation derived by the textile goniometer and accelerometer considered separately. In future work, we will extend this method to more complex and multi-degree of freedom joints.

  5. Bilateral Medial Tibiofemoral Joint Stiffness in Full Extension and 20° of Knee Flexion

    PubMed Central

    Aronson, Patricia A; Rijke, Arie M; Ingersoll, Christopher D

    2008-01-01

    Context: The valgus stress test is used clinically to assess injury to the medial knee structures in 2 positions: full extension and some degree of flexion. The amount of flexion used to “isolate” the medial collateral ligament is not consistent in the literature, but most studies have shown that stiffness of the ligaments was consistent between the limbs. Objective: To determine (1) if the stiffness of the medial knee structures was the same bilaterally, and (2) if the stiffness was different in full extension compared with 20° of knee flexion. Design: Criterion standard, before-after design. Setting: University research laboratory. Patients or Other Participants: Both knees of 45 healthy and active volunteers (26 females, 19 males; age  =  23.2 ± 3.96 years, height  =  170.6 ± 7.75 cm, mass  =  74.2 ± 15.14 kg) were studied. Intervention(s): A valgus force of 60 N was applied to the lateral aspect of both knees in full extension and in 20° of flexion. Main Outcome Measure(s): The slope of the force-strain line of the medial knee during a valgus force was calculated using the LigMaster arthrometer. Results: Slope means in full extension were 16.1 ± 3.3 (right knee) and 15.8 ± 3.1(left knee). Means for 20° of flexion were 12.2 ± 3.1 (right) and 11.7 ± 2.8 (left). Stiffness was greater when the knee was in full extension versus 20° of flexion (t44  =  12.04, P < .001). No difference was noted between the slopes of the 2 knees in extension (t44  =  0.74, P  =  .46) or in flexion (t44  =  1.2, P  =  .27). Conclusions: These findings support the use of the contralateral knee as a control. Further, the valgus stress test should be performed in full extension and in some degree of flexion to assess the different restraining structures of the medial tibiofemoral joint. PMID:18345340

  6. Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

    PubMed Central

    Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

    2015-01-01

    [Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used to detect the muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus before and after neuromuscular training. [Results] There was significant relaxation in tibial anterior displacement of the affected and sound sides in the supine position before neuromuscular training. Furthermore, the difference in the tibial anterior displacement of the affected knee joints in the standing position was reduced after neuromuscular training. Moreover, the variation of the muscle activation evoked higher muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus. [Conclusion] Neuromuscular training may improve functional joint stability in patients with orthopedic musculoskeletal injuries in the postoperative period. PMID:26834316

  7. Intrinsic innervation of the rat knee joint articular capsule and ligaments.

    PubMed

    Marinozzi, G; Ferrante, F; Gaudio, E; Ricci, A; Amenta, F

    1991-01-01

    In spite of the practical importance of having a detailed knowledge of knee joint innervation to understand the pathophysiologic aspects, little information is now available concerning the density and pattern of the nerve fibres which are distributed to it. The present study has been designed to investigate the density and distribution of nerve fibres and receptor corpuscles in the knee joint articular capsule, cruciate and collateral ligaments in the rat, using the acetylcholinesterase (AChE) histochemical in toto staining technique. The investigation was performed on male Wistar rats of 3 months of age, some of which had been treated with capsaicin to deplete their afferent 'C' fibres of their content of neuropeptides. AChE-positive nerve fibres and different types of receptor corpuscle endings were found within articular capsule and ligaments. The highest density of AChE-positive nerve fibres was noticeable in the fibular collateral ligament followed by the tibial collateral ligament, the posterior cruciate ligament, the anterior cruciate ligament and the articular capsule. In the articular capsule the number of type I endings was higher than in the ligaments. The opposite is true for the other type of receptor corpuscles found as well as for nerve endings. Capsaicin treatment significantly reduced the density of AChE-positive nerve fibres in knee joint ligaments but did not affect nerve fibres in the articular capsule. Moreover, it caused the disappearance of some kind of receptor corpuscles within the collateral and cruciate ligaments. The above data collectively suggest that the AChE in toto staining technique may represent a good method for investigating joint innervation and that a significant percentage of nerve fibres supplying knee joint ligaments is represented by C fibre afferents.

  8. Knee acoustic emission: a potential biomarker for quantitative assessment of joint ageing and degeneration.

    PubMed

    Shark, L K; Chen, H; Goodacre, J

    2011-06-01

    Based on a single time-point study of 34 healthy and 19 osteoarthritic knees in three different age groups (early, middle and late adulthood), this paper reports the potential of knee acoustic emission as a biomarker to monitor joint ageing and degeneration. Measurements were made of short transient high frequency acoustic emission signals generated by knee joints under stress during repeated sit-stand-sit movements along with joint angle. A statistically significant feature profile was established using a four-phase model of sit-stand-sit movements and two waveform features. The four-phase movement model is derived from joint angle measurement during repeated sit-stand-sit movements, and it consists of the ascending-acceleration and ascending-deceleration phases in the sit-to-stand movement, followed by the descending-acceleration and descending-deceleration phases in the stand-to-sit movement. The two statistically significant waveform features are extracted from AE measurement during repeated sit-stand-sit movements, and they consist of the peak magnitude value and average signal level of each AE burst. In addition to the use of bilateral plots, statistical distributions and 2D colour histograms to visualise the differences and similarities among participants, use of principal component analysis showed not only distinct data clusters corresponding to participating groups, but also an age- and disease-related trajectory progressing from the early adulthood healthy group to the late adulthood healthy group followed by the middle adulthood osteoarthritic group to the late adulthood osteoarthritic group. Furthermore, this trajectory shows increasing areas for each data cluster, with a highly compact cluster for the early adulthood healthy group at one end and a widely spread cluster for the late adulthood osteoarthritic group at the other end. From these results, a strong basis is formed for further development of knee acoustic emission as a convenient and non

  9. 21 CFR 888.3535 - Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... across-the-joint. This generic type of device is designed to achieve biological fixation to bone without the use of bone cement. This identification includes fixed-bearing knee prostheses where the...

  10. 21 CFR 888.3535 - Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... across-the-joint. This generic type of device is designed to achieve biological fixation to bone without the use of bone cement. This identification includes fixed-bearing knee prostheses where the...

  11. 21 CFR 888.3535 - Knee joint femorotibial (uni-compartmental) metal/polymer porous-coated uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... across-the-joint. This generic type of device is designed to achieve biological fixation to bone without the use of bone cement. This identification includes fixed-bearing knee prostheses where the...

  12. Non-operative management of osteoarthritis of the knee joint.

    PubMed

    Vaishya, Raju; Pariyo, Godfrey B; Agarwal, Amit Kumar; Vijay, Vipul

    2016-01-01

    Osteoarthritis is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by the growth of osteophytes. Treatment designed for osteoarthritis should aim at reducing pain, improve joint mobility, and limit functional impairment. It can be achieved by pharmacological and non-pharmacological means. Non-operative treatment of OA is useful for patients with KL grade 1-3, which are early stages of OA. However, in an advanced stage of OA (KL grade 4), surgical treatment is needed as definitive treatment.

  13. Using a surrogate contact pair to evaluate polyethylene wear in prosthetic knee joints.

    PubMed

    Sanders, Anthony P; Lockard, Carly A; Weisenburger, Joel N; Haider, Hani; Raeymaekers, Bart

    2016-01-01

    With recent improvements to the properties of ultra-high molecular weight polyethylene (UHMWPE) used in joint replacements, prosthetic knee and hip longevity may extend beyond two decades. However, it is difficult and costly to replicate such a long in vivo lifetime using clinically relevant in vitro wear testing approaches such as walking gait joint simulators. We advance a wear test intermediate in complexity between pin-on-disk and knee joint simulator tests. The test uses a surrogate contact pair, consisting of a surrogate femoral and tibial specimen that replicate the contact mechanics of any full-scale knee condyle contact pair. The method is implemented in a standard multi-directional pin-on-disk wear test machine, and we demonstrate its application via a two-million-cycle wear test of three different UHMWPE formulations. Further, we demonstrate the use of digital photography and image processing to accurately quantify fatigue damage based on the reduced transmission of light through a damage area in a UHMWPE specimen. The surrogate contact pairs replicate the knee condyle contact areas within -3% to +12%. The gravimetric wear test results reflect the dose of crosslinking radiation applied to the UHMWPE: 35 kGy yielded a wear rate of 7.4 mg/Mcycles, 55 kGy yielded 1.0 mg/Mcycles, and 75 kGy (applied to a 0.1% vitamin E stabilized UHMWPE) yielded 1.5 mg/Mcycles. A precursor to spalling fatigue is observed and precisely measured in the radiation-sterilized (35 kGy) and aged UHMWPE specimen. The presented techniques can be used to evaluate the high-cycle fatigue performance of arbitrary knee condyle contact pairs under design-specific contact stresses, using existing wear test machines. This makes the techniques more economical and well-suited to standardized comparative testing.

  14. Design and characterisation of a piezoelectric knee-joint energy harvester with frequency up-conversion through magnetic plucking

    NASA Astrophysics Data System (ADS)

    Kuang, Yang; Yang, Zhihao; Zhu, Meiling

    2016-08-01

    Piezoelectric energy harvesting from human motion is challenging because of the low energy conversion efficiency at a low-frequency excitation. Previous studies by the present authors showed that mechanical plucking of a piezoelectric bimorph cantilever was able to provide frequency up-conversion from a few hertz to the resonance frequency of the cantilever, and that a piezoelectric knee-joint energy harvester (KEH) based on this mechanism was able to generate sufficient energy to power a wireless sensor node. However, the direct contact between the bimorph and the plectra leads to reduced longevity and considerable noise. To address these limitations, this paper introduces a magnetic plucking mechanism to replace the mechanical plucking in the KEH, where primary magnets (PM) actuated by knee-joint motion excite the bimorphs through a secondary magnet (SM) fixed on the bimorphs tip and so achieve frequency up-conversion. The key parameters of the new KEH that affect the energy output of a plucked bimorph were investigated. It was found that the bimorph plucked by a repulsive magnetic force produced a higher energy output than an attractive force. The energy output peaked at 32 PMs and increased with a decreasing gap between PM and SM as well as an increasing rotation speed of the PMs. Based on these investigations, a KEH with high energy output was prototyped, which featured 8 piezoelectric bimorphs plucked by 32 PMs through repulsive magnetic forces. The gap between PM and SM was set to 1.5 mm with a consideration on both the energy output and longevity of the bimorphs. When actuated by knee-joint motion of 0.9 Hz, the KEH produced an average power output of 5.8 mW with a life time >7.3 h (about 3.8 × 105 plucking excitations).

  15. Agreement between weight bearing and non-weight bearing joint position replication tasks at the knee and hip.

    PubMed

    Foch, Eric; Milner, Clare E

    2013-01-01

    Peak joint angles assumed during the stance phase of running may indicate a runner's ability to sense limb position in space. Joint position sense can be assessed through weight bearing and non-weight bearing tasks. The purpose of this investigation was to determine if weight bearing and non-weight bearing knee and hip joint replication tasks elicited similar joint position sense test results. Absolute replication error was measured during sagittal plane knee and frontal plane hip conditions on 23 healthy runners. Three-dimensional kinematics was recorded during running. Intraclass correlation coefficients (ICCs) determined agreement between the two measures of joint position sense. Pearson's correlation coefficients measured the relationship between hip and knee absolute error and peak joint angles during running. Despite similar mean absolute error, ICCs indicated low agreement between weight bearing and non-weight bearing conditions at each joint. The results indicate the tests are not interchangeable. Absolute error for non-weight bearing hip replication was correlated with peak stance hip adduction during running. Weight bearing and non-weight bearing joint position sense tasks within the knee and hip joints measure joint position sense differently. Therefore, a task that is relevant to the activity of interest should be selected to measure joint position sense.

  16. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Classification. Class II. ...) translation in one or more planes. It has no linkage across-the-joint. This prosthesis is made of alloys, such as cobalt-chromium-molybdenum, and is intended to resurface one tibial condyle. The generic type...

  17. Osteochondral grafting for cartilage defects in the patellar grooves of bilateral knee joints.

    PubMed

    Nakagawa, Yasuaki; Matsusue, Yoshitaka; Suzuki, Takashi; Kuroki, Hiroshi; Nakamura, Takashi

    2004-07-01

    Autogenous osteochondral grafts have become popular recently for use in small, isolated, contained articular cartilage defects. We treated a 35-year-old man who had cartilage defects, which were the same shape and probably the result of overuse, in the patellar grooves of both knee joints. The left side was 30 x 25 mm, and the right side was 17 x 17 mm in his right patellar groove, and 15 x 7 mm in his right medial femoral condyle. Therefore, we performed multiple osteochondral grafting of the bilateral lesions. Thirty-two months after his right knee operation (37 months after his left one), he had no pain or symptoms in his left knee and occasional mild pain and catching in his right knee. At second-look arthroscopy, the joint surface of the articular cartilage in the bilateral patellar groove was almost completely smooth. However, the whole of the weight-bearing area around the grafted plugs in the medial femoral condyle showed cartilage degeneration. Approximately 3 years after implantation of osteochondral grafts into similarly shaped cartilage lesions in the bilateral patellar grooves, the operative results were good. However, careful follow up is needed.

  18. Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Czaplicki, Adam; Jarocka, Marta; Walawski, Jacek

    2015-01-01

    The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR) in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ≤ 0.05) in peak knee extension and flexion torques, hamstring/quadriceps (H/Q) strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age. PMID:26646385

  19. Sodium inversion recovery MRI of the knee joint in vivo at 7T

    NASA Astrophysics Data System (ADS)

    Madelin, Guillaume; Lee, Jae-Seung; Inati, Souheil; Jerschow, Alexej; Regatte, Ravinder R.

    2010-11-01

    The loss of proteoglycans (PG) in the articular cartilage is an early signature of osteoarthritis (OA). The ensuing changes in the fixed charge density in the cartilage can be directly linked to sodium concentration via charge balance. Sodium ions in the knee joint appear in two pools: in the synovial fluids or joint effusion where the ions are in free motion and bound within the cartilage tissue where the Na+ ions have a restricted motion. The ions in these two compartments have therefore different T1 and T2 relaxation times. The purpose of this study is to demonstrate the feasibility of a fluid-suppressed 3D ultrashort TE radial sodium sequence by implementing an inversion recovery (IR) preparation of the magnetization at 7T. This method could allow a more accurate and more sensitive quantification of loss of PG in patients with OA. It is shown that adiabatic pulses offer significantly improved performance in terms of robustness to B1 and B0 inhomogeneities when compared to the hard pulse sequence. Power deposition considerations further pose a limit to the RF inversion power, and we demonstrate in simulations and experiments how a practical compromise can be struck between clean suppression of fluid signals and power deposition levels. Two IR sequences with different types of inversion pulses (a rectangular pulse and an adiabatic pulse) were tested on a liquid phantom, ex vivo on a human knee cadaver and then in vivo on five healthy volunteers, with a (Nyquist) resolution of ∼3.6 mm and a signal-to-noise ratio of ∼30 in cartilage without IR and ∼20 with IR. Due to specific absorption rate limitations, the total acquisition time was ∼17 min for the 3D radial sequence without inversion or with the rectangular IR, and 24:30 min for the adiabatic IR sequence. It is shown that the adiabatic IR sequence generates a more uniform fluid suppression over the whole sample than the rectangular IR sequence.

  20. Effects of electrical noise to a knee joint on quiet bipedal stance and treadmill walking.

    PubMed

    Kimura, T; Taki, C; Shiozawa, N; Kouzaki, M

    2013-01-01

    The present study assessed whether an unperceivable, noise-like electrical stimulation of a knee joint enhances the stability of quiet bipedal stance and treadmill walking in young subjects. The results showed that the slow postural sway measures in quiet bipedal stance were significantly reduced by the electrical noise (P<0.05). In the treadmill walking, low frequency component (below 1 Hz) of mediolateral acceleration, measured at the third lumbar vertebra, significantly decreased with the electrical noise (P<0.05), while there were no changes in the anteroposterior and vertical directions. These results indicate that the electrical noise to a knee joint can be applied to enhance postural control in quiet bipedal stance and treadmill walking.

  1. Three-dimensional anatomy of the ostrich (Struthio camelus) knee joint

    PubMed Central

    Regnault, Sophie; Allen, Vivian; Hutchinson, John R.

    2014-01-01

    The three-dimensional anatomy of the ostrich (Struthio camelus) knee (femorotibial, femorofibular, and femoropatellar) joint has scarcely been studied, and could elucidate certain mechanobiological properties of sesamoid bones. The adult ostrich is unique in that it has double patellae, while another similar ratite bird, the emu, has none. Understanding why these patellae form and what purpose they may serve is dually important for future studies on ratites as well as for understanding the mechanobiological characteristics of sesamoid bone development. For this purpose, we present a three-dimensional anatomical study of the ostrich knee joint, detailing osteology, ligaments and menisci, and myology. We have identified seven muscles which connect to the two patellae and compare our findings to past descriptions. These descriptions can be used to further study the biomechanical loading and implications of the double patella in the ostrich. PMID:25551024

  2. Below-knee amputation through a joint-sparing proximal tibial replacement for recurrent tumour.

    PubMed

    Spiegelberg, B G I; Speigelberg, B G I; Sewell, M D; Coltman, T; Blunn, G W; Flanagan, A M; Cannon, S R; Briggs, T W R

    2009-06-01

    We report a case which highlights the progression of osteofibrous dysplasia to adamantinoma and questions whether intralesional curettage is the appropriate treatment. The role of a joint-sparing massive endoprosthesis using cortical fixation is demonstrated and we describe a unique biomedical design which resulted in the manufacture of an end cap to allow amputation through a custom-made proximal tibial replacement, rather than an above-knee amputation following recurrence.

  3. Catecholamine secretion and adrenal nerve activity in response to movements of normal and inflamed knee joints in cats.

