Conceptualization of an exoskeleton Continuous Passive Motion(CPM) device using a link structure.

PubMed

Kim, Kyu-Jung; Kang, Min-Sung; Choi, Youn-Sung; Han, Jungsoo; Han, Changsoo

2011-01-01

This study is about developing an exoskeleton Continuous Passive Motion (CPM) with the same Range of Motion (ROM) and instant center of rotation as the human knee. The key feature in constructing a CPM is an accurate alignment with the human knee joint enabling it to deliver the same movements as the actual body on the CPM. In this research, we proposed an exoskeleton knee joint through kinematic interpretation, measured the knee joint torque generated while using a CPM and applied it to the device. Thus, this new exoskeleton type CPM will allow precise alignment with the human knee joint, and follow the same ROM as the human knee in any position. © 2011 IEEE

Interdependence of torque, joint angle, angular velocity and muscle action during human multi-joint leg extension.

PubMed

Hahn, Daniel; Herzog, Walter; Schwirtz, Ansgar

2014-08-01

Force and torque production of human muscles depends upon their lengths and contraction velocity. However, these factors are widely assumed to be independent of each other and the few studies that dealt with interactions of torque, angle and angular velocity are based on isolated single-joint movements. Thus, the purpose of this study was to determine force/torque-angle and force/torque-angular velocity properties for multi-joint leg extensions. Human leg extension was investigated (n = 18) on a motor-driven leg press dynamometer while measuring external reaction forces at the feet. Extensor torque in the knee joint was calculated using inverse dynamics. Isometric contractions were performed at eight joint angle configurations of the lower limb corresponding to increments of 10° at the knee from 30 to 100° of knee flexion. Concentric and eccentric contractions were performed over the same range of motion at mean angular velocities of the knee from 30 to 240° s(-1). For contractions of increasing velocity, optimum knee angle shifted from 52 ± 7 to 64 ± 4° knee flexion. Furthermore, the curvature of the concentric force/torque-angular velocity relations varied with joint angles and maximum angular velocities increased from 866 ± 79 to 1,238 ± 132° s(-1) for 90-50° knee flexion. Normalised eccentric forces/torques ranged from 0.85 ± 0.12 to 1.32 ± 0.16 of their isometric reference, only showing significant increases above isometric and an effect of angular velocity for joint angles greater than optimum knee angle. The findings reveal that force/torque production during multi-joint leg extension depends on the combined effects of angle and angular velocity. This finding should be accounted for in modelling and optimisation of human movement.

Correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students.

PubMed

Cho, Misuk

2015-06-01

[Purpose] This study aimed to identify correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students. [Subjects] Thirty female university students were enrolled and their pelvic positions and differences in lower extremity joint angles were measured. [Methods] Pelvic position, pelvic torsion, and pelvic rotation were assessed using the BackMapper. In addition, motion analysis was performed to derive differences between left and right flexion, abduction, and external rotation ranges of hip joints; flexion, abduction, and external rotation ranges of knee joints; and dorsiflexion, inversion, and abduction ranges of ankle joints, according to X, Y, and Z-axes. [Results] Pelvic position was found to be positively correlated with differences between left and right hip flexion (r=0.51), hip abduction (r=0.62), knee flexion (r=0.45), knee abduction (r=0.42), and ankle inversion (r=0.38). In addition, the difference between left and right hip abduction showed a positive correlation with difference between left and right ankle dorsiflexion (r=0.64). Moreover, differences between left and right knee flexion exhibited positive correlations with differences between left and right knee abduction (r=0.41) and ankle inversion (r=0.45). [Conclusion] Bilateral pelvic tilt angles are important as they lead to bilateral differences in lower extremity joint angles during walking.

Radiographic assessment of knee joint rotation.