    PubMed Central

    Sato, A; Sato, Y; Schmidt, R F

    1986-01-01

    The effects of articular stimulation on adrenal catecholamine secretion and adrenal sympathetic nerve activity were studied using halothane anaesthetized cats. Various natural passive movements were applied to the normal and inflamed knee joints. Rhythmic flexions and extensions as well as rhythmic inward and outward rotation of normal knee joints within their physiological range of motion did not change nerve activity or the secretion of adrenal catecholamines. Static outward rotation in the normal working range was also ineffective. However, as soon as this static rotation was extended into the noxious range, significant increases in both of these variables were elicited. In the acutely inflamed knee joint, various passive movements produced increases in both adrenal sympathetic and catecholamine secretion. Especially noteworthy was the finding that movements of the inflamed knee joint that were within the normal range of motion produced increases in all variables. Articularly induced increases in adrenal sympathetic nerve activity were diminished by severing various hind-limb somatic afferent nerves and abolished by complete denervation of the knee joint. Additionally, section of the adrenal sympathetic nerves eliminated the catecholamine secretion response. From these data it was concluded that the responses observed in these experiments were reflexes having an afferent limb in hind-limb nerves and an efferent limb in the adrenal sympathetic nerves. A contribution of supraspinal structures was suggested for the reflex responses of sympatho-adrenal medullary function evoked by knee joint stimulations, since spinal transection at the C2 level completely abolished the responses. PMID:3795070

  4. Impact of decline-board squat exercises and knee joint angles on the muscle activity of the lower limbs.

    PubMed

    Lee, Daehee; Lee, Sangyong; Park, Jungseo

    2015-08-01

    [Purpose] This study aims to investigate how squat exercises on a decline board and how the knee joint angles affect the muscle activity of the lower limbs. [Subjects] The subjects were 26 normal adults. [Methods] A Tumble Forms wedge device was used as the decline board, and the knee joint angles were measured with a goniometer. To examine the muscle activity of the biceps femoris, rectus femoris, gastrocnemius lateralis, and tibialis anterior of the lower limbs, a comparison analysis with electromyography was conducted. [Results] The muscle activity of the biceps femoris, rectus femoris, gastrocnemius lateralis, and tibialis anterior increased with increased knee joint angles, both for squat exercises on the decline board and on a flat floor. When the knee joint angle was 45°, 60°, and 90°, the muscle activity of the rectus femoris was significantly higher and that of the tibialis anterior was significantly lower during squat exercises on the decline board than on the flat floor. When the knee joint angle was 90°, the muscle activity of the gastrocnemius lateralis was significantly lower. [Conclusion] Squat exercises on a decline board are an effective intervention to increase the muscle activity of the rectus femoris with increased knee joint angles.

  5. An enhanced algorithm for knee joint sound classification using feature extraction based on time-frequency analysis.

    PubMed

    Kim, Keo Sik; Seo, Jeong Hwan; Kang, Jin U; Song, Chul Gyu

    2009-05-01

    Vibroarthrographic (VAG) signals, generated by human knee movement, are non-stationary and multi-component in nature and their time-frequency distribution (TFD) provides a powerful means to analyze such signals. The objective of this paper is to improve the classification accuracy of the features, obtained from the TFD of normal and abnormal VAG signals, using segmentation by the dynamic time warping (DTW) and denoising algorithm by the singular value decomposition (SVD). VAG and knee angle signals, recorded simultaneously during one flexion and one extension of the knee, were segmented and normalized at 0.5 Hz by the DTW method. Also, the noise within the TFD of the segmented VAG signals was reduced by the SVD algorithm, and a back-propagation neural network (BPNN) was used to classify the normal and abnormal VAG signals. The characteristic parameters of VAG signals consist of the energy, energy spread, frequency and frequency spread parameter extracted by the TFD. A total of 1408 segments (normal 1031, abnormal 377) were used for training and evaluating the BPNN. As a result, the average classification accuracy was 91.4 (standard deviation +/-1.7) %. The proposed method showed good potential for the non-invasive diagnosis and monitoring of joint disorders such as osteoarthritis.

  6. Tracking Knee Joint Functional Axes through Tikhonov Filtering and Plűcker Coordinates

    PubMed Central

    Kim, Wangdo; Kim, Yoon-Hyuk; Veloso, António P; Kohles, Sean S

    2013-01-01

    Researchers have reported several compensation methods to estimate bone and joint position from a cluster of skin-mounted markers as influenced by Soft Tissue Artifacts (STA). Tikhonov Regularization Filtering (TRF) as a means to estimate Instantaneous Screw Axes (ISA) was introduced here as a means to reduce the displacement of a rigid body to its simplest geometric form. Recent studies have suggested that the ISA of the knee, i.e., Knee Functional Axes (KFA), might be closely connected to the estimation of constraint forces such as those due to medial and lateral connective tissues. The estimations of ISAs were known to be highly sensitive to noisy data, which may be mathematically ill-posed, requiring smoothing such as that conducted by regularization. The main contribution in this work was to establish the reciprocal connection between the KFA and Ground Reaction Forces (GRF) as a means to estimate joint constraint forces. Presented results compare the computational performance with published kinetic and kinematic joint data generated from an instrumented total knee replacement. Implications of these preliminary findings with respect to dynamic alignment as a functional anatomic metric are discussed. PMID:23720709

  7. Reflex Responses to Ligament Loading: Implications for Knee Joint Stability

    DTIC Science & Technology

    2007-11-02

    American Volume. 63(5): p. 780-7, 1981. [21] Y.C. Fung, Biomechanics : Mechanical Properties of living tissue. 2nd ed. 1993: Springer-Verlag. [22...To quantify the input (abduction angle)/output (NR) properties of the sustained response, an exponential regression model was used given as (3...joint stiffness through co-contraction [22], and (b) selective activation based on the efficient biomechanical role of muscles. In the context of

  8. Magnetic resonance knee arthrography. Enhanced contrast by gadolinium complex in the rabbit and in humans.

    PubMed

    Engel, A

    1990-01-01

    This study contains the fundamentals and the technique of the intraarticular application of an MRI contrast agent in connection with magnetic resonance imaging (MRI arthrography). It also presents the resulting clinical relevance for knee joint diagnostics. The significance of MRI arthrography is linked above all to the central question of whether or not it is possible to depict the hyaline cartilage, its surface and its thickness with the help of MRI arthrography. MRI arthrography was used for in vitro examinations of rabbit knee joint cartilage and human joint cartilage. The in vivo application was carried out in 73 patients. Apart from the metric evaluation and the assessment of the information content of the MRI image, the corresponding histologic sections were made in 20 knee joints in order to compare the cartilage surface and the thickness of the cartilage with the results in the MRI image. The optimum amount of contrast agent for visualization was determined, the uptake and clearance of the contrast agent from the cartilage were assessed, and trace elements from the cartilage were also analyzed. The examination showed that the molecular structure of the contrast agent (gadolinium-DTPA) does not prevent the uptake of the contrast agent into the matrix of the hyaline cartilage. But this process is reversible. Thus, 14 hours after the intraarticular application of the contrast agent no measurable traces of gadolinium-DTPA could be established. The intraarticular application of the contrast agent also made it possible to achieve a constant and reproducible visualization of all joint structures. This affected mainly the surface of the hyaline cartilage. The best imaging quality was achieved with intraarticular application of 30 to 40 mL of a 2 mmolar solution of gadolinium-DTPA. The technique used for the intraarticular application is the same as for the common procedures of knee joint aspiration. The clinical importance of MRI arthrography lies in the fact that

  9. The effects of joint immobilization on articular cartilage of the knee in previously exercised rats

    PubMed Central

    Maldonado, Diogo Correa; da Silva, Marcelo Cavenaghi Pereira; Neto, Semaan El-Razi; Souza, Mônica Rodrigues; Souza, Romeu Rodrigues

    2013-01-01

    Studies have determined the effects of joint immobilization on the articular cartilage of sedentary animals, but we are not aware of any studies reporting the effects of joint immobilization in previously trained animals. The objective of the present study was to determine whether exercise could prevent degeneration of the articular cartilage that accompanies joint immobilization. We used light microscopy to study the thickness, cell density, nuclear size, and collagen density of articular cartilage of the femoral condyle of Wistar rats subjected to aerobic physical activity on an adapted treadmill five times per week. Four groups of Wistar rats were used: a control group (C), an immobilized group (I), an exercised group (E), and an exercised and then immobilized group (EI). The right knee joints from rats in groups I and EI were immobilized at 90 °C of flexion using a plastic cast for 8 weeks. Cartilage thickness decreased significantly in group I (mean, 120.14 ± 15.6 μm, P < 0.05), but not in group EI (mean, 174 ± 2.25), and increased significantly in group E (mean, 289.49 ± 9.15) compared with group C (mean, 239.20 ± 6.25). The same results were obtained for cell density, nuclear size, and collagen density (in all cases, P < 0.05). We concluded that exercise can prevent degenerative changes in femoral articular cartilage caused by immobilization of the knee joint. PMID:23480127

  10. Pathophysiology of obesity on knee joint homeostasis: contributions of the infrapatellar fat pad.

    PubMed

    Santangelo, Kelly S; Radakovich, Lauren B; Fouts, Josie; Foster, Michelle T

    2016-05-01

    Osteoarthritis (OA) is a debilitating condition characterized by inflammation, breakdown, and consequent loss of cartilage of the joints. Epidemiological studies indicate obesity is an important risk factor involved in OA initiation and progression. Traditional views propose OA to be a biomechanical consequence of excess weight on weight-bearing joints; however, emerging data demonstrates that systemic and local factors released from white adipose depots play a role. Hence, current views characterize OA as a condition exacerbated by a metabolic link related to adipose tissue, and not solely related to redistributed/altered weight load. Factors demonstrated to influence cartilage and bone homeostasis include adipocyte-derived hormones ("adipokines") and adipose depot released cytokines. Epidemiological studies demonstrate a positive relation between systemic circulating cytokines, leptin, and resistin with OA types, while the association with adiponectin is controversial. Local factors in joints have also been shown to play a role in OA. In particular, this includes the knee, a weight-bearing joint that encloses a relatively large adipose depot, the infrapatellar fat pad (IFP), which serves as a source of local inflammatory factors. This review summarizes the relation of obesity and OA as it specifically relates to the IFP and other integral supporting structures. Overall, studies support the concept that metabolic effects associated with systemic obesity also extend to the IFP, which promotes inflammation, pain, and cartilage destruction within the local knee joint environment, thus contributing to development and progression of OA.

  11. Changes in the activity of trunk and hip extensor muscles during bridge exercises with variations in unilateral knee joint angle

    PubMed Central

    Kim, Juseung; Park, Minchul

    2016-01-01

    [Purpose] This study compared abdominal and hip extensor muscle activity during a bridge exercise with various knee joint angles. [Subjects and Methods] Twenty-two healthy male subjects performed a bridge exercise in which the knee joint angle was altered. While subjects performed the bridge exercise, external oblique, internal oblique, gluteus maximus, and semitendinosus muscle activity was measured using electromyography. [Results] The bilateral external and internal oblique muscle activity was significantly higher at 0° knee flexion compared to 120°, 90°, and 60°. The bilateral gluteus maximus muscle activity was significantly different at 0° of knee flexion compared to 120°, 90°, and 60°. The ipsilateral semitendinosus muscle activity was significantly increased at 90° and 60° of knee flexion compared to 120°, and significantly decreased at 0° knee flexion compared with 120°, 90°, and 60°. The contralateral semitendinosus muscle activity was significantly higher at 60° of knee flexion than at 120°, and significantly higher at 0° of knee flexion than at 120°, 90°, and 60°. [Conclusion] Bridge exercises performed with knee flexion less than 90° may be used to train the ipsilateral semitendinosus. Furthermore, bridge exercise performed with one leg may be used to train abdominal and hip extensor muscles. PMID:27799688

  12. Accurate joint space quantification in knee osteoarthritis: a digital x-ray tomosynthesis phantom study

    NASA Astrophysics Data System (ADS)

    Sewell, Tanzania S.; Piacsek, Kelly L.; Heckel, Beth A.; Sabol, John M.

    2011-03-01

    The current imaging standard for diagnosis and monitoring of knee osteoarthritis (OA) is projection radiography. However radiographs may be insensitive to markers of early disease such as osteophytes and joint space narrowing (JSN). Relative to standard radiography, digital X-ray tomosynthesis (DTS) may provide improved visualization of the markers of knee OA without the interference of superimposed anatomy. DTS utilizes a series of low-dose projection images over an arc of +/-20 degrees to reconstruct tomographic images parallel to the detector. We propose that DTS can increase accuracy and precision in JSN quantification. The geometric accuracy of DTS was characterized by quantifying joint space width (JSW) as a function of knee flexion and position using physical and anthropomorphic phantoms. Using a commercially available digital X-ray system, projection and DTS images were acquired for a Lucite rod phantom with known gaps at various source-object-distances, and angles of flexion. Gap width, representative of JSW, was measured using a validated algorithm. Over an object-to-detector-distance range of 5-21cm, a 3.0mm gap width was reproducibly measured in the DTS images, independent of magnification. A simulated 0.50mm (+/-0.13) JSN was quantified accurately (95% CI 0.44-0.56mm) in the DTS images. Angling the rods to represent knee flexion, the minimum gap could be precisely determined from the DTS images and was independent of flexion angle. JSN quantification using DTS was insensitive to distance from patient barrier and flexion angle. Potential exists for the optimization of DTS for accurate radiographic quantification of knee OA independent of patient positioning.

  13. Inferiorly based thigh flap for reconstruction of defects around the knee joint

    PubMed Central

    Akhtar, Md. Sohaib; Khan, Arshad Hafeez; Khurram, Mohammed Fahud; Ahmad, Imran

    2014-01-01

    Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh. PMID:25190918

  14. Reductions in knee joint forces with weight loss are attenuated by gait adaptations in class III obesity.

    PubMed

    DeVita, Paul; Rider, Patrick; Hortobágyi, Tibor

    2016-03-01

    A consensus exists that high knee joint forces are a precursor to knee osteoarthritis and weight loss reduces these forces. Because large weight loss also leads to increased step length and walking velocity, knee contact forces may be reduced less than predicted by the magnitude of weight loss. The purpose was to determine the effects of weight loss on knee muscle and joint loads during walking in Class III obese adults. We determined through motion capture, force platform measures and biomechanical modeling the effects of weight loss produced by gastric bypass surgery over one year on knee muscle and joint loads during walking at a standard, controlled velocity and at self-selected walking velocities. Weight loss equaling 412 N or 34% of initial body weight reduced maximum knee compressive force by 824 N or 67% of initial body weight when walking at the controlled velocity. These changes represent a 2:1 reduction in knee force relative to weight loss when walking velocity is constrained to the baseline value. However, behavioral adaptations including increased stride length and walking velocity in the self-selected velocity condition attenuated this effect by ∼50% leading to a 392 N or 32% initial body weight reduction in compressive force in the knee joint. Thus, unconstrained walking elicited approximately 1:1 ratio of reduction in knee force relative to weight loss and is more indicative of walking behavior than the standard velocity condition. In conclusion, massive weight loss produces dramatic reductions in knee forces during walking but when patients stride out and walk faster, these favorable reductions become substantially attenuated.

  15. THE EFFECT OF CONSERVATIVELY TREATED ACL INJURY ON KNEE JOINT POSITION Sense

    PubMed Central

    Herrington, Lee

    2016-01-01

    ABSTRACT Background Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention. Purpose The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement. Study Design Observational study design using a cross-section of ACL deficient patients and matched uninjured controls. Methods Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle. Results The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects

  16. Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms.

    PubMed

    Higuchi, Hiroshi; Hatayama, Kazuhisa; Shimizu, Masaki; Kobayashi, Atsushi; Kobayashi, Tsutomu; Takagishi, Kenji

    2009-08-01

    The objective of this study was to investigate the range of motion (ROM) of the knee before and four years after total knee arthroplasty (TKA) with a mobile or fixed type of platform and to prospectively evaluate whether there was a difference in ligament balance between the platform types. The subjects were 68 patients involving 76 joints. The mobile type was used in 31 joints and fixed type in 45 joints by employing a prospective randomised method. The passive maximum ROM was measured using a goniometer before and four years after surgery. Also, the intraoperative knee ligament balance was measured. The postoperative extension ROM was significantly improved after TKA using a mobile bearing type compared with that employing a fixed bearing type. In TKA using the former, the intraoperative gap difference was not related to the postoperative flexion angle of the knee. However, they were related in TKA using a fixed bearing type, with a positive correlation regarding the flexion gap.

  17. Detection of DNA from a range of bacterial species in the knee joints of dogs with inflammatory knee arthritis and associated degenerative anterior cruciate ligament rupture.

    PubMed

    Muir, Peter; Oldenhoff, William E; Hudson, Alan P; Manley, Paul A; Schaefer, Susan L; Markel, Mark D; Hao, Zhengling

    2007-01-01

    Mixtures of bacterial nucleic acids can often be detected in synovial joints affected with arthritis. We investigated the potential role of such mixtures of bacterial nucleic acids in the pathogenesis of arthritis in a naturally occurring canine model. Dogs with a common inflammatory knee arthritis in which associated pathological degenerative anterior cruciate ligament (ACL) rupture often develops were studied. Synovial biopsies were obtained from 43 dogs with the naturally occurring ACL rupture arthropathy, 12 dogs with normal knees and intact ACL, and 16 dogs with normal knees and experimentally induced ACL rupture. Using PCR, specimens were tested for Borrelia burgdorferi OspA and p66 gene sequences. Broad-ranging 16S rRNA primers were also used; 'panbacterial' PCR products were cloned and multiple clones were sequenced for bacterial identification. Synovium was also studied histologically. The presence of bacterial DNA within the synovium was significantly associated with the naturally occurring ACL rupture arthropathy (p<0.05); knee joints from 37% of these dogs were PCR-positive. Mixtures of bacterial DNA were common and often included environmental bacteria; predominant organisms included Borrelia burgdorferi and Stenotrophomonas maltophilia. DNA from environmental bacteria was only found in dogs with the naturally occurring ACL rupture arthopathy; joints from 33% of affected dogs contained such bacterial DNA. Synovial inflammation developed in dogs with both naturally occurring and experimentally induced ACL rupture, when compared with intact ACL controls (p<0.01). These results indicate that mixtures of DNA derived from environmental bacteria are commonly found in the knee joint of a naturally occurring canine arthropathy, often in association with a recognized joint pathogen. Our results also suggest that knee instability alone is not responsible for this finding and have led us to hypothesize that mixtures of bacterial DNA are an important causative

  18. Effect of interleukin 17 on proteoglycan degradation in murine knee joints

    PubMed Central

    Dudler, J.; Renggli-Zulliger, N.; Busso, N.; Lotz, M.; So, A.

    2000-01-01

    OBJECTIVE—To evaluate the effect of murine interleukin 17 (IL17) on cartilage catabolism and joint inflammation by direct intra-articular injection of the cytokine into murine knee joints.
METHODS—Knees of normal C57 Bl mice were injected once or repeatedly with recombinant IL17 or IL1β. Inflammation was estimated by technetium-99m pertechnetate (99Tc) uptake and histological scoring of tissue sections. Proteoglycan depletion was evaluated by histological scoring of safranin O stained sections. Effects on proteoglycan synthesis were studied by 35SO4 incorporation.
RESULTS—A single intra-articular injection of IL17 (10 ng/knee) produced effects very similar to those of IL1β (10 ng/knee). No inflammation was detected at six or 24 hours by 99Tc uptake. However, safranin O staining showed depletion of proteoglycan at 48 hours. Repeated injections of IL17 induced joint inflammation and cartilage proteoglycan depletion as shown by histological scoring. Unlike IL1β, proteoglycan depletion induced by IL17 seemed to be the result of increased degradation only, as no suppression of 35SO4 incorporation was seen.
CONCLUSION—These findings confirm, in vivo, the catabolic effects of IL17 on cartilage. IL17 is thus the first T cell cytokine showing a direct catabolic effect on cartilage in addition to stimulatory effects on macrophages and synoviocytes, making it a potentially important cytokine in the pathogenesis of arthritis.

 PMID:10873962

  19. Acute effects of lateral shoe wedges on joint biomechanics of patients with medial compartment knee osteoarthritis during stationary cycling.

    PubMed

    Gardner, Jacob K; Klipple, Gary; Stewart, Candice; Asif, Irfan; Zhang, Songning

    2016-09-06

    Cycling is commonly prescribed for individuals with knee osteoarthritis (OA) but very little biomechanical research exists on the topic. Individuals with OA may be at greater risk of OA progression or other knee injuries because of their altered knee kinematics. This study investigated the effects of lateral wedges on knee joint biomechanics and pain in patients with medial compartment knee OA during stationary cycling. Thirteen participants with OA and 11 paired healthy participants volunteered for this study. A motion analysis system and a customized instrumented pedal were used to collect 5 pedal cycles of kinematics and kinetics, respectively, during 2 minutes of cycling in 1 neutral and 2 lateral wedge (5° and 10°) conditions. Participants pedaled at 60 RPM and an 80W workrate and rated their knee pain on a visual analog scale during each minute of each condition. There was a 22% decrease in the internal knee abduction moment with the 10° wedge. However, this finding was not accompanied by a decrease in knee adduction angle or subjective pain. Additionally, there was an increase in vertical and horizontal pedal reaction force which may negate the advantages of the decreased internal knee abduction moment. For people with medial knee OA, cycling with 10° lateral wedges may not be sufficient to slow the progression of OA beyond the neutral riding condition.

  20. Frequency dependent changes in mechanosensitivity of rat knee joint afferents after antidromic saphenous nerve stimulation.

    PubMed

    Just, S; Heppelmann, B

    2002-01-01

    The aim of the present study was to examine the effect of electrical saphenous nerve stimulation (14 V, 1-10 Hz) on the mechanosensitivity of rat knee joint afferents. The responses to passive joint rotations at defined torque were recorded from slowly conducting knee joint afferent nerve fibres (0.6-20.0 m/s). After repeated nerve stimulation with 1 Hz, the mechanosensitivity of about 79% of the units was significantly affected. The effects were most prominent at a torque close to the mechanical threshold. In about 46% of the examined nerve fibres a significant increase was obtained, whereas about 33% reduced their mechanosensitivity. The sensitisation was prevented by an application of 5 microM phentolamine, an alpha-adrenergic receptor blocker, together with a neuropeptide Y receptor blocker. An inhibition of N-type Ca(2+) channels by an application of 1 microM omega-conotoxin GVIA caused comparable changes of the mechanosensitivity during the electrical stimulation. Electrical nerve stimulation with higher frequencies resulted in a further reduction of the mean response to joint rotations. After stimulation with 10 Hz, there was a nearly complete loss of mechanosensitivity.In conclusion, antidromic electrical nerve stimulation leads to a frequency dependent transient decrease of the mechanosensitivity. A sensitisation was only obtained at 1 Hz, but this effect may be based on the influence of sympathetic nerve fibres.

  1. Knee joint input into the peripheral region of the ventral posterior lateral nucleus of cat thalamus.

    PubMed

    Hutchison, W D; Lühn, M A; Schmidt, R F

    1992-05-01

    1. Experiments were carried out in chloralose-anesthetized cats to study the responses of neurons in the lateral thalamus to excitation of afferent fibres from the knee joint. 2. Single- and multi-unit recordings were made with tungsten electrodes in dorsoventral penetrations through the ventral posterior lateral nucleus (VPL) during electrical stimulation of the medial articular nerve (MAN) of the cat's knee joint at an intensity sufficient to excite slowly conducting unmyelinated fibers. The locations of the recording sites were verified by recovering electrolytic lesion sites in histological sections (Nissl and cytochrome oxidase staining). 3. The average earliest latency for excitation of thalamic responses was 19.1 +/- 8.5 (SD) ms (n = 50). The threshold for excitation of most thalamic units was found to correspond to peripheral joint afferent fibers of the A-delta group. 4. The majority of neurons responding to MAN stimulation were found to be dorsal or ventral to the low-threshold cutaneous hindlimb region of the lateral division of the VPL (stereotaxic coordinates: AP 9.0-11.5; ML 7.0-9.5). In the ventral periphery of the VPL, most neurons responding to MAN stimulation (11/14) were wide dynamic range (WDR) with a discrete cutaneous receptive field on the hindpaw digits. Six WDR neurons were found dorsal to the hindlimb VPL with a convergent receptive field on the hindlimb (but not hindpaw digits). No nociceptive-specific knee joint units were found. 5. Other neurons were found dorsal to the hindlimb VPL with large receptive fields often encompassing the whole contralateral leg, including skin and deep hindlimb structures, possibly in a region described as the dorsal portion of the posterior complex (POd). Some neurons were found with no receptive field. 6. This study provides the first observations on the responses of lateral thalamic neurons to stimulation of the MAN of the cat knee joint. These results demonstrate a central pathway conveying impulses from

  2. The pizzicato knee-joint energy harvester: characterization with biomechanical data and the effect of backpack load

    NASA Astrophysics Data System (ADS)

    Pozzi, Michele; Aung, Min S. H.; Zhu, Meiling; Jones, Richard K.; Goulermas, John Y.

    2012-07-01

    The reduced power requirements of miniaturized electronics offer the opportunity to create devices which rely on energy harvesters for their power supply. In the case of wearable devices, human-based piezoelectric energy harvesting is particularly difficult due to the mismatch between the low frequency of human activities and the high-frequency requirements of piezoelectric transducers. We propose a piezoelectric energy harvester, to be worn on the knee-joint, that relies on the plucking technique to achieve frequency up-conversion. During a plucking action, a piezoelectric bimorph is deflected by a plectrum; when released due to loss of contact, the bimorph is free to vibrate at its resonant frequency, generating electrical energy with the highest efficiency. A prototype, featuring four PZT-5H bimorphs, was built and is here studied in a knee simulator which reproduces the gait of a human subject. Biomechanical data were collected with a marker-based motion capture system while the subject was carrying a selection of backpack loads. The paper focuses on the energy generation of the harvester and how this is affected by the backpack load. By altering the gait, the backpack load has a measurable effect on performance: at the highest load of 24 kg, a minor reduction in energy generation (7%) was observed and the output power is reduced by 10%. Both are so moderate to be practically unimportant. The average power output of the prototype is 2.06 ± 0.3 mW, which can increase significantly with further optimization.

  3. A neural network approach for determining gait modifications to reduce the contact force in knee joint implant.

    PubMed

    Ardestani, Marzieh Mostafavizadeh; Chen, Zhenxian; Wang, Ling; Lian, Qin; Liu, Yaxiong; He, Jiankang; Li, Dichen; Jin, Zhongmin

    2014-10-01

    There is a growing interest in non-surgical gait rehabilitation treatments to reduce the loading in the knee joint. In particular, synergetic kinematic changes required for joint offloading should be determined individually for each subject. Previous studies for gait rehabilitation designs are typically relied on a "trial-and-error" approach, using multi-body dynamic (MBD) analysis. However MBD is fairly time demanding which prevents it to be used iteratively for each subject. This study employed an artificial neural network to develop a cost-effective computational framework for designing gait rehabilitation patterns. A feed forward artificial neural network (FFANN) was trained based on a number of experimental gait trials obtained from literature. The trained network was then hired to calculate the appropriate kinematic waveforms (output) needed to achieve desired knee joint loading patterns (input). An auxiliary neural network was also developed to update the ground reaction force and moment profiles with respect to the predicted kinematic waveforms. The feasibility and efficiency of the predicted kinematic patterns were then evaluated through MBD analysis. Results showed that FFANN-based predicted kinematics could effectively decrease the total knee joint reaction forces. Peak values of the resultant knee joint forces, with respect to the bodyweight (BW), were reduced by 20% BW and 25% BW in the midstance and the terminal stance phases. Impulse values of the knee joint loading patterns were also decreased by 17% BW*s and 24%BW*s in the corresponding phases. The FFANN-based framework suggested a cost-effective forward solution which directly calculated the kinematic variations needed to implement a given desired knee joint loading pattern. It is therefore expected that this approach provides potential advantages and further insights into knee rehabilitation designs.

  4. One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections

    PubMed Central

    Nguyen, Manny; Sukeik, Mohamed; Zahar, Akos; Nizam, Ikram; Haddad, Fares Sami

    2016-01-01

    Background: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function. Methods: We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes. Results: Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements. Conclusion: The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition. PMID:28144374

  5. Basic kinematics and biomechanics of the patellofemoral joint part 2: the patella in total knee arthroplasty.

    PubMed

    Schindler, Oliver S

    2012-02-01

    Patellar and femoral component in total knee arthroplasty are inextricably linked as a functional unit. The configuration of this unit has been a matter of ongoing debate, and the myriad of different patellar and femoral components currently available reflect the lack of consensus with respect to the ideal design. One of the major challenges is to overcome the biomechanical disadvantages of a small contact area through which high contact pressures are transferred, making this mechanical construct the weakest part of the prosthetic knee. Contact areas are highly dependent on the congruency of the patellofemoral joint articulation, and are significantly smaller for dome shaped patellar components compared to those of more anatomic designs. However, when exposed to 3-dimensional movements, the contact areas of the dome shaped patella are significantly greater, indicating enhanced forgiveness regarding patellar malpositioning. Although contact stresses, a function of implant design and surface conformity, can reach levels far beyond the yield strength of UHMWPE, catastrophic failure of resurfaced patellar components, commonly seen in metal backed patellae, fashionable in the 1980s, has rarely been observed since. Although plastic deformation and wear of UHMWPE continue to represent a problem, in the absence of suitable alternatives polyethylene remains the bearing surface of choice. The appreciation of the consequences of the mechanical environment on the behaviour of the patellofemoral joint is of particular importance in the endeavour to develop knee replacement systems which provide satisfactory function together with clinical long-term success.

  6. Intra-articular injection of tenoxicam in osteoarthritic knee joints with effusion.

    PubMed

    Oztuna, Volkan; Eskandari, Metin; Bugdayci, Resul; Kuyurtar, Fehmi

    2007-12-01

    Thirty patients who had grade II to III osteoarthritis according to Kellgren-Lawrence system and presenting with acute effusion of the knee joint were randomly assigned to 2 groups. All patients were treated with aspiration of the synovial fluid, cold application, and rest. Fifteen patients received an intra-articular injection of tenoxicam 20 mg following aspiration. The other group was administered oral tenoxicam 20 mg a day for 10 days. Patients were examined at 2, 4, and 8 weeks and then in 3-month intervals. At followup visits, pain was assessed using visual analog scale: range of motion, and effusion of the knee joint were recorded. A repeated measure test was used to determine the significance of changes in pain and mobility between the groups. Student's Neyman Keuls test was used to determine the significance of differences within the groups. Chi-square test was used for the number of episodes. The intra-articular injection group had more rapid pain relief than the oral treatment group (P < .01). At the end of 1 year, the number of effusions was significantly lower in the intra-articular treatment group (P < .01). These results indicate that intra-articular injection of tenoxicam provides rapid pain relief in the patients with acute flare-up of knee osteoarthritis and helps to prevent effusion.

  7. Effect of music on anxiety and pain during joint lavage for knee osteoarthritis.

    PubMed

    Ottaviani, Sébastien; Bernard, Jean-Luc; Jean-Luc, Bernard; Bardin, Thomas; Thomas, Bardin; Richette, Pascal; Pascal, Richette

    2012-03-01

    Joint lavage for knee osteoarthritis is an invasive procedure that can be stressful and painful. We aimed to assess the impact of music therapy on perioperative anxiety, pain and tolerability of the procedure in patients undergoing joint lavage performed with two needles. We randomized all patients diagnosed with knee osteoarthritis and undergoing joint lavage in our department from November 2009 to October 2010 to an experimental group listening to recorded music or a control group receiving no music intervention. Perioperative anxiety and pain related to the procedure were self-reported on a visual analogic scale (0-100 mm visual analog scale [VAS]), and heart rate and blood pressure were measured during the procedure. Tolerability was assessed on a four-grade scale directly after the procedure. We included 62 patients (31 in each group). Mean age was 68.8 ± 12.6 years (72% females). As compared with the control group, the music group had lower levels of perioperative anxiety (40.3 ± 31.1 vs. 58.2 ± 26.3 mm; p = 0.046) and pain related to the procedure (26.6 ± 16.2 vs. 51.2 ± 23.7 mm; p = 0.0005). Moreover, heart rate was lower in the music group (69.5 ± 11.4 vs. 77.2 ± 13.2; p = 0.043) but not diastolic or systolic blood pressure. Tolerability was higher in the music group (p = 0.002). Music is a simple and effective tool to alleviate pain and anxiety in patients undergoing joint lavage for knee osteoarthritis.

  8. Knee joint position sense of roller hockey players: a comparative study.

    PubMed

    Venâncio, João; Lopes, Diogo; Lourenço, Joaquim; Ribeiro, Fernando

    2016-06-01

    This study aimed to compare knee joint position sense of roller hockey players with an age-matched group of non-athletes. Forty-three male participants voluntarily participated in this cross-sectional study: 21 roller hockey players (mean age: 23.2 ± 4.2 years old, mean weight: 81.8 ± 9.8 kg, mean height: 180.5 ± 4.1 cm) and 22 age-matched non-athletes (mean age: 23.7 ± 3.9 years old, mean weight: 85.0 ± 6.2 kg, mean height: 181.5 ± 5.0 cm). Knee joint position sense of the dominant limb was evaluated using a technique of open-kinetic chain and active knee positioning. Joint position sense was reported using absolute, relative and variable angular errors. The main results indicated that the group of roller hockey players showed significantly lower absolute (2.4 ± 1.2º vs. 6.5 ± 3.2º, p ≤ 0.001) and relative (1.7 ± 2.1º vs. 5.8 ± 4.4º, p ≤ 0.001) angular errors in comparison with the non-athletes group. In conclusion, the results from this present study suggest that proprioceptive acuity, assessed by measuring joint position sense, is increased in roller hockey players. The enhanced proprioception of the roller hockey players could contribute to injury prevention and improved performance during sporting activities.

  9. Residual force enhancement during multi-joint leg extensions at joint- angle configurations close to natural human motion.

    PubMed

    Paternoster, Florian Kurt; Seiberl, Wolfgang; Hahn, Daniel; Schwirtz, Ansgar

    2016-03-21

    The isometric steady-state forces following lengthening are greater than those produced at the same muscle length and activation level but without prior lengthening. Although residual force enhancement (RFE) has been investigated across a range of conditions, its relevance for daily human movement is still poorly understood. We aimed to study RFE in a setup imitating daily activity, i.e., submaximal activation of the lower extremity's muscles with slightly flexed knee joints comparable to human walking. A motor-driven leg press dynamometer was used for randomly arranged purely isometric and isometric-eccentric-isometric contractions. Thirteen subjects performed multi-joint leg extensions, which were feedback-controlled at 30% of maximum voluntary vastus lateralis activation. Isometric-eccentric-isometric contractions incorporated a stretch from 30° to 50° knee flexion, while isometric contractions were performed at 50° knee flexion. Isometric contractions following stretch and purely isometric reference contractions were performed at 50° knee flexion. Kinematics, forces, and muscular activity were measured using 3D optical motion tracking, force plates, and surface EMG of 9 lower limb muscles of the right leg and joint torques were calculated by inverse dynamics. Variables of standardization (EMG, joint angles) showed no differences between contraction conditions. Eight of 13 subjects showed RFE of up to 24.8±32.5% for external forces and joint torques. Because the remaining 5 non-responders failed to produce enhanced forces during the stretch, we believe that RFE is functionally relevant for muscle function comparable to everyday human motion but only if there is enhanced force during stretch that sufficiently triggers mechanisms underlying RFE.

  10. Isometric and isokinetic torque curves at the knee joint.

    PubMed

    Yoon, T S; Park, D S; Kang, S W; Chun, S I; Shin, J S

    1991-03-01

    Isometric and isokinetic torques of bilateral quadriceps and hamstrings were measured with Isokinetic Rehabilitation and Testing System (Model No. Cybex 340) on 40 normal untrained subjects, 20 males and 20 females, ranging between the ages of 23 and 35 years. The mean peak isometric and isokinetic torque values of both muscle groups showed no significant differences between dominant (right) and nondominant (left) limbs in both sexes; however there were significant differences between the male and the female. As the angular velocity increased, the peak torque significantly decreased, and the point of peak torque output occurred significantly later in the range of motion for quadriceps and hamstrings (p less than 0.01). There were no significant changes in the hamstrings to quadriceps (H/Q) ratios as the angular velocity increased. However, there were significant differences of mean H/Q ratio between male and female (p less than 0.01). Height had significant positive correlation with peak isometric and isokinetic torques for both quadriceps and hamstrings (p less than 0.01). Weight was found to correlate significantly with peak isometric and isokinetic torques (p less than 0.01). The mean isometric torques were significantly higher than the mean isokinetic torques for any joint angles in both sexes (p less than .01).

  11. Reconfigurable analog classifier for knee-joint rehabilitation.

    PubMed

    Shah, Sahil; Toreyin, Hakan; Inan, Omer T; Hasler, Jennifer

    2016-08-01

    We present a System-On-Chip Field Programmable Analog Array (FPAA) for analyzing and processing the signals off an accelerometer for a wearable joint health assessment device. FPAAs have been shown to compute with an efficiency of 1000 times, as well as area efficiencies of 100 times, more than digital solutions. This work presents a low power signal processing system which allows us to extract features from the output of the accelerometer. These features are used by the classifier, implemented using a vector matrix multiplication and a two output 1-winner-take-all, to detect flexion and extension cycles in the subject. The compiled design consumes 0.636 μW of power for the front end analog signal processing chain where as the single layer classifier uses 13 μW of power. Thus the system is highly suitable for wearable applications where power consumption is a major concern. The current FPAA is fabricated in a 0.35 μm CMOS process and is operated at a power supply of 2.5 volts. The Gm-C filters and other circuits are operated in the subthreshold regime of the transistor to obtain the highest transconductance to current ratio offered by the process.

  12. Computed Tomographic Image Analysis Based on FEM Performance Comparison of Segmentation on Knee Joint Reconstruction

    PubMed Central

    Jang, Seong-Wook; Seo, Young-Jin; Yoo, Yon-Sik

    2014-01-01

    The demand for an accurate and accessible image segmentation to generate 3D models from CT scan data has been increasing as such models are required in many areas of orthopedics. In this paper, to find the optimal image segmentation to create a 3D model of the knee CT data, we compared and validated segmentation algorithms based on both objective comparisons and finite element (FE) analysis. For comparison purposes, we used 1 model reconstructed in accordance with the instructions of a clinical professional and 3 models reconstructed using image processing algorithms (Sobel operator, Laplacian of Gaussian operator, and Canny edge detection). Comparison was performed by inspecting intermodel morphological deviations with the iterative closest point (ICP) algorithm, and FE analysis was performed to examine the effects of the segmentation algorithm on the results of the knee joint movement analysis. PMID:25538950

  13. Computed tomographic image analysis based on FEM performance comparison of segmentation on knee joint reconstruction.

    PubMed

    Jang, Seong-Wook; Seo, Young-Jin; Yoo, Yon-Sik; Kim, Yoon Sang

    2014-01-01

    The demand for an accurate and accessible image segmentation to generate 3D models from CT scan data has been increasing as such models are required in many areas of orthopedics. In this paper, to find the optimal image segmentation to create a 3D model of the knee CT data, we compared and validated segmentation algorithms based on both objective comparisons and finite element (FE) analysis. For comparison purposes, we used 1 model reconstructed in accordance with the instructions of a clinical professional and 3 models reconstructed using image processing algorithms (Sobel operator, Laplacian of Gaussian operator, and Canny edge detection). Comparison was performed by inspecting intermodel morphological deviations with the iterative closest point (ICP) algorithm, and FE analysis was performed to examine the effects of the segmentation algorithm on the results of the knee joint movement analysis.

  14. Dynamic Contact Mechanics on the Tibial Plateau of the Human Knee During Activities of Daily Living

    PubMed Central

    Gilbert, Susannah; Chen, Tony; Hutchinson, Ian D.; Choi, Dan; Voigt, Clifford; Warren, Russell F.; Maher, Suzanne A.

    2013-01-01

    Despite significant advances in scaffold design, manufacture, and development, it remains unclear what forces these scaffolds must withstand when implanted into the heavily loaded environment of the knee joint. The objective of this study was to fully quantify the dynamic contact mechanics across the tibial plateau of the human knee joint during gait and stair climbing. Our model consisted of a modified Stanmore knee simulator (to apply multi-directional dynamic forces), a two-camera motion capture system (to record joint kinematics), an electronic sensor (to record contact stresses on the tibial plateau), and a suite of post-processing algorithms. During gait, peak contact stresses on the medial plateau occurred in areas of cartilage-cartilage contact; while during stair climb, peak contact stresses were located in the posterior aspect of the plateau, under the meniscus. On the lateral plateau, during gait and in early stair-climb, peak contact stresses occurred under the meniscus, while in late stair-climb, peak contact stresses were experienced in the zone of cartilage-cartilage contact. At 45% of the gait cycle, and 20% and 48% of the stair-climb cycle, peak stresses were simultaneously experienced on both the medial and lateral compartment, suggesting that these phases of loading warrant particular consideration in any simulation intended to evaluate scaffold performance. Our study suggests that in order to design a scaffold capable of restoring ‘normal’ contact mechanics to the injured knees, the mechanics of the intended site of implantation should be taken into account in any pre-clinical testing regime. PMID:24296275

  15. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis.

    PubMed

    Gandhi, Rajiv; Zywiel, Michael G; Mahomed, Nizar N; Perruccio, Anthony V

    2015-01-01

    The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement.

  16. Inequalities in access to knee joint replacements for people in need

    PubMed Central

    Yong, P; Milner, P; Payne, J; Lewis, P; Jennison, C

    2004-01-01

    Objectives: To quantify the effects of socioeconomic deprivation and rurality on evidence of need for total knee joint replacement and the use of health services, after adjusting for age and sex. Methods: A random stratified sample of 15 000 people aged ⩾65 years taken from central age/sex registers for the geographical areas covered by the previous Sheffield and Wiltshire Health Authorities. A self completion validated questionnaire was then mailed directly to subjects to assess need for knee joint replacement surgery and whether general practice and hospital services were being used. Subjects were followed up for 18 months to evaluate access to surgery. Results: The response rate was 78% after three mailings. In those aged 65 years and over (with and without comorbidity), the proportion with no comorbid factors and in need of knee replacement was 5.1%; the rate of need among subjects without comorbidity was 7.9%. There were inequalities in health and access to health related to age, sex, geography, and deprivation but not rurality. People who were more deprived had greater need. Older and deprived people were less likely to access health services. Only 6.4% of eligible people received knee replacement surgery after 18 months of follow up. Conclusions: There is an important unmet need in older people, with significant age, sex, geographical, and deprivation inequalities in levels of need and access to services. The use of waiting list numbers as a performance indicator is perverse for this procedure. There is urgent need to expand orthopaedic services and training. PMID:15479899

  17. The influence of the test setup on knee joint kinematics - A meta-analysis of tibial rotation.

    PubMed

    Hacker, Steffen P; Ignatius, Anita; Dürselen, Lutz

    2016-09-06

    The human knee is one of the most investigated joints in the human body. Various test setups exist to measure and analyse knee kinematics in vitro which differ in a wide range of parameters. The purpose of this article is to find an answer to the question if the test setup influences the kinematic outcome of studies and to what extend the results can be compared. To answer this question, we compared the tibial rotation as a function of flexion angle presented in 19 published studies. Raw data was extracted via image segmentation from the graphs depicted in these publications and the differences between the publications was analysed. Additionally, all test setups were compared regarding four aspects: method for angle calculation, system for data acquisition, loading condition and testing rig design. The resulting correlation matrix shows the influence of the test setup on the study outcome. Our results indicate that each study needs to collect its own reference data. Finally, we provide a mean internal rotation as a function of flexion angle based on more than 140 specimens tested in 14 different studies.

  18. Histological study of effects of colloidal 90 yttrium on knee joint tissues of rabbits.

    PubMed

    Pavelka, K; Meier-Ruge, W; Müller, W; Fridrich, R

    1975-02-01

    The administration of 0-2-0-4 mCi 90 yttrium (90Y) into a normal rabbit knee joint fails to induce medical synovectomy and results in the proliferation of the synovialis. The synovial mesothelium shows early radiation damage but subsequently follows a restitution of the whole. Later (within 4 to 16 weeks) an extensive fibrosis of the stratum synovialis develops, as well as an occlusion and sclerosis of smaller synovial vessels and capillaries. These changes explain the beneficial therapeutic effect of 90Y in a chronic inflammatory joint effusion. After irradiation that joint cartilage shows an increased cellular proliferation of the superficial tangential cells and in the vicinity of the cruciate ligaments small foci of degenerated cartilage are present. The overall pattern of a joint treated with intra-articular 90Y corresponds to the histological pattern encountered regularly in joints of older people. Changes of the cartilage after the 90Y radiation could represent a factor predisposing the treated joint to a subsequent development of osteoarthrosis.

  19. Design of a knee and leg muscle exerciser for paraplegics using a shape memory alloy rotary joint actuator

    NASA Astrophysics Data System (ADS)

    Wang, Guoping; Shahinpoor, Mohsen

    1998-07-01

    This paper presents a design of an active knee and leg muscle exerciser using a shape memory alloy (SMA) rotary joint actuator. This active exerciser is designed for a paraplegic to exercise his or her knee and leg muscles. The exerciser is composed of a lower extremity orthosis or a knee brace, an SMA rotary joint actuator, and an electronic control unit. The lower extremity orthosis and knee brace are commercially available. The analysis model of the SMA rotary joint actuator is introduced and the design formulas are derived. A quasi-static analysis of the SMA rotary joint actuator is assumed in this design. The actuating component of the SMA rotary joint actuator is a bundle of lengthy SMA wires which are wrapped on several wrapping pulleys. A constant force spring is incorporated in this actuator to provide the SMA wires with a bias force to maintain a recoverable initial position of the actuator. A prototype of the active knee and leg muscle exerciser is designed, and an electronic control unit in the prototype provides users with a means of adjusting forward rotation speed and cycle time of the exerciser.

  20. β1 Integrin Deficiency Results in Multiple Abnormalities of the Knee Joint*

    PubMed Central

    Raducanu, Aurelia; Hunziker, Ernst B.; Drosse, Inga; Aszódi, Attila

    2009-01-01

    The lack of β1 integrins on chondrocytes leads to severe chondrodysplasia associated with high mortality rate around birth. To assess the impact of β1 integrin-mediated cell-matrix interactions on the function of adult knee joints, we conditionally deleted the β1 integrin gene in early limb mesenchyme using the Prx1-cre transgene. Mutant mice developed short limbed dwarfism and had joint defects due to β1 integrin deficiency in articular regions. The articular cartilage (AC) was structurally disorganized, accompanied by accelerated terminal differentiation, altered shape, and disrupted actin cytoskeleton of the chondrocytes. Defects in chondrocyte proliferation, cytokinesis, and survival resulted in hypocellularity. However, no significant differences in cartilage erosion, in the expression of matrix-degrading proteases, or in the exposure of aggrecan and collagen II cleavage neoepitopes were observed between control and mutant AC. We found no evidence for disturbed activation of MAPKs (ERK1/2, p38, and JNK) in vivo. Furthermore, fibronectin fragment-stimulated ERK activation and MMP-13 expression were indistinguishable in control and mutant femoral head explants. The mutant synovium was hyperplastic and frequently underwent chondrogenic differentiation. β1-null synoviocytes showed increased proliferation and phospho-focal adhesion kinase expression. Taken together, deletion of β1 integrins in the limb bud results in multiple abnormalities of the knee joints; however, it does not accelerate AC destruction, perturb cartilage metabolism, or influence intracellular MAPK signaling pathways. PMID:19586917

  1. Effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain

    PubMed Central

    Yoo, Won-gyu

    2016-01-01

    [Purpose] This study investigated the effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain. [Subjects and Methods] A 39-year-old female had severe pain in the right medial buttock and right anterior knee. This study assessed the anterior pelvic tilt angle and pain provocation tests before and after single-leg, lateral oblique, decline squat exercise for 4 weeks. [Results] Following the course of exercise, the anterior pelvic tilt angles were increased, and the visual analog scale pain scores for both the right buttock and right knee were 2/10. [Conclusion] Single-leg, lateral oblique, decline squat exercise may be effective for treating SI joint pain with knee pain in females. PMID:27799721

  2. Comparative study on isokinetic capacity of knee and ankle joints by functional injury

    PubMed Central

    Jeon, Kyoungkyu; Seo, Byoung-Do; Lee, Sang-Ho

    2016-01-01

    [Purpose] To collect basic data for exercise programs designed to enhance functional knee and ankle joint stability based on isokinetic measurement and muscle strength evaluations in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were randomly assigned to the athlete group and the control group (n = 12 each). Data were collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and 240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results] Significant intergroup differences were observed in peak torque of the right extensors at 60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and 240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation stimulates muscle contraction at motion-dependent speeds and may contribute to the development of intervention programs to improve knee and ankle joint function and correct lower-extremity instability. PMID:26957768

  3. Correlation study of knee joint proprioception test results using common test methods.

    PubMed

    Li, Lin; Ji, Zhong-Qiu; Li, Yan-Xia; Liu, Wei-Tong

    2016-01-01

    [Purpose] To study the correlation of the results obtained from different proprioception test methods, namely, the joint angle reset method, the motion minimum threshold measurement method, and the force sense reproduction method, performed on the same subjects' knees. [Subjects and Methods] Different proprioception test methods, the joint angle reset method, the motion minimum threshold measurement method and the force sense reproduction method were used to test the knees of 30 healthy young men. [Results] Correlations were found in the following descending order from strong to weak: the correlation between the joint angle reset method and the force sense reproduction method (correlation coefficient of 0.41), the correlation between the joint angle reset method and the motion minimum threshold measurement method (correlation coefficient of 0.29), the correlation between the motion minimum threshold measurement method and the force sense reproduce method (correlation coefficient of 0.15). [Conclusion] No correlation was found among the results obtained using the joint angle reset method, the motion minimum threshold measurement method and the force sense reproduction method. Therefore, no correlation was found among the position sense, the motion sense and the force sense represented by these methods. Using the results of only one of the test methods to represent proprioception is one-sided. Force sensation depends more on the sensory input of information from the Golgi tendon organs, motion sense depends more on the input information of the muscle spindles, and position sense relies on the double input information of the muscle spindles and the Golgi tendon organs.

  4. Biological activity and migration of wear particles in the knee joint: an in vivo comparison of six different polyethylene materials.

    PubMed

    Utzschneider, S; Lorber, V; Dedic, M; Paulus, A C; Schröder, C; Gottschalk, O; Schmitt-Sody, M; Jansson, V

    2014-06-01

    Wear of polyethylene causes loosening of joint prostheses because of the particle mediated activity of the host tissue. It was hypothesized that conventional and crosslinked polyethylene particles lead to similar biological effects around the knee joint in vivo as well as to a similar particle distribution in the surrounding tissues. To verify these hypotheses, particle suspensions of six different polyethylene materials were injected into knee joints of Balb/C mice and intravital microscopic, histological and immunohistochemical evaluations were done after 1 week. Whereas the biological effects on the synovial layer and the subchondral bone of femur and tibia were similar for all the polyethylenes, two crosslinked materials showed an elevated cytokine expression in the articular cartilage. Furthermore, the distribution of particles around the joint was dependent on the injected polyethylene material. Those crosslinked particles, which remained mainly in the joint space, showed an increased expression of TNF-alpha in articular cartilage. The data of this study support the use of crosslinked polyethylene in total knee arthroplasty. In contrast, the presence of certain crosslinked wear particles in the joint space can lead to an elevated inflammatory reaction in the remaining cartilage, which challenges the potential use of those crosslinked polyethylenes for unicondylar knee prostheses.

  5. Evaluation of distance maps from fast GRE MRI as a tool to study the knee joint space

    NASA Astrophysics Data System (ADS)

    Tamez-Pena, Jose G.; Lerner, Amy L.; Yao, Jiang; Salo, Arthur D.; Totterman, Saara

    2003-05-01

    A new three-dimensional (3D) method of evaluating the joint space from fast GRE MRI has been developed that allows the reconstruction of the two dimensional (2D) distance map between the femur and the tibia bone plates. This method uses the MRI data, an automated 3D segmentation, and an unsupervised joint space extraction algorithm that identify the medial and lateral compartments of the knee joint. The extracted medial and lateral compartments of the tibia-femur joint space were analyzed by 2D distance maps, where visual as well quantitative information was extracted. This method was applied to study the dynamic behavior of the knee joint space under axial load. Three healthy volunteers' knees were imaged using fast GRE sequences in a clinical scanner under unloaded (normal) conditions and with an axial load that mimics the person's standing load. Furthermore, one volunteer's knee was imaged at four regular time intervals while the load was applied and at four regular intervals without load. The results show that changes of 50 microns in the average distance between bones can be measured and that normal axial loads reduce the joint space width significantly and can be detected by this method.

  6. Neuropathic Knee Joint - A Complication of Syrinx Following Spinal Anesthesia: A Rare Case Report and Review of Literature

    PubMed Central

    Chandra, S Swaroop; Harshavardhan, J K Giriraj; Ram, Ganesan G; Vijayaraghavan, P V

    2016-01-01

    Introduction: Neurological complications due to spinal anesthesia are dysesthesia, paresthesia, cauda equina syndrome, and neuropathic joint. However, neurological complications are rare. We report a case of neuropathic joint of knee as a complication of syrinx following postspinal anesthesia. Case Report: A 33-year-old female came with complaints of pain and instability of her left knee and left foot drop. She had developed weakness of her left lower limb following her cesarean section surgery done under spinal anesthesia. Clinically and radiologically, she had features of the neuropathic left knee joint which had occurred as a complication of syrinx following spinal anesthesia. Conclusion: The case is reported for its rarity and to highlight the possible neurological complications of spinal anesthesia. PMID:28164059

  7. Effects of Warm-Up and Fatigue on Knee Joint Position Sense and Jump Performance.

    PubMed

    Romero-Franco, N; Jiménez-Reyes, P

    2017-01-01

    The purpose of this study was to evaluate the effects of a warm-up and fatigue protocol on the vertical jump and knee joint position sense of sprinters. Thirty-two sprinters were randomly allocated to either a control group (CONT) or a plyometric group (PLYO) that performed a warm-up, followed by a high-intensity plyometric protocol. Absolute (AAE), relative (RAE), and variable (VAE) angular errors and vertical jump were evaluated before and after the warm-up, as well as after the plyometric protocol and again 5 min later. After the warm-up, athletes improved RAE and jump performance. After the plyometric protocol, scores on the RAE, VAE, and the vertical jump performance worsened compared to the control group and to the values obtained after the warm-up. Five minutes later, RAE and vertical jump continued to be impaired. AAE did not show significant differences. The vertical jump is improved after the warm-up, although it is deteriorated after high-intensity plyometry. Regarding knee proprioception, the lack of impairments in the AAE make unclear the effects of the plyometric exercises on knee proprioception.

  8. [The indicators of immunity in patients with aseptic instability of knee joint].

    PubMed

    Chepeleva, M V; Chegurov, O K; Kuznetsova, E I; Shved, N S

    2014-08-01

    The examination was applied to sampling of 17 patients with stable implants after 18-36 months after endoprosthesis replacement of knee joint and to sampling of 17 patients with developed within this time-frame aseptic instability of endoprosthesis within the same time-frame. The typing of lymphocytes of peripheral blood was implemented using laser flow cytometry. The detection of immunoglobulins, cytokines, circulating immune complexes was made applying the technique of enzymoimmunoassay. In case of development of aseptic instability the signs testifying moderate activation of immune system and starting dysfunction of monocyte macrophage component of immune system. At that, IL-6, TNFα, CD14+HLA-DR provided the most complete information on the side of diagnostic of developing aseptic instability of joint.

  9. The role of adipocytokines in the pathogenesis of knee joint osteoarthritis.

    PubMed

    Richter, Magdalena; Trzeciak, Tomasz; Owecki, Maciej; Pucher, Andrzej; Kaczmarczyk, Jacek

    2015-06-01

    Osteoarthritis (OA) is one of the most common causes of musculoskeletal disability in the world. Traditionally, it has been thought that obesity contributes to the development and progression of OA by increased mechanical load of the joint structures. Nevertheless, studies have shown that adipose tissue-derived cytokines (adipocytokines) are a possible link between obesity and OA. Furthermore, according to recent findings, not only articular cartilage may be the main target of these cytokines but also the synovial membrane, subchondral bone and infrapatellar fat pad may be encompassed in the process of degradation. This review presents the most recent reports on the contribution of adipocytokines to the knee joint cartilage degradation, osteophyte formation, infrapatellar fat pad alterations and synovitis.

  10. Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings

    PubMed Central

    Malfait, Bart; Dingenen, Bart; Smeets, Annemie; Staes, Filip; Pataky, Todd; Robinson, Mark A.; Vanrenterghem, Jos; Verschueren, Sabine

    2016-01-01

    Purpose The purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ). Methods Fifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping. Results The peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001). Conclusion This study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an

  11. Environmental disruption of circadian rhythm predisposes mice to osteoarthritis-like changes in knee joint.

    PubMed

    Kc, Ranjan; Li, Xin; Voigt, Robin M; Ellman, Michael B; Summa, Keith C; Vitaterna, Martha Hotz; Keshavarizian, Ali; Turek, Fred W; Meng, Qing-Jun; Stein, Gary S; van Wijnen, Andre J; Chen, Di; Forsyth, Christopher B; Im, Hee-Jeong

    2015-09-01

    Circadian rhythm dysfunction is linked to many diseases, yet pathophysiological roles in articular cartilage homeostasis and degenerative joint disease including osteoarthritis (OA) remains to be investigated in vivo. Here, we tested whether environmental or genetic disruption of circadian homeostasis predisposes to OA-like pathological changes. Male mice were examined for circadian locomotor activity upon changes in the light:dark (LD) cycle or genetic disruption of circadian rhythms. Wild-type (WT) mice were maintained on a constant 12 h:12 h LD cycle (12:12 LD) or exposed to weekly 12 h phase shifts. Alternatively, male circadian mutant mice (Clock(Δ19) or Csnk1e(tau) mutants) were compared with age-matched WT littermates that were maintained on a constant 12:12 LD cycle. Disruption of circadian rhythms promoted osteoarthritic changes by suppressing proteoglycan accumulation, upregulating matrix-degrading enzymes and downregulating anabolic mediators in the mouse knee joint. Mechanistically, these effects involved activation of the PKCδ-ERK-RUNX2/NFκB and β-catenin signaling pathways, stimulation of MMP-13 and ADAMTS-5, as well as suppression of the anabolic mediators SOX9 and TIMP-3 in articular chondrocytes of phase-shifted mice. Genetic disruption of circadian homeostasis does not predispose to OA-like pathological changes in joints. Our results, for the first time, provide compelling in vivo evidence that environmental disruption of circadian rhythms is a risk factor for the development of OA-like pathological changes in the mouse knee joint.

  12. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

    PubMed Central

    Cook, Jon R; Warren, Meghan; Ganley, Kathleen J; Prefontaine, Paul; Wylie, Jack W

    2008-01-01

    Background Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe

  13. Non-invasive, non-radiological quantification of anteroposterior knee joint ligamentous laxity

    PubMed Central

    Russell, D. F.; Deakin, A. H.; Fogg, Q. A.; Picard, F.

    2013-01-01

    Objectives We performed in vitro validation of a non-invasive skin-mounted system that could allow quantification of anteroposterior (AP) laxity in the outpatient setting. Methods A total of 12 cadaveric lower limbs were tested with a commercial image-free navigation system using trackers secured by bone screws. We then tested a non-invasive fabric-strap system. The lower limb was secured at 10° intervals from 0° to 60° of knee flexion and 100 N of force was applied perpendicular to the tibia. Acceptable coefficient of repeatability (CR) and limits of agreement (LOA) of 3 mm were set based on diagnostic criteria for anterior cruciate ligament (ACL) insufficiency. Results Reliability and precision within the individual invasive and non-invasive systems was acceptable throughout the range of flexion tested (intra-class correlation coefficient 0.88, CR 1.6 mm). Agreement between the two systems was acceptable measuring AP laxity between full extension and 40° knee flexion (LOA 2.9 mm). Beyond 40° of flexion, agreement between the systems was unacceptable (LOA > 3 mm). Conclusions These results indicate that from full knee extension to 40° flexion, non-invasive navigation-based quantification of AP tibial translation is as accurate as the standard validated commercial system, particularly in the clinically and functionally important range of 20° to 30° knee flexion. This could be useful in diagnosis and post-operative evaluation of ACL pathology. Cite this article: Bone Joint Res 2013;2:233–7. PMID:24184443

  14. [Some biochemical parameters of the synovial liquid for estimation of effectiveness of the treatment of the knee joint osteoarthrosis].

    PubMed

    Meshcheriakova, M G; Trilis, Ia G; Kirillova, N V; Alpatova, T F; Mukhin, I A; Kozhevin, A A

    2012-01-01

    The knee joint osteoarthrosis is accompanied by activation of the oxidative stress in the synovial liquid. Specific treatment decreased or even normalized such biochemical parameters of the synovial liquid as the carbonyl groups, thiobarbituric acid reactive substances (TBARS) and total protein content. The most demonstrative changes were found for early and late markers of the oxidative modification of proteins. These parameters may be used in laboratory diagnostics of the depth of the degenerative-dystrophic process in the knee joint and for the estimation of the effectiveness of the treatment.

  15. Shod landing provides enhanced energy dissipation at the knee joint relative to barefoot landing from different heights.

    PubMed

    Yeow, C H; Lee, P V S; Goh, J C H

    2011-12-01

    Athletic shoes can directly provide shock absorption at the foot due to its cushioning properties, however it remains unclear how these shoes may affect the level of energy dissipation contributed by the knee joint. This study sought to investigate biomechanical differences, in terms of knee kinematics, kinetics and energetics, between barefoot and shod landing from different heights. Twelve healthy male recreational athletes were recruited and instructed to perform double-leg landing from 0.3-m and 0.6-m heights in barefoot and shod conditions. The shoe model tested was Brooks Maximus II. Markers were placed on the subjects based on the Plug-in Gait Marker Set. Force-plates and motion-capture system were used to capture ground reaction force (GRF) and kinematics data respectively. 2×2-ANOVA (barefoot/shod condition×landing height) was performed to examine differences in knee kinematics, kinetics and energetics between barefoot and shod conditions from different landing heights. Peak GRF was not significantly different (p=0.732-0.824) between barefoot and shod conditions for both landing heights. Knee range-of-motion, flexion angular velocity, external knee flexion moment, and joint power and work were higher during shod landing (p<0.001 to p=0.007), compared to barefoot landing for both landing heights. No significant interactions (p=0.073-0.933) were found between landing height and barefoot/shod condition for the tested parameters. While the increase in landing height can elevate knee energetics independent of barefoot/shod conditions, we have also shown that the shod condition was able to augment the level of energy dissipation contributed by the knee joint, via the knee extensors, regardless of the tested landing heights.

  16. Changes in Joint Gap Balances between Intra- and Postoperation in Total Knee Arthroplasty.

    PubMed

    Nakajima, Arata; Aoki, Yasuchika; Murakami, Masazumi; Nakagawa, Koichi

    2014-01-01

    Achieving correct soft tissue balance and preparing equal and rectangular extension and flexion joint gaps are crucial goals of TKA. Intraoperative gap balances would change postoperatively; however, changes in joint gap balances between pre- and postoperation remain unclear. To explore these changes associated with TKA, we prospectively investigated 21 posterior cruciate ligament retaining TKAs for varus knees. Intraoperative extension gap balance (iEGB) was 2.6 ± 2.0° varus versus postoperative extension gap balance (pEGB) of 0.77 ± 1.8° valgus (P < 0.01), while no significant difference between intraoperative flexion gap balance (iFGB) and postoperative flexion gap balance (pFGB) was observed. We also explored correlations between intraoperative and postoperative gap balances but found no significant correlations. These observations indicate that (i) surgeons should avoid excessive release of the medial soft tissue during TKA for varus knees and (ii) intraoperative gap balance may not be necessarily reflected on postoperative gap balance.

  17. Elimination of tritium-labelled hyaluronic acid from normal and osteoarthritic rabbit knee joints.

    PubMed

    Lindenhayn, K; Heilmann, H H; Niederhausen, T; Walther, H U; Pohlenz, K

    1997-05-01

    The half-life of [3H]hyaluronic acid in rabbit knee joints was estimated using two methods: (i) by following the [3H]hyaluronan content of the synovial fluid after intra-articular injection and (ii) by following the 3H2O radioactivity of plasma after intra-articular injection of [3H]hyaluronan. For normal rabbits we obtained a half-life of 15.8 hours (method I) and 17.5 +/- 1.0 hours (mean +/- SEM, method II), respectively. The second method was used to estimate the kinetics of the hyaluronan elimination from normal, sham-operated, as well as from osteoarthritic rabbit knee joints (Colombo model of osteoarthritis). Four weeks after injury, during the developing phase of osteoarthritis, the half-life of hyaluronan rose significantly to 23.5 +/- 2.1 hours and returned to normal levels (17.4 +/- 2.7 hours) 12 weeks after the operation (osteoarthritis developed). At the stage of developed osteoarthritis, the clearance rates were considerably higher than in normal rabbits.

  18. Sodium inversion recovery MRI on the knee joint at 7 T with an optimal control pulse

    NASA Astrophysics Data System (ADS)

    Lee, Jae-Seung; Xia, Ding; Madelin, Guillaume; Regatte, Ravinder R.

    2016-01-01

    In the field of sodium magnetic resonance imaging (MRI), inversion recovery (IR) is a convenient and popular method to select sodium in different environments. For the knee joint, IR has been used to suppress the signal from synovial fluids, which improves the correlation between the sodium signal and the concentration of glycosaminoglycans (GAGs) in cartilage tissues. For the better inversion of the magnetization vector under the spatial variations of the B0 and B1 fields, the IR sequence usually employ adiabatic pulses as the inversion pulse. On the other hand, it has been shown that RF shapes robust against the variations of the B0 and B1 fields can be generated by numerical optimization based on optimal control theory. In this work, we compare the performance of fluid-suppressed sodium MRI on the knee joint in vivo, between one implemented with an adiabatic pulse in the IR sequence and the other with the adiabatic pulse replaced by an optimal-control shaped pulse. While the optimal-control pulse reduces the RF power deposited to the body by 58%, the quality of fluid suppression and the signal level of sodium within cartilage are similar between two implementations.

  19. Feature selection and classification methodology for the detection of knee-joint disorders.

    PubMed

    Nalband, Saif; Sundar, Aditya; Prince, A Amalin; Agarwal, Anita

    2016-04-01

    Vibroarthographic (VAG) signals emitted from the knee joint disorder provides an early diagnostic tool. The nonstationary and nonlinear nature of VAG signal makes an important aspect for feature extraction. In this work, we investigate VAG signals by proposing a wavelet based decomposition. The VAG signals are decomposed into sub-band signals of different frequencies. Nonlinear features such as recurrence quantification analysis (RQA), approximate entropy (ApEn) and sample entropy (SampEn) are extracted as features of VAG signal. A total of twenty-four features form a vector to characterize a VAG signal. Two feature selection (FS) techniques, apriori algorithm and genetic algorithm (GA) selects six and four features as the most significant features. Least square support vector machines (LS-SVM) and random forest are proposed as classifiers to evaluate the performance of FS techniques. Results indicate that the classification accuracy was more prominent with features selected from FS algorithms. Results convey that LS-SVM using the apriori algorithm gives the highest accuracy of 94.31% with false discovery rate (FDR) of 0.0892. The proposed work also provided better classification accuracy than those reported in the previous studies which gave an accuracy of 88%. This work can enhance the performance of existing technology for accurately distinguishing normal and abnormal VAG signals. And the proposed methodology could provide an effective non-invasive diagnostic tool for knee joint disorders.

  20. [Autologous chondrocyte transplantation for treatment of cartilage defects of the knee joint. Clinical results].

    PubMed

    Erggelet, C; Browne, J E; Fu, F; Mandelbaum, B R; Micheli, L J; Mosely, J B

    2000-01-01

    Cartilage defects in the knee joint are common and have a bad tendency for healing due to the limited regeneration of hyaline cartilage. Surgeons have an ample choice of various operative treatment measures. Especially for the treatment of larger lesions first results of autologous chondrocyte transplantation (ACT) were published in 1994 [3]. Autologous chondrocytes are isolated from an arthoscopically harvested cartilage biopsy, cultured in vitro and implanted in the defect under a periostal flap in a second procedure. In an international multicenter study 1,051 patients treated with ACT between 6/95 and 12/98 were documented with follow-up examinations after 12 months (588 patients), 24 months (220 patients) and 36 months (40 patients). The majority of the defects (61.2%) were localized on the medial femoral condyle, measuring 4.6 cm2 and mostly described as grade III/IV lesions. The clinical evaluation was performed using a modified Cincinnati knee rating system independently for clinician and patient. Evaluations showed an increase from 3.35 to 6.25 after 24 months and from 3.10 to 6.77 in a scale from 1 (bad) to 10 (excellent). ACT favours defects of the femur with an improvement rate of 85%. Adverse events possibly related to ACT were described in 4.8% of the patients. Diagnostic second-look arthroscopies are included in the reoperation rate of 5.1%. The presented data indicate autologous chondrocyte transplantation as an effective and safe option for the treatment of large full thickness cartilage defects in the knee joint.

  1. Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty.

    PubMed

    Daniilidis, Kiriakos; Skwara, Adrian; Vieth, Volker; Fuchs-Winkelmann, Susanne; Heindel, Walter; Stückmann, Volker; Tibesku, Carsten O

    2012-08-01

    The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.

  2. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  3. Influence of restricted vision and knee joint range of motion on gait properties during level walking and stair ascent and descent.

    PubMed

    Demura, Tomohiro; Demura, Shin-ich

    2011-01-01

    Because elderly individuals experience marked declines in various physical functions (e.g., vision, joint function) simultaneously, it is difficult to clarify the individual effects of these functional declines on walking. However, by imposing vision and joint function restrictions on young men, the effects of these functional declines on walking can be clarified. The authors aimed to determine the effect of restricted vision and range of motion (ROM) of the knee joint on gait properties while walking and ascending or descending stairs. Fifteen healthy young adults performed level walking and stair ascent and descent during control, vision restriction, and knee joint ROM restriction conditions. During level walking, walking speed and step width decreased, and double support time increased significantly with vision and knee joint ROM restrictions. Stance time, step width, and walking angle increased only with knee joint ROM restriction. Stance time, swing time, and double support time were significantly longer in level walking, stair descent, and stair ascent, in that order. The effects of vision and knee joint ROM restrictions were significantly larger than the control conditions. In conclusion, vision and knee joint ROM restrictions affect gait during level walking and stair ascent and descent. This effect is marked in stair ascent with knee joint ROM restriction.

  4. Simultaneous segmentation of the bone and cartilage surfaces of a knee joint in 3D

    NASA Astrophysics Data System (ADS)

    Yin, Y.; Zhang, X.; Anderson, D. D.; Brown, T. D.; Hofwegen, C. Van; Sonka, M.

    2009-02-01

    We present a novel framework for the simultaneous segmentation of multiple interacting surfaces belonging to multiple mutually interacting objects. The method is a non-trivial extension of our previously reported optimal multi-surface segmentation. Considering an example application of knee-cartilage segmentation, the framework consists of the following main steps: 1) Shape model construction: Building a mean shape for each bone of the joint (femur, tibia, patella) from interactively segmented volumetric datasets. Using the resulting mean-shape model - identification of cartilage, non-cartilage, and transition areas on the mean-shape bone model surfaces. 2) Presegmentation: Employment of iterative optimal surface detection method to achieve approximate segmentation of individual bone surfaces. 3) Cross-object surface mapping: Detection of inter-bone equidistant separating sheets to help identify corresponding vertex pairs for all interacting surfaces. 4) Multi-object, multi-surface graph construction and final segmentation: Construction of a single multi-bone, multi-surface graph so that two surfaces (bone and cartilage) with zero and non-zero intervening distances can be detected for each bone of the joint, according to whether or not cartilage can be locally absent or present on the bone. To define inter-object relationships, corresponding vertex pairs identified using the separating sheets were interlinked in the graph. The graph optimization algorithm acted on the entire multiobject, multi-surface graph to yield a globally optimal solution. The segmentation framework was tested on 16 MR-DESS knee-joint datasets from the Osteoarthritis Initiative database. The average signed surface positioning error for the 6 detected surfaces ranged from 0.00 to 0.12 mm. When independently initialized, the signed reproducibility error of bone and cartilage segmentation ranged from 0.00 to 0.26 mm. The results showed that this framework provides robust, accurate, and

  5. Effects of Series Elasticity on the Human Knee Extension Torque-Angle Relationship in Vivo

    ERIC Educational Resources Information Center

    Kubo, Keitaro; Ohgo, Kazuya; Takeishi, Ryuichi; Yoshinaga, Kazunari; Tsunoda, Naoya; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2006-01-01

    The purpose of this study was to investigate the effects of series elasticity on the torque-angle relationship of the knee extensors in vivo. Forty-two men volunteered to take part in the present study. The participants performed maximal voluntary isometric contractions at eight knee-joint angles (40, 50, 60, 70, 80, 90, 100, 110[degree]). The…

  6. Mechanical Influences on Morphogenesis of the Knee Joint Revealed through Morphological, Molecular and Computational Analysis of Immobilised Embryos

    PubMed Central

    Roddy, Karen A.; Prendergast, Patrick J.; Murphy, Paula

    2011-01-01

    Very little is known about the regulation of morphogenesis in synovial joints. Mechanical forces generated from muscle contractions are required for normal development of several aspects of normal skeletogenesis. Here we show that biophysical stimuli generated by muscle contractions impact multiple events during chick knee joint morphogenesis influencing differential growth of the skeletal rudiment epiphyses and patterning of the emerging tissues in the joint interzone. Immobilisation of chick embryos was achieved through treatment with the neuromuscular blocking agent Decamethonium Bromide. The effects on development of the knee joint were examined using a combination of computational modelling to predict alterations in biophysical stimuli, detailed morphometric analysis of 3D digital representations, cell proliferation assays and in situ hybridisation to examine the expression of a selected panel of genes known to regulate joint development. This work revealed the precise changes to shape, particularly in the distal femur, that occur in an altered mechanical environment, corresponding to predicted changes in the spatial and dynamic patterns of mechanical stimuli and region specific changes in cell proliferation rates. In addition, we show altered patterning of the emerging tissues of the joint interzone with the loss of clearly defined and organised cell territories revealed by loss of characteristic interzone gene expression and abnormal expression of cartilage markers. This work shows that local dynamic patterns of biophysical stimuli generated from muscle contractions in the embryo act as a source of positional information guiding patterning and morphogenesis of the developing knee joint. PMID:21386908

  7. Prediction of In Vivo Knee Joint Loads Using a Global Probabilistic Analysis

    PubMed Central

    Navacchia, Alessandro; Myers, Casey A.; Rullkoetter, Paul J.; Shelburne, Kevin B.

    2016-01-01

    Musculoskeletal models are powerful tools that allow biomechanical investigations and predictions of muscle forces not accessible with experiments. A core challenge modelers must confront is validation. Measurements of muscle activity and joint loading are used for qualitative and indirect validation of muscle force predictions. Subject-specific models have reached high levels of complexity and can predict contact loads with surprising accuracy. However, every deterministic musculoskeletal model contains an intrinsic uncertainty due to the high number of parameters not identifiable in vivo. The objective of this work is to test the impact of intrinsic uncertainty in a scaled-generic model on estimates of muscle and joint loads. Uncertainties in marker placement, limb coronal alignment, body segment parameters, Hill-type muscle parameters, and muscle geometry were modeled with a global probabilistic approach (multiple uncertainties included in a single analysis). 5–95% confidence bounds and input/output sensitivities of predicted knee compressive loads and varus/valgus contact moments were estimated for a gait activity of three subjects with telemetric knee implants from the “Grand Challenge Competition.” Compressive load predicted for the three subjects showed confidence bounds of 333 ± 248 N, 408 ± 333 N, and 379 ± 244 N when all the sources of uncertainty were included. The measured loads lay inside the predicted 5–95% confidence bounds for 77%, 83%, and 76% of the stance phase. Muscle maximum isometric force, muscle geometry, and marker placement uncertainty most impacted the joint load results. This study demonstrated that identification of these parameters is crucial when subject-specific models are developed. PMID:26720096

  8. [The ultrasonography of the capsular ligamentous apparatus of the knee joint in the early stages of rheumatoid arthritis].

    PubMed

    Herasymenko, S I; Huzhevs'kyĭ, I V; Vovchenko, H Ia; Babko, A N

    1999-07-01

    With the purpose of finding out informative value of the ultrasound investigation designed to study the capsular and ligamentous apparatus of the knee joint in its instability during the early stages of rheumatoid arthritis and correlating clinical symptoms with ultrasonographic findings an examination was done of twenty joints of patients in early stages of rheumatoid arthritis presenting with clinical signs of anterior-medial instability. Sonography confirmed the presence of instability and permitted the qualitative assessment of its degree to be done. The method allows us to disclose relative incompetence of the anterior-medial sector of the knee joint in those patients presenting with early stages of rheumatoid arthritis, which is one of causes of instability, with the cruciate and lateral ligaments remaining uninjured. Ultrasonography makes it possible to perform a quantitative assessment of the degree of instability of the joint irrespective of the clinical test used and experience of the orthopedist.

  9. Is high flexion following total knee arthroplasty safe?: evaluation of knee joint loads in the patients during maximal flexion.

    PubMed

    Nagura, Takeo; Otani, Toshiro; Suda, Yasunori; Matsumoto, Hideo; Toyama, Yoshiaki

    2005-08-01

    The purpose of this study was to indicate the mechanical loads and the flexion angle at the knee during rise from maximal flexion following total knee arthroplasty (TKA). Twenty three knees were evaluated using skin marker-based motion analysis system during four different activities of daily living. The average maximum flexion was 90 degrees (34 degrees less than passive flexion) and all subjects required support for their weight to rise from maximal flexion. The external moments and the external forces at the knee during the maximal flexion were smaller than those during the stair descending activity. The results indicate that capable flexion angle for the patients following TKA is approximately 90 degrees which has smaller mechanical loads at the knee than the stair descending activity.

  10. [Association between allergy to benzoyl peroxide, vitiligo and implantation of a cemented total knee joint prosthesis: Is there a connection?].

    PubMed

    Gothner, M; Ozokyay, L; Godau, P; Kälicke, T; Muhr, G; Schildhauer, T A; Dudda, M

    2011-09-01

    Allergies against bone cement or bone cement components have been well-described. We report on a 63-year-old patient who presented with progressive vitiligo all over the body after implantation of a cemented total knee replacement. A dermatological examination was performed and an allergy to benzoyl peroxide was found. A low-grade infection was diagnosed 5 months after implantation of the total knee replacement and the prosthesis was replaced with a cement spacer. After treating the infection of the knee replacement non-cemented arthrodesis of the knee was performed. In cases of new, unknown skin efflorescence, urticaria and periprosthetic loosening of cemented joint replacement, the differential diagnosis should include not only infections but also possible allergies against bone-cement and components such as benzoyl peroxide or metal components.

  11. Spatial variation in sympathetic influences on the vasculature of the synovium and medial collateral ligament of the rabbit knee joint.

    PubMed

    McDougall, J J; Ferrell, W R; Bray, R C

    1997-09-01

    1. Laser Doppler perfusion imaging was used to assess the role of the sympathetic nervous system in the control of blood flow to the medial collateral ligament and capsule (synovium and overlying fibrous tissues) of the rabbit knee joint. 2. Electrical stimulation of the saphenous nerve (width 1 ms; amplitude 20V; 1-30 Hz) produced a frequency-dependent vasoconstriction of knee joint vasculature. The response was maximal at 30 Hz and gave the greatest fall in perfusion at the femoral insertion of the ligament (by 33.8 +/- 7.4%, mean +/- S.E.M.; n = 5-6) and the smallest decrease at the tibial insertion of the ligament (by 10.6 +/- 2.9%). 3. Topical application of phentolamine (10(-6) mol) had no significant effect on basal knee joint blood flow. However, it abolished the nerve-mediated constrictor responses in all regions of the medial collateral ligament and synovium at all frequencies. 4. Topical administration of adrenaline (10(-14) to 10(-7) mol) caused a dose-dependent decrease in knee joint blood flow with the highest dose producing > 75% reduction in perfusion at all areas. 5. There was no evidence of a reactive hyperaemia in the 5 min following a 5 min period of femoral artery occlusion. Artificial manipulation of arterial blood pressure by intravenous infusion or withdrawal of blood caused a proportional change in ligament and synovial blood flow. These observations may indicate a lack of autoregulation in the joint and its exclusion from baroreflex modulation. 6. These results suggest a potential role for the sympathetic nervous system in the control of knee joint blood flow. Neuromodulation of ligament perfusion appears to predominate at the femoral insertion and this could prove to have functional significance.

  12. Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension

    PubMed Central

    2013-01-01

    Background Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment, and (ii) whether the range in which these exercises are performed affects outcomes. Methods A prospective, parallel-group, randomised controlled trial conducted in a tertiary hospital in Sydney, Australia compared an 8 week exercise programme performed into either the full hypermobile range or only to neutral knee extension, following a minimum 2 week baseline period without treatment. Randomisation was computer-generated, with allocation concealed by sequentially numbered opaque sealed envelopes. Knee pain was the primary outcome. Quality of life, thigh muscle strength, and function were also measured at (i) initial assessment, (ii) following the baseline period and (iii) post treatment. Assessors were blinded to the participants’ treatment allocation and participants blinded to the difference in the treatments. Results Children with JHS and knee pain (n=26) aged 7-16 years were randomly assigned to the hypermobile (n=12) or neutral (n=14) treatment group. Significant improvements in child-reported maximal knee pain were found following treatment, regardless of group allocation with a mean 14.5 mm reduction on the visual analogue scale (95% CI 5.2 – 23.8 mm, p=0.003). Significant differences between treatment groups were noted for parent-reported overall psychosocial health (p=0.009), specifically self-esteem (p=0.034), mental health (p=0.001) and behaviour (p=0.019), in favour of exercising into the hypermobile range (n=11) compared to neutral only (n=14). Conversely, parent

  13. The tolerance of the human hip to dynamic knee loading.

    PubMed

    Rupp, Jonathan D; Reed, Matthew P; Van Ee, Chris A; Kuppa, Shashi; Wang, Stewart C; Goulet, James A; Schneider, Lawrence W

    2002-11-01

    Based on an analysis of the National Automotive Sampling System (NASS) database from calendar years 1995-2000, over 30,000 fractures and dislocations of the knee-thigh-hip (KTH) complex occur in frontal motor-vehicle crashes each year in the United States. This analysis also shows that the risk of hip injury is generally higher than the risks of knee and thigh injuries in frontal crashes, that hip injuries are occurring to adult occupants of all ages, and that most hip injuries occur at crash severities that are equal to, or less than, those used in FMVSS 208 and NCAP testing. Because previous biomechanical research produced mostly knee or distal femur injuries, and because knee and femur injuries were frequently documented in early crash investigation data, the femur has traditionally been viewed as the weakest part of the KTH complex. However, the relative risk of hip injuries to the risks of knee and thigh injuries in frontal crashes of late-model vehicles suggests that this may not be the case. This study investigated the frontal-impact fracture tolerance of the hip in nineteen tests performed on the KTH complexes from sixteen unembalmed human cadavers. In each test, the pelvis was rigidly fixed by gripping the iliac wings with the thigh-to-pelvis angle set to correspond to a standard automotive-seated posture. A dynamic load was applied to the knee along the axis of the femur at loading rates that are representative of knee-to-knee bolster impacts in frontal crashes. Rigidly fixing the pelvis minimizes inertial effects along the KTH complex, which results in similar force levels along the KTH complex. Consequently, in these tests, the weakest part of the KTH complex failed first. All seventeen fixed pelvis tests that produced usable data resulted in acetabular fractures at an average applied force of 5.70 kN (sd = 1.38 kN). The lack of injuries to the femoral shaft and distal femur in these tests indicates that the tolerance of the hip is less than that of the

  14. A comparison of muscle stiffness and musculoarticular stiffness of the knee joint in young athletic males and females.

    PubMed

    Wang, Dan; De Vito, Giuseppe; Ditroilo, Massimiliano; Fong, Daniel T P; Delahunt, Eamonn

    2015-06-01

    The objective of this study was to investigate the gender-specific differences in peak torque (PT), muscle stiffness (MS) and musculoarticular stiffness (MAS) of the knee joints in a young active population. Twenty-two male and twenty-two female recreational athletes participated. PT of the knee joint extensor musculature was assessed on an isokinetic dynamometer, MS of the vastus lateralis (VL) muscle was measured in both relaxed and contracted conditions, and knee joint MAS was quantified using the free oscillation technique. Significant gender differences were observed for all dependent variables. Females demonstrated less normalized PT (mean difference (MD)=0.4Nm/kg, p=0.005, η(2)=0.17), relaxed MS (MD=94.2N/m, p<.001, η(2)=0.53), contracted MS (MD=162.7N/m, p<.001, η(2)=0.53) and MAS (MD=422.1N/m, p<.001, η(2)=0.23) than males. MAS increased linearly with the external load in both genders with males demonstrating a significantly higher slope (p=0.019) than females. The observed differences outlined above may contribute to the higher knee joint injury incidence and prevalence in females when compared to males.

  15. [Minor bcr/abl positive acute lymphoblastic leukemia preceded by knee joint pain due to bone marrow necrosis].

    PubMed

    Sato, Kazuya; Mori, Masaki; Meguro, Akiko; Miyoshi, Takuji; Nagai, Tadashi; Muroi, Kazuo; Komatsu, Norio; Ozawa, Keiya

    2004-11-01

    A 16-year-old male was referred to our hospital in April 2003 due to severe knee joint pain from five months previously. Lymphoblasts were identified in his peripheral blood, resulting in a diagnosis of acute lymphoblastic leukemia (ALL). Bone marrow examination revealed massive necrosis with clusters of lymphoblasts and the bcr/abl fusion gene. Magnetic resonance imaging (MRI) of the knee joint showed low signal intensity on T1-weighted images, and peripheral rim enhancement on Gd-DTPA enhanced fat suppression images, which was compatible with bone marrow necrosis. After the patient achieved complete remission (CR), the knee joint pain has disappeared. He was treated with an allogeneic bone marrow transplantation (BMT) from an HLA-identical unrelated donor and has been in CR for 26 months after the diagnosis of ALL. In the knee joint, the replacement of fatty marrow after BMT has been confirmed with MRI. Hematological malignancies including ALL should be considered in the cases of bone marrow necrosis and adequate treatment may improve necrosis.

  16. The effects of shoe heel height and gait velocity on position sense of the knee joint and balance

    PubMed Central

    Jang, Il-Yong; Kang, Da-Haeng; Jeon, Jae-Keun; Jun, Hyun-Ju; Lee, Joon-Hee

    2016-01-01

    [Purpose] The aim of this study was to examine the effects of increased heel height and gait velocity on balance control and knee joint position sense. [Subjects and Methods] Forty healthy adults were randomly allocated to 4 groups: low-heel, low-speed group (3 cm, 2 km/h), low-heel, high-speed group (3 cm, 4 km/h), high-heel, low-speed group (9 cm, 2 km/h), high-heel, and high-speed group (9 cm, 4 km/h), with 10 subjects per group. Static and dynamic balance was evaluated using the I-Balance system and knee joint position sense using a goniometer. Measurements were compared using a pre- and posttest design. [Results] Increasing heel height and gait velocity decreased knee joint position sense and significantly increased the amplitude of body sway under conditions of static and dynamic balance, with highest sway amplitude induced by the high-heel, high-speed condition. [Conclusion] Increased walking speed in high heels produced significant negative effects on knee joint sense and balance control. PMID:27799675

  17. The effect of gluteus medius strengthening on the knee joint function score and pain in meniscal surgery patients

    PubMed Central

    Kim, Eun-Kyung

    2016-01-01

    [Purpose] The purpose of this study was to analyze the effect of gluteus medius activity strengthening due to squat with isometric hip adduction and hip abduction in side-lying exercise on knee joint function index and pain in meniscal surgery patients. [Subjects and Methods] This study selected sample of 26 patients who had meniscal surgery more than 4 weeks ago. The patients were divided into squat with isometric hip adduction exercise group I (n=8), hip abduction in side-lying exercise group II (n=9), and combined exercise group III. The lysholm score was used to evaluate knee joint function and visual analog scale was used to evaluate pain index of knee joint. [Results] Two-way repeated measures ANOVA was used to analyze the lysholm score and visual analog scale and showed significant interaction between the groups and durations. [Conclusion] Strengthening vastus medialis oblique and gluteus medius improved functional recovery and pain reduction of knee joint in meniscal injury surgery patients. Gluteus medius strengthening exercise is essential to meniscal injury surgery patients and should be included in rehabilitation program in early stages to be conducted systematically. PMID:27821928

  18. Age and gender differences in the control of vertical ground reaction force by the hip, knee and ankle joints.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2015-06-01

    [Purpose] This study examined the relationships between joint moment and the control of the vertical ground reaction force during walking in the elderly and young male and female individuals. [Subjects and Methods] Forty elderly people, 65 years old or older (20 males and 20 females), and 40 young people, 20 to 29 years old (20 males and 20 females), participated in this study. Joint moment and vertical ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Stepwise linear regression analysis determined the joint moments that predict the amplitude of the vertical ground reaction force. [Results] Knee extension moment was related to the vertical ground reaction force in the young males and females. On the other hand, in the elderly females, hip, ankle, and knee joint moments were related to the first peak and second peak forces, and the minimum value of vertical ground reaction force, respectively. [Conclusion] Our results suggest that the young males and females make use of the knee joint moment to control of the vertical ground reaction force. There were differences between the elderly and the young females with regard to the joints used for the control of the vertical ground reaction force.

  19. OARSI osteoarthritis cartilage histopathology assessment system: A biomechanical evaluation in the human knee.

    PubMed

    Waldstein, Wenzel; Perino, Giorgio; Gilbert, Susannah L; Maher, Suzanne A; Windhager, Reinhard; Boettner, Friedrich

    2016-01-01

    The study compared the OARSI osteoarthritis cartilage histopathology assessment system with the biomechanical quality of human in vivo cartilage samples. In a prospective cohort study, 84 patients (100 knees) with varus deformity of the knee were included between May, 2010 and January, 2012. Osteochondral samples underwent biomechanical and histologic analysis. The dynamic modulus significantly (p < 0.001) decreased with each advancing grade of degeneration from OARSI Grade 0 (surface intact) to OARSI Grade 4 (erosion). For the aggregate modulus, there were significant (p < 0.001) differences between OARSI Grade 0 and OARSI Grade 1 as well as between OARSI Grade 1 and OARSI Grade 2. From OARSI Grade 2 to OARSI Grade 5, no differences in aggregate modulus occurred. The new OARSI grading system provides useful information about the functional properties of cartilage. There is a significant difference in cartilage stiffness between samples with intact surface and no signs of degeneration (OARSI Grade 0) and samples with intact surface and early signs of arthritis (OARSI Grade 1). Surgeons performing joint preserving procedures have to be aware that in knees with an intact cartilage surface (OARSI Grade 0/1), significant differences in the biomechanical properties may exist.

  20. Nonuniform distribution of collagen density in human knee ligaments.

    PubMed

    Mommersteeg, T J; Blankevoort, L; Kooloos, J G; Hendriks, J C; Kauer, J M; Huiskes, R

    1994-03-01

    It is generally recognized that the mechanical properties of soft connective tissues are affected by their structural components. We documented collagen density distributions in human knee ligaments to quantify differences in density within and between these ligaments. In order to explain the variations in mechanical properties within and between different knee ligaments as described in the literature, the distributions of collagen density were correlated with these biomechanical findings. Human knee ligaments were shown to be nonhomogeneous structures with regard to collagen density. The anterior bundles of all ligaments contained significantly more collagen mass per unit of volume than the posterior bundles did. The percentage differences between the anterior and posterior bundles, in relation to the posterior bundles, were about 25% for the anterior cruciate ligament (ACL) and the collateral ligaments and about 10% for the posterior cruciate ligament (PCL). Along the cruciate ligaments, the central segments had higher collagen densities than did segments adjacent to the ligament insertions (ACL 9%, PCL 24%). The collagen density in the ACL was significantly lower than that in the other ligaments. These variations within and between the ligaments correlate well with the variations in mechanical properties described in the literature; however, other structural differences have to be taken into account to fully explain the variations in mechanical properties from the structural components.

  1. Radiographic Measurement of Joint Space Width Using the Fixed Flexion View in 1,102 Knees of Japanese Patients with Osteoarthritis in Comparison with the Standing Extended View

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Kobayashi, Masashi; Nakagawa, Shuji; Inoue, Hiroaki; Hino, Manabu; Komaki, Shintaro; Ikoma, Kazuya; Ueshima, Keiichiro; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2017-01-01

    Purpose The fixed flexion view (FFV) of the knee is considered useful for evaluating the joint space when assessing the severity of osteoarthritis (OA) of the knee. To clarify the usefulness of FFV for evaluation of the joint space and severity of knee OA, this study evaluated changes in the joint space on the FFV and standing extended view (SEV) in patients with knee OA. Materials and Methods The SEV and FFV images were acquired in 567 patients (1,102 knees) who visited the hospital with a chief complaint of knee joint pain. Medial joint space width (MJSW) and Kellgren-Lawrence (K-L) classification assessed using the SEV and FFV images were compared. Results Mean MJSW was significantly smaller when assessed on the FFV than on the SEV (3.02±1.55 mm vs. 4.31±1.30 mm; p<0.001). The K-L grade was the same or higher on the FFV than on the SEV. Conclusions The FFV is more useful than the SEV for evaluating the joint space in OA knees. Treatment strategies in patients with knee OA should be determined based on routinely acquired FFV images. PMID:28231651

  2. Knee joint reconstruction after hemiarticular resection using pedicled patella and vascularized fibular graft.

    PubMed

    El-Gammal, Tarek A; El-Sayed, Amr; Kotb, Mohamed M; Saleh, Waleed Riad; Ragheb, Yasser Farouk

    2010-11-01

    Between 1999 and 2005, seven patients had resection of tumors around the knee joint that involved half of the articular surface of the femoral or tibial side. Average age of the patients was 28 years (range, 14-40). Tumor pathology was giant cell tumor in four patients, osteoblastoma in two, and benign fibrous histocytoma in one patient. Two patients had recurrent tumors. The tumor was located in the distal femur in five patients and in the proximal tibia in the remaining two. The ipsilateral patella pedicled on the infrapatellar fat pad was used to substitute the resected articular surface and a vascularized fibula osteoseptocutaneous flap was used to reconstruct the metaphyseal defect. Average follow-up period was 6.5 years (range, 3.5-10 years). All flaps survived. Average time to bone union was 3.5 months (range, 3-4 months), and average time to full weight-bearing was 5 months (range, 4-6 months). No radiological signs of avascular necrosis of the patella were observed in any patient. Two patients required secondary procedures for correction of instability. One patient had local recurrence. At final follow-up, the median range of knee motion was from 10° to 100°. The average Knee Society Score (KSS) was 76 points (range; 50-85 points), and the average KSS functional score was 76.6 points (range, 70-90 points). In conclusion, the procedure is a reliable option for after resection of tumors that involve half the articular surface of the femur or the tibia.

  3. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections

    PubMed Central

    Kini, Sunil Gurpur; Gabr, Ayman; Das, Rishi; Sukeik, Mohamed; Haddad, Fares Sami

    2016-01-01

    Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following hip and knee surgery. The diagnostic workflow of PJI includes detailed clinical examination, serum markers, imaging and aspiration/biopsy of the affected joint. The goals of treatment are eradication of the infection, alleviation of pain, and restoration of joint function. Surgical management of PJI consists of debridement, antibiotics and implant retention (DAIR) and single or two-stage revision procedures. Two-stage revision remains the gold standard for treatment of PJIs. We aim to discuss the two stage procedure in this article and report the outcomes. Methods: The first stage of the two stages consists of removal of all components and associated cement with aggressive debridement and placement of an antibiotic-loaded cement spacer. Patients are then treated with variable periods of parenteral antibiotics, followed by an antibiotic free period to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest infection control, then the second stage can be undertaken and this involves removal of the cement spacer, repeat debridement, and placement of a new prosthesis. Results: Common themes around the two-stage revision procedure include timing of the second stage, antibiotics used in the interim period, length of the interim period before consideration of reimplantation and close liaising with microbiologists. Conclusion: Successful eradication of infection and good functional outcome using the two stage procedure is dependent on a multidisciplinary approach and having a standard reproducible startegy. PMID:28144371

  4. Intelligent algorithm tuning PID method of function electrical stimulation using knee joint angle.

    PubMed

    Qiu, Shuang; He, Feng; Tang, Jiabei; Xu, Jiapeng; Zhang, Lixin; Zhao, Xin; Qi, Hongzhi; Zhou, Peng; Cheng, Xiaoman; Wan, Baikun; Ming, Dong

    2014-01-01

    Functional electrical stimulation (FES) could restore motor functions for individuals with spinal cord injury (SCI). By applying electric current pulses, FES system could produce muscle contractions, generate joint torques, and thus, achieve joint movements automatically. Since the muscle system is highly nonlinear and time-varying, feedback control is quite necessary for precision control of the preset action. In the present study, we applied two methods (Proportional Integral Derivative (PID) controller based on Back Propagation (BP) neural network and that based on Genetic Algorithm (GA)), to control the knee joint angle for the FES system, while the traditional Ziegler-Nichols method was used in the control group for comparison. They were tested using a muscle model of the quadriceps. The results showed that intelligent algorithm tuning PID controller displayed superior performance than classic Ziegler-Nichols method with constant parameters. More particularly, PID controller tuned by BP neural network was superior on controlling precision to make the feedback signal track the desired trajectory whose error was less than 1.2°±0.16°, while GA-PID controller, seeking the optimal parameters from multipoint simultaneity, resulted in shortened delay in the response. Both strategies showed promise in application of intelligent algorithm tuning PID methods in FES system.

  5. A handheld computer as part of a portable in vivo knee joint load monitoring system

    PubMed Central

    Szivek, JA; Nandakumar, VS; Geffre, CP; Townsend, CP

    2009-01-01

    In vivo measurement of loads and pressures acting on articular cartilage in the knee joint during various activities and rehabilitative therapies following focal defect repair will provide a means of designing activities that encourage faster and more complete healing of focal defects. It was the goal of this study to develop a totally portable monitoring system that could be used during various activities and allow continuous monitoring of forces acting on the knee. In order to make the monitoring system portable, a handheld computer with custom software, a USB powered miniature wireless receiver and a battery-powered coil were developed to replace a currently used computer, AC powered bench top receiver and power supply. A Dell handheld running Windows Mobile operating system(OS) programmed using Labview was used to collect strain measurements. Measurements collected by the handheld based system connected to the miniature wireless receiver were compared with the measurements collected by a hardwired system and a computer based system during bench top testing and in vivo testing. The newly developed handheld based system had a maximum accuracy of 99% when compared to the computer based system. PMID:19789715

  6. Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.

    PubMed

    Jakobs, Oliver; Schoof, Benjamin; Klatte, Till Orla; Schmidl, Stefan; Fensky, Florian; Guenther, Daniel; Frommelt, Lars; Gehrke, Thorsten; Gebauer, Matthias

    2015-03-03

    Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.

  7. Activation of PAR2 receptors sensitizes primary afferents and causes leukocyte rolling and adherence in the rat knee joint

    PubMed Central

    Russell, FA; Schuelert, N; Veldhoen, VE; Hollenberg, MD; McDougall, JJ

    2012-01-01

    Background and Purpose The PAR2 receptors are involved in chronic arthritis by mechanisms that are as yet unclear. Here, we examined PAR2 activation in the rat knee joint. Experimental Approach PAR2 in rat knee joint dorsal root ganglia (DRG) cells at L3-L5, retrogradely labelled with Fluoro-gold (FG) were demonstrated immunohistochemically. Electrophysiological recordings from knee joint nerve fibres in urethane anaesthetized Wistar rats assessed the effects of stimulating joint PAR2 with its activating peptide, 2-furoyl-LIGRLO-NH2 (1–100 nmol·100 μL−1, via close intra-arterial injection). Fibre firing rate was recorded during joint rotations before and 15 min after administration of PAR2 activating peptide or control peptide. Leukocyte kinetics in the synovial vasculature upon PAR2 activation were followed by intravital microscopy for 60 min after perfusion of 2-furoyl-LIGRLO-NH2 or control peptide. Roles for transient receptor potential vanilloid-1 (TRPV1) or neurokinin-1 (NK1) receptors in the PAR2 responses were assessed using the selective antagonists, SB366791 and RP67580 respectively. Key Results PAR2 were expressed in 59 ± 5% of FG-positive DRG cells; 100 nmol 2-furoyl-LIGRLO-NH2 increased joint fibre firing rate during normal and noxious rotation, maximal at 3 min (normal; 110 ± 43%, noxious; 90 ± 31%). 2-Furoyl-LIGRLO-NH2 also significantly increased leukocyte rolling and adhesion over 60 min. All these effects were blocked by pre-treatment with SB366791 and RP67580 (P < 0.05 compared with 2-furoyl-LIGRLO-NH2 alone). Conclusions and Implications PAR2 receptors play an acute inflammatory role in the knee joint via TRPV1- and NK1-dependent mechanisms involving both PAR2-mediated neuronal sensitization and leukocyte trafficking. PMID:22849826

  8. Spinal GABA-B receptor modulates neutrophil recruitment to the knee joint in zymosan-induced arthritis.

    PubMed

    Bassi, Gabriel S; do C Malvar, David; Cunha, Thiago M; Cunha, Fernando Q; Kanashiro, Alexandre

    2016-08-01

    Recent studies have demonstrated that the central nervous system controls inflammatory responses by activating complex efferent neuroimmune pathways. The present study was designed to evaluate the role that central gamma-aminobutyric acid type B (GABA-B) receptor plays in neutrophil migration in a murine model of zymosan-induced arthritis by using different pharmacological tools. We observed that intrathecal administration of baclofen, a selective GABA-B agonist, exacerbated the inflammatory response in the knee after zymosan administration characterized by an increase in the neutrophil recruitment and knee joint edema, whereas saclofen, a GABA-B antagonist, exerted the opposite effect. Intrathecal pretreatment of the animals with SB203580 (an inhibitor of p38 mitogen-activated protein kinase) blocked the pro-inflammatory effect of baclofen. On the other hand, systemic administration of guanethidine, a sympatholytic drug that inhibits catecholamine release, and nadolol, a beta-adrenergic receptor antagonist, reversed the effect of saclofen. Moreover, saclofen suppressed the release of the pro-inflammatory cytokines into the knee joint (ELISA) and pain-related behaviors (open field test). Since the anti-inflammatory effect of saclofen depends on the sympathetic nervous system integrity, we observed that isoproterenol, a beta-adrenergic receptor agonist, mimics the central GABA-B blockade decreasing knee joint neutrophil recruitment. Together, these results demonstrate that the pharmacological manipulation of spinal GABAergic transmission aids control of neutrophil migration to the inflamed joint by modulating the activation of the knee joint-innervating sympathetic terminal fibers through a mechanism dependent on peripheral beta-adrenergic receptors and central components, such as p38 MAPK.

  9. Surgical treatment for septic arthritis of the knee joint in elderly patients: a 10-year retrospective clinical study.

    PubMed

    Chen, Chao-Ming; Lin, Hsi-Hsien; Hung, Shih-Chieh; Huang, Tung-Fu; Chen, Wei-Ming; Liu, Chien-Lin; Chen, Tain-Hsiung

    2013-04-01

    Septic arthritis is the most rapidly destructive joint disease, but its early diagnosis remains challenging; delayed or inadequate treatment, even by expert physicians, can lead to irreversible joint destruction. Between 25% and 50% of patients develop irreversible loss of joint function, which is especially concerning in elderly patients. To understand the factors influencing the outcome of septic arthritis, the authors reviewed patients aged older than 50 years who had undergone debridement surgery for primary septic arthritis at their institution between 1998 and 2008. Ninety-two patients (92 knees) were enrolled in the study; 14 did not meet inclusion criteria and were excluded from the final analysis. Of the 78 included patients, 7 underwent arthrodesis, 22 underwent total knee arthroplasty, 19 were indicated for total knee arthroplasty for severe knee joint osteoarthritis but did not undergo surgery by the end of this study, and the remaining 30 had no or mild symptoms of osteoarthrosis and did not receive any surgical procedure. Staphylococcus aureus was the most common pathogenic agent (38%), followed by mixed bacterial infection (10%). Several factors negatively influenced the final clinical outcome, including delayed treatment, advanced macroscopic staging made during debridement surgery, performing multiple debridement surgeries, and a larger Lysholm score difference pre- and posttreatment. More antibiotics administered, longer duration of antibiotic treatment, and more pathogenic agents present were also significantly correlated with poor outcome. These findings shed new light on the management of septic arthritis. Accurate diagnoses and effective treatments are important for the clinical outcome of knee joint bacterial infection in elderly patients.

  10. Gender Dimorphic ACL Strain In Response to Combined Dynamic 3D Knee Joint Loading: Implications for ACL Injury Risk

    PubMed Central

    Mizuno, Kiyonori; Andrish, Jack T.; van den Bogert, Antonie J.; McLean, Scott G.

    2009-01-01

    While gender-based differences in knee joint anatomies/laxities are well documented, the potential for them to precipitate gender-dimorphic ACL loading and resultant injury risk has not been considered. To this end, we generated gender-specific models of ACL strain as a function of any six degrees of freedom (6DOF) knee joint load state via a combined cadaveric and analytical approach. Continuously varying joint forces and torques were applied to five male and five female cadaveric specimens and recorded along with synchronous knee flexion and ACL strain data. All data (~10,000 samples) were submitted to specimen-specific regression analyses, affording ACL strain predictions as a function of the combined 6 DOF knee loads. Following individual model verifications, generalized gender-specific models were generated and subjected to 6 DOF external load scenarios consistent with both a clinical examination and a dynamic sports maneuver. The ensuing model-based strain predictions were subsequently examined for gender-based discrepancies. Male and female specimen specific models predicted ACL strain within 0.51% ± 0.10% and 0.52% ± 0.07% of the measured data respectively, and explained more than 75% of the associated variance in each case. Predicted female ACL strains were also significantly larger than respective male values for both of simulated 6 DOF load scenarios. Outcomes suggest that the female ACL will rupture in response to comparatively smaller external load applications. Future work must address the underlying anatomical/laxity contributions to knee joint mechanical and resultant ACL loading, ultimately affording prevention strategies that may cater to individual joint vulnerabilities. PMID:19464897

  11. Magnetoledtherapy in the treatment of wounds after surgical procedures of the knee joint.

    PubMed

    Pasek, Jarosław; Pasek, Tomasz; Sieroń, Aleksander

    2014-01-01

    The intense development of methods of physical medicine has been noted recently. The new methods are treatment methods, which in many cases allow a reduction of treatment time and positively influence the quality of life of patients undergoing treatment. This applies to illnesses and injuries of the locomotor system and diseases affecting soft tissues, as well as chronic wounds. This article discusses the positive results of the treatment of a 63-year-old woman with a persisting chronic wound of her right lower extremity after knee joint endoprosthesis surgery. The physical medicine method applied, in the form of magnetoledtherapy, contributed to complete wound healing and alleviation of pain suffered, as well as improvement of the quality of life of the treated patient.

  12. Magnetoledtherapy in the treatment of wounds after surgical procedures of the knee joint

    PubMed Central

    Pasek, Jarosław; Pasek, Tomasz; Sieroń, Aleksander

    2014-01-01

    The intense development of methods of physical medicine has been noted recently. The new methods are treatment methods, which in many cases allow a reduction of treatment time and positively influence the quality of life of patients undergoing treatment. This applies to illnesses and injuries of the locomotor system and diseases affecting soft tissues, as well as chronic wounds. This article discusses the positive results of the treatment of a 63-year-old woman with a persisting chronic wound of her right lower extremity after knee joint endoprosthesis surgery. The physical medicine method applied, in the form of magnetoledtherapy, contributed to complete wound healing and alleviation of pain suffered, as well as improvement of the quality of life of the treated patient. PMID:25214792

  13. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

    PubMed Central

    Mahmoud, Samer S.S.; Sukeik, Mohamed; Alazzawi, Sulaiman; Shaath, Mohammed; Sabri, Omar

    2016-01-01

    Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions. PMID:28144373

  14. Water on the Knee

    MedlinePlus

    ... your knee joint. Some people call this condition "water on the knee." A swollen knee may be ... Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don't place continuous weight- ...

  15. Muscle force production during bent-knee, bent-hip walking in humans.

    PubMed

    Foster, Adam D; Raichlen, David A; Pontzer, Herman

    2013-09-01

    Researchers have long debated the locomotor posture used by the earliest bipeds. While many agree that by 3-4 Ma (millions of years ago), hominins walked with an extended-limb human style of bipedalism, researchers are still divided over whether the earliest bipeds walked like modern humans, or walked with a more bent-knee, bent-hip (BKBH) ape-like form of locomotion. Since more flexed postures are associated with higher energy costs, reconstructing early bipedal mechanics has implications for the selection pressures that led to upright walking. The purpose of this study is to determine how modern human anatomy functions in BKBH walking to clarify the links between morphology and energy costs in different mechanical regimes. Using inverse dynamics, we calculated muscle force production at the major limb joints in humans walking in two modes, both with extended limbs and BKBH. We found that in BKBH walking, humans must produce large muscle forces at the knee to support body weight, leading to higher estimated energy costs. However, muscle forces at the hip remained similar in BKBH and extended limb walking, suggesting that anatomical adaptations for hip extension in humans do not necessarily diminish the effective mechanical advantage at the hip in more flexed postures. We conclude that the key adaptations for economical walking, regardless of joint posture, seem to center on maintaining low muscle forces at the hip, primarily by keeping low external moments at the hip. We explore the implications of these results for interpreting locomotor energetics in early hominins, including australopithecines and Ardipithecus ramidus.

  16. A prosthetic knee using magnetorhelogical fluid damper for above-knee amputees

    NASA Astrophysics Data System (ADS)

    Park, Jinhyuk; Choi, Seung-Bok

    2015-04-01

    A prosthetic knee for above-knee (AK) amputees is categorized into two types; namely a passive and an active type. The passive prosthetic knee is generally made by elastic materials such as carbon fiber reinforced composite material, titanium and etc. The passive prosthetic knee easy to walk. But, it has disadvantages such that a knee joint motion is not similar to ordinary people. On the other hand, the active prosthetic knee can control the knee joint angle effectively because of mechanical actuator and microprocessor. The actuator should generate large damping force to support the weight of human body. But, generating the large torque using small actuator is difficult. To solve this problem, a semi-active type prosthetic knee has been researched. This paper proposes a semi-active prosthetic knee using a flow mode magneto-rheological (MR) damper for AK amputees. The proposed semi-active type prosthetic knee consists of the flow mode MR damper, hinge and prosthetic knee body. In order to support weight of human body, the required energy of MR damper is smaller than actuator of active prosthetic leg. And it can control the knee joint angle by inducing the magnetic field during the stance phase.

  17. Sick leave in Sweden before and after total joint replacement in hip and knee osteoarthritis patients

    PubMed Central

    Stigmar, Kjerstin; Dahlberg, Leif E; Zhou, Caddie; Jacobson Lidgren, Helena; Petersson, Ingemar F; Englund, Martin

    2017-01-01

    Background and purpose Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA). Patients and methods Using registers from southern Sweden, we identified hip and knee OA patients aged 40–59 years who had a THR or TKR in the period 2004–2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated. Results The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12–17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4–7% during the entire study period. Interpretation A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery. PMID:27996342

  18. Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis

    PubMed Central

    Mootanah, R.; Imhauser, C.W.; Reisse, F.; Carpanen, D.; Walker, R.W.; Koff, M.F.; Lenhoff, M.W.; Rozbruch, S.R.; Fragomen, A.T.; Dewan, Z.; Kirane, Y.M.; Cheah, Pamela A.; Dowell, J.K.; Hillstrom, H.J.

    2014-01-01

    A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 65°-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligament-tuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between EE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning. PMID:24786914

  19. Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis.

    PubMed

    Mootanah, R; Imhauser, C W; Reisse, F; Carpanen, D; Walker, R W; Koff, M F; Lenhoff, M W; Rozbruch, S R; Fragomen, A T; Dewan, Z; Kirane, Y M; Cheah, K; Dowell, J K; Hillstrom, H J

    2014-01-01

    A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 65°-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligament-tuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between FE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning.

  20. Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates.

    PubMed

    Niinimäki, Tuukka T; Murray, David W; Partanen, Juha; Pajala, Ari; Leppilahti, Juhana I

    2011-12-01

    The indications and contraindications for unicompartmental knee arthroplasty (UKA) are controversial. The aim of the study was to determine the risk factors for re-operation in our practice. A series of 113 medial UKAs with mean follow-up of 63 months were reviewed retrospectively. Pre-operatively all knees had radiographic or arthroscopic evidence of severe cartilage damage. The re-operation rate was not related to age, gender, arthroscopic finding or body mass index. It was related to the joint space on pre-operative standing weight bearing radiographs taken in extension. The re-operation rate was 6 (95% CI 2.1-17, P<0.001) times higher when the thickness of the pre-operative medial joint space was >2 mm rather than ≤2 mm. It was 8 (95% CI 2.8-22.5, P<0.001) times higher when the thickness of the pre-operative medial space was >40% of the thickness of the lateral space. The ratio of pre-operative joint spaces has a greater influence on revision rate than the absolute measurement and is independent of radiographic magnification or the patient's normal cartilage thickness. We therefore recommend that, in medial knee osteoarthritis, UKA should only be used if the pre-operative medial joint space on standing radiographs is ≤40% of the lateral joint space, even if severe cartilage damage is seen arthroscopically.

  1. Comparative assessment of knee joint models used in multi-body kinematics optimisation for soft tissue artefact compensation.

    PubMed

    Richard, Vincent; Cappozzo, Aurelio; Dumas, Raphaël

    2017-01-31

    Estimating joint kinematics from skin-marker trajectories recorded using stereophotogrammetry is complicated by soft tissue artefact (STA), an inexorable source of error. One solution is to use a bone pose estimator based on multi-body kinematics optimisation (MKO) embedding joint constraints to compensate for STA. However, there is some debate over the effectiveness of this method. The present study aimed to quantitatively assess the degree of agreement between reference (i.e., artefact-free) knee joint kinematics and the same kinematics estimated using MKO embedding six different knee joint models. The following motor tasks were assessed: level walking, hopping, cutting, running, sit-to-stand, and step-up. Reference knee kinematics was taken from pin-marker or biplane fluoroscopic data acquired concurrently with skin-marker data, made available by the respective authors. For each motor task, Bland-Altman analysis revealed that the performance of MKO varied according to the joint model used, with a wide discrepancy in results across degrees of freedom (DoFs), models and motor tasks (with a bias between -10.2° and 13.2° and between -10.2mm and 7.2mm, and with a confidence interval up to ±14.8° and ±11.1mm, for rotation and displacement, respectively). It can be concluded that, while MKO might occasionally improve kinematics estimation, as implemented to date it does not represent a reliable solution to the STA issue.

  2. Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion.

    PubMed

    Andrade, R J; Freitas, S R; Vaz, J R; Bruno, P M; Pezarat-Correia, P

    2015-06-01

    This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque-angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P < 0.05). Upper trunk positioning had an effect on the knee submaximal torque (P < 0.05), observed as an increase in the knee passive submaximal torque when the cervical and thoracic spines were flexed (P < 0.05). In conclusion, other apparently mechanical unrelated body segments influence torque-angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension.

  3. Intra-articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature.

    PubMed

    Krudwig, W K; Schulte, K-K; Heinemann, C

    2004-03-01

    Intra-articular ganglia and cysts of the knee joint are rare and mostly incidental findings in MRI and arthroscopy. During a period of 15 years, nearly 8000 knees were arthroscopically examined. In total, 85 intra-articular soft tissue masses were found within the knee cavity. Of these, 76 were incidental and asymptomatic findings in arthroscopy performed for treatment of osteoarthritic symptoms. Several repeated minor knee traumata were reported in this group but no histories of serious traumatic events. Nine ganglion cysts were obviously solely responsible for the intermittent or chronic non-specific knee discomfort, and classified as symptomatic. There were no histories of previous injury to the knees, no clinical signs of instabilities or meniscal and femoropatellar pathologies, and no associated further intra-articular lesions in arthroscopy. Forty-nine cystic masses originated from the ACL, 16 from the PCL, 12 from the anterior (eight medial, four lateral) and three from the posterior horn of the menisci (two medial, one lateral). Three were located in the infrapatellar fat pad, one arose from a medial plica and one from a subchondral bone cyst. All ganglion cysts were successfully resected or excised using arthroscopic technique. A review of the literature is given and compared with the findings and data of this study.

  4. [Validation of the Tekscan system for statistic and dynamic pressure measurements of the human femorotibial joint].

    PubMed

    Wirz, D; Becker, R; Li, S Feng; Friederich, N F; Müller, W

    2002-01-01

    In vitro dynamic pressure measurements in the healthy and pathologically altered knee joint help to improve our understanding of the loading pattern on femorotibial surfaces. The aim of the study was to evaluate a piezoresistive pressure measuring system. A human cadaveric knee was mounted in a material-testing machine (Bionix 858) using a specially designed knee-holding device. Axial loading of the knee, flexed at 20o, at 500 N, 1000N and 1500 N was then carried out. For the static investigations, the piezoresistive measuring system (Tekscan), was compared with the FUJI measuring system. In addition, dynamic measurements were also performed with the Tekscan System. With the exception of the lateral compartment at a load of 1500 N, no differences in maximum pressures were observed between the two systems. Nor were there any differences with regard to contact surfaces, either in the medial or lateral compartment (p > 0.05). However, the reproducibility of the data was significantly higher with the Tekscan System (p < 0.01). Dynamic pressure measurements obtained with the knee flexed 20 to 90o showed that the lateral contact area shifted from anterior to posterior, while the medial contact area remained virtually unchanged. The Tekscan System proved to be more reliable than the FUJI System, and permits simultaneous measurements in both compartments. The Tekscan System is suitable for dynamic measurement of the femorotibial joint, and permits measurements to be made under more physiological conditions.

  5. Impact of physiotherapy on the functional status of elbow and knee joints and quality of life in patients with hemophilia.

    PubMed

    Wojna, Dorota; Anwajler, Joanna; Mladzka, Irena; Ostrowska, Bozena; Skolimowski, Tadeusz

    2006-06-30

    Background. The objective of our research was to assess the impact of physiotherapy on the frequency of intraarticular and intramuscular hemorrhages and on elbow and knee joint function, in hemophilic patients. Material and methods. We examined 22 boys, 6-14 years of age, suffering from hemophilia A. The research program included patient history in respect to intraarticular hemorrhages in elbows and knees before therapy, observation of intra-articular bleeding during physiotherapy, goniometric measurements of the range of movement in the elbow and knee, measurement of the circumference of the arm, forearm, thigh and calf, and momentum dynamometric measurements of the relative and absolute force of the flexors and extensors of the lower leg at the knee joints and of the forearm at the elbow joints, in static conditions. The treatment program included deficit coagulant agent replacement therapy, physiotherapy, and kinesitherapy. Results. The physiotherapy program we applied resulted in a considerable improvement in mobility, as well as increased muscle strength and mass. Conclusions. Our research showed that, due to the application of the appropriate replacement treatment, there was a decrease in the frequency and size of intraarticular hemorrhages, despite intense rehabilitation and physical activity.

  6. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    PubMed

    Burston, James J; Sagar, Devi Rani; Shao, Pin; Bai, Mingfeng; King, Emma; Brailsford, Louis; Turner, Jenna M; Hathway, Gareth J; Bennett, Andrew J; Walsh, David A; Kendall, David A; Lichtman, Aron; Chapman, Victoria

    2013-01-01

    Osteoarthritis (OA) of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2) receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation of chronic OA

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

    PubMed

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

    2016-10-01

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

  8. Does addition of low-level laser therapy (LLLT) in conservative care of knee arthritis successfully postpone the need for joint replacement?

    PubMed

    Ip, David

    2015-12-01

    The current study evaluates whether the addition of low-level laser therapy into standard conventional physical therapy in elderly with bilateral symptomatic tri-compartmental knee arthritis can successfully postpone the need for joint replacement surgery. A prospective randomized cohort study of 100 consecutive unselected elderly patients with bilateral symptomatic knee arthritis with each knee randomized to receive either treatment protocol A consisting of conventional physical therapy or protocol B which is the same as protocol A with added low-level laser therapy. The mean follow-up was 6 years. Treatment failure was defined as breakthrough pain which necessitated joint replacement surgery. After a follow-up of 6 years, patients clearly benefited from treatment with protocol B as only one knee needed joint replacement surgery, while nine patients treated with protocol A needed surgery (p < 0.05). We conclude low-level laser therapy should be incorporated into standard conservative treatment protocol for symptomatic knee arthritis.

  9. Knee Injuries and Disorders

    MedlinePlus

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt ... your life. The most common disease affecting the knee is osteoarthritis. The cartilage in the knee gradually wears away, ...

  10. An Acute Bout of Quadriceps Muscle Stretching has no Influence on Knee Joint Proprioception.

    PubMed

    Torres, Rui; Duarte, José Alberto; Cabri, Jan Mh

    2012-10-01

    The main objective of this study was to determine if an acute bout of static stretching of the quadriceps muscle affects the sense of joint position, the threshold to detect passive movement, and the sense of force. Thirty young, healthy men (age : 22.1 ± 2.7 years) were randomly divided into two groups. The Stretching Group (n=15) underwent stretching of the dominant quadriceps muscle, which comprised ten passive stretches lasting 30 seconds each, while the Control Group (n=15) remained seated for the same length of time. A repeated-measures analysis of variance was used to establish intragroup differences over time, and an independent sample t-test was used to compare the dependent variables between groups at each moment. None of the measurements revealed any significant change between both groups in each assessment moment or between moments within groups (p>0.05). This study demonstrated that static quadriceps muscle stretching has no effect on the sense of knee joint position, threshold to detect passive movement, and force sense, suggesting that stretching does not have appreciable effect on the spindle firing characteristics and tendon organs activation.

  11. Acute Molecular Changes in Synovial Fluid Following Human Knee Injury: Association With Early Clinical Outcomes

    PubMed Central

    Paterson, Erin; Freidin, Andrew; Kenny, Mark; Judge, Andrew; Saklatvala, Jeremy; Williams, Andy; Vincent, Tonia L.

    2016-01-01

    Objective To investigate whether molecules found to be up‐regulated within hours of surgical joint destabilization in the mouse are also elevated in the analogous human setting of acute knee injury, how this molecular response varies between individuals, and whether it is related to patient‐reported outcomes in the 3 months after injury. Methods Seven candidate molecules were analyzed in blood and synovial fluid (SF) from 150 participants with recent structural knee injury at baseline (<8 weeks from injury) and in blood at 14 days and 3 months following baseline. Knee Injury and Osteoarthritis Outcome Score 4 (KOOS4) was obtained at baseline and 3 months. Patient and control samples were compared using Meso Scale Discovery platform assays or enzyme‐linked immunosorbent assay. Results Six of the 7 molecules were significantly elevated in human SF immediately after injury: interleukin‐6 (IL‐6), monocyte chemotactic protein 1, matrix metalloproteinase 3 (MMP‐3), tissue inhibitor of metalloproteinases 1 (TIMP‐1), activin A, and tumor necrosis factor–stimulated gene 6 (TSG‐6). There was low‐to‐moderate correlation with blood measurements. Three of the 6 molecules were significantly associated with baseline KOOS4 (those with higher SF IL‐6, TIMP‐1, or TSG‐6 had lower KOOS4). These 3 molecules, MMP‐3, and activin A were all significantly associated with greater improvement in KOOS4 over 3 months, after adjustment for other relevant factors. Of these, IL‐6 alone significantly accounted for the molecular contribution to baseline KOOS4 and change in KOOS4 over 3 months. Conclusion Our findings validate relevant human biomarkers of tissue injury identified in a mouse model. Analysis of SF rather than blood more accurately reflects this response. The response is associated with patient‐reported outcomes over this early period, with SF IL‐6 acting as a single representative marker. Longitudinal outcomes will determine if these molecules are

  12. Associations between joint effusion in the knee and gene expression levels in the circulation: a meta-analysis

    PubMed Central

    Peters, Marjolein J.; Ramos, Yolande F.M.; den Hollander, Wouter; Schiphof, Dieuwke; Hofman, Albert; Uitterlinden, André G.; Oei, Edwin H.G.; Slagboom, P. Eline; Kloppenburg, Margreet; Bloem, Johan L.; Bierma-Zeinstra, Sita M.A.; Meulenbelt, Ingrid; van Meurs, Joyce B.J.

    2016-01-01

    Objective: To identify molecular biomarkers for early knee osteoarthritis (OA), we examined whether joint effusion in the knee associated with different gene expression levels in the circulation. Materials and Methods: Joint effusion grades measured with magnetic resonance (MR) imaging and gene expression levels in blood were determined in women of the Rotterdam Study (N=135) and GARP (N=98). Associations were examined using linear regression analyses, adjusted for age, fasting status, RNA quality, technical batch effects, blood cell counts, and BMI. To investigate enriched pathways and protein-protein interactions, we used the DAVID and STRING webtools. Results: In a meta-analysis, we identified 257 probes mapping to 189 unique genes in blood that were nominally significantly associated with joint effusion grades in the knee. Several compelling genes were identified such as C1orf38 and NFATC1. Significantly enriched biological pathways were: response to stress, gene expression, negative regulation of intracellular signal transduction, and antigen processing and presentation of exogenous pathways. Conclusion: Meta-analyses and subsequent enriched biological pathways resulted in interesting candidate genes associated with joint effusion that require further characterization. Associations were not transcriptome-wide significant most likely due to limited power. Additional studies are required to replicate our findings in more samples, which will greatly help in understanding the pathophysiology of OA and its relation to inflammation, and may result in biomarkers urgently needed to diagnose OA at an early stage. PMID:27134727

  13. Excessive fluctuations in knee joint moments during early stance in sprinting are caused by digital filtering procedures.

    PubMed

    Bezodis, Neil E; Salo, Aki I T; Trewartha, Grant

    2013-09-01

    Inverse dynamics analyses are commonly used to understand movement patterns in all forms of gait. The aim of this study was to determine the effect of digital filtering procedures on the knee joint moments calculated during sprinting as an example of the possible influence of data analysis processes on interpretation of movement patterns. Data were obtained from three highly trained sprinters who completed a series of 30 m sprints. Ten different combinations of cut-off frequency were applied to the two-dimensional kinematic and kinetic input data with the kinetic cut-off frequency set equal to or higher than the kinematic cut-off frequency. When using the commonly adopted practice of filtering the kinetic data with a higher cut-off frequency than the kinematic data, exaggerated fluctuations in the knee joint moment existed soon after contact. In extreme cases, the knee moved between flexor, extensor and flexor dominance in less than 33 ms and through ranges exceeding 500 Nm. During an inverse dynamics analysis of locomotion, mismatched cut-off frequencies will likely affect the calculated joint moments if the cut-off frequency applied to the kinematic data is less than the true frequency content, particularly during impact phases. In the example of sprinting, exaggerated fluctuations in the knee joint moment appear to be data processing artefact rather than genuine characteristics of the joint kinetics. When the cut-off frequencies, and thus the frequency content of all input data, are matched, the fluctuations after contact are minimal and such a procedure is suggested for inverse dynamics analyses of gait.

  14. Feasibility of a gait retraining strategy for reducing knee joint loading: increased trunk lean guided by real-time biofeedback.

    PubMed

    Hunt, Michael A; Simic, Milena; Hinman, Rana S; Bennell, Kim L; Wrigley, Tim V

    2011-03-15

    The purpose of this feasibility study was to examine changes in frontal plane knee and hip walking biomechanics following a gait retraining strategy focused on increasing lateral trunk lean and to quantify reports of difficulty and joint discomfort when performing such a gait modification. After undergoing a baseline analysis of normal walking, 9 young, healthy participants were trained to modify their gait to exhibit small (4°), medium (8°), and large (12°) amounts of lateral trunk lean. Training was guided by the use of real-time biofeedback of the actual trunk lean angle. Peak frontal plane external knee and hip joint moments were compared across conditions. Participants were asked to report the degree of difficulty and the presence of any joint discomfort for each amount of trunk lean modification. Small (4°), medium (8°), and large (12°) amounts of lateral trunk lean reduced the peak external knee adduction moment (KAM) by 7%, 21%, and 25%, respectively, though the peak KAM was only significantly less in the medium and large conditions (p<0.001). Increased trunk lean also significantly reduced the peak external hip adduction moments (p<0.001). All participants reported at least some difficulty performing the exaggerated trunk lean pat