PubMed Central

Straiton, J A; Todd, B; Venner, R M

1987-01-01

A radiographic technique for measuring conjunct rotation at the knee joint is described. Conjunct rotation was demonstrated to occur over a greater range of values of flexion than conventionally believed. Rotation increased progressively as the knee extended, and was not confined to the last phase of extension. Consideration of such rotatory movement is relevant to the design of knee arthroplasties and also to possible mechanisms of non-bony injury of the knee. PMID:3503049

Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint.

PubMed

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

2011-01-27

The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty.No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA).Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations. In this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA). Rotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation. BKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA.

Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position.

PubMed

Cho, Kang Hee; Jeon, Yumi; Lee, Hyunkeun

2016-04-01

To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint.

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

PubMed

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.

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

[EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES].

PubMed

Li, Xin; Li, Heng; Ni, Ming; Li, Xiang; Song, Xinggui; Kong, Xiangpeng; Li, Yucong; Chen, Jiying

2016-11-08

To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones ( P <0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of >2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up ( P >0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint ( P <0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found ( P >0.05). A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.

Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

ERIC Educational Resources Information Center

Tali, Maie; Maaroos, Jaak

2010-01-01

The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

Influence of footwear and equipment on stride length and range of motion of ankle, knee and hip joint.

PubMed

Schulze, Christoph; Lindner, Tobias; Woitge, Sandra; Schulz, Katharina; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

2014-01-01

Footwear and equipment worn by military personnel is of importance for them to be able to meet the physical demands specific to their profession daily activities. The aim of the present study was to investigate by means of gait analysis how army-provided footwear and equipment influence the range of motion of hip, knee and ankle joints as well as stride length. Thirty-two soldiers were subjected to gait analysis on a treadmill by way of video recordings and goniometric measurements. The stride length increased when military shoes are worn. We found no influence on stride length in connection to increased loading. The weight of the shoes represents the decisive factor. Neither shoes nor equipment changed the range of motion of the knee joint. Weight of equipment affected range of motion of the hip joint. The range of motion of the upper and lower ankle joints was mainly influenced by the properties of the shoes. Military footwear and weight of equipment influence stride length and range of motion of joints of the lower extremities in a specific way. Shape of material is the decisive factor.

Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint

PubMed Central

2011-01-01

Background The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty. No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA). Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations. Methods In this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA). Results Rotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation. Conclusions BKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA. PMID:21272328

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.

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.

Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position

PubMed Central

Cho, Kang Hee; Lee, Hyunkeun

2016-01-01

Objective To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. Methods One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. Results There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. Conclusion To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint. PMID:27152277

Hemi-wedge osteotomy in the management of large angular deformities around the knee joint.

PubMed

El-Alfy, Barakat Sayed

2016-08-01

Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint. Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity. At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury. Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.

An improved OpenSim gait model with multiple degrees of freedom knee joint and knee ligaments.

PubMed

Xu, Hang; Bloswick, Donald; Merryweather, Andrew

2015-08-01

Musculoskeletal models are widely used to investigate joint kinematics and predict muscle force during gait. However, the knee is usually simplified as a one degree of freedom joint and knee ligaments are neglected. The aim of this study was to develop an OpenSim gait model with enhanced knee structures. The knee joint in this study included three rotations and three translations. The three knee rotations and mediolateral translation were independent, with proximodistal and anteroposterior translations occurring as a function of knee flexion/extension. Ten elastic elements described the geometrical and mechanical properties of the anterior and posterior cruciate ligaments (ACL and PCL), and the medial and lateral collateral ligaments (MCL and LCL). The three independent knee rotations were evaluated using OpenSim to observe ligament function. The results showed that the anterior and posterior bundles of ACL and PCL (aACL, pACL and aPCL, pPCL) intersected during knee flexion. The aACL and pACL mainly provided force during knee flexion and adduction, respectively. The aPCL was slack throughout the range of three knee rotations; however, the pPCL was utilised for knee abduction and internal rotation. The LCL was employed for knee adduction and rotation, but was slack beyond 20° of knee flexion. The MCL bundles were mainly used during knee adduction and external rotation. All these results suggest that the functions of knee ligaments in this model approximated the behaviour of the physical knee and the enhanced knee structures can improve the ability to investigate knee joint biomechanics during various gait activities.

Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis.

PubMed

Khademi-Kalantari, Khosro; Mahmoodi Aghdam, Somayeh; Akbarzadeh Baghban, Alireza; Rezayi, Mehdi; Rahimi, Abbas; Naimee, Sedighesadat

2014-10-01

The aim of this study was to evaluate the clinical results of non surgical knee distraction in patients with severe knee osteoarthritis. forty female patients with severe knee osteoarthritis were randomly divided in two groups. A standard physiotherapy treatment was applied to both groups and in one group it was accompanied with 20 min knee joint distraction. The patients were treated for 10 sessions. Clinical examination consisted of functional examination, completion of a quality of life questionnaire, pain scale, and assessment of joint mobility and joint edema. The standard physiotherapy treatment accompanied by knee distraction resulted in significantly higher improvement in pain (P = 0.004), functional ability (P = 0.02), quality of life (P = 0.002) and knee flexion range of motion (p = 0.02) compared to the standard physiotherapy treatment alone post treatment and after 1 month follow up. Adding knee distraction to standard physiotherapy treatment can result in further improvement in pain relief, increased functional ability and better quality of life in patients with severe knee osteoarthritis. Copyright © 2013 Elsevier Ltd. All rights reserved.

The effect of tibio-femoral traction mobilization on passive knee flexion motion impairment and pain: a case series

PubMed Central

Maher, Sara; Creighton, Doug; Kondratek, Melodie; Krauss, John; Qu, Xianggui

2010-01-01

The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC95, was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant’s knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration. PMID:21655421

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report.

PubMed

Simpson, Brad G; Simon, Corey B

2014-05-01

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.

Effects of Novel Guidance Tubing Gait on Electromyographic Neuromuscular Imbalance and Joint Angular Kinematics During Locomotion in Hemiparetic Stroke Patients.

PubMed

Lee, Jeong J; You, Joshua Sung H

2017-12-01

To compare the immediate effects of conventional treadmill gait and guidance tubing gait (GTG) on electromyographic neuromuscular imbalance and knee joint kinematics in hemiparetic gait. Case-control study. University medical center. Participants (N=33; 19 men, 14 women) were patients with hemiparetic stroke (n=18 [experimental]; mean age ± SD, 39.2±16.8y) and healthy controls (n=15; mean age ± SD, 26.3±2.6y). The GTG was provided for approximately 30 minutes and involved application of an assistive guidance force using the tubing, specifically to improve knee joint stabilization during midstance and increase knee joint flexion during midswing phase. Clinical tests included the Korean Mini-Mental State Examination, Modified Ashworth Scale, Berg Balance Scale, manual muscle test, and knee joint range of motion and sensory tests. Knee joint muscle electromyographic and kinematic analyses were determined at pretest and posttest. After the intervention, the experimental group showed significantly greater improvements in balanced quadriceps and hamstring electromyographic coactivation and knee joint kinematics relative to the control group (P=.005). The GTG intervention decreased overactive hamstring activity (P=.018) and reciprocally increased quadriceps activity (P<.001). The knee joint kinematic analysis showed significant changes in the hemiparetic stroke group (P=.004). This study demonstrates the effectiveness of the tubing gait condition to restore knee joint muscle imbalance and kinematics in individuals with hemiparetic stroke who present with an abnormal hyperextension knee gait. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[Restricted motion after total knee arthroplasty].

PubMed

Kucera, T; Urban, K; Karpas, K; Sponer, P

2007-10-01

The aim of the study was to ascertain what proportion of patients undergoing total knee arthroplasty (TKA) complain of restricted knee joint motion, and to investigate options for improvement of this situation. Our evaluation included a group of 796 patients treated with TKA at our department in the period from January 1, 1990, to December 31, 2004. In all cases, a condylar implant with preservation of the posterior cruciate ligaments was used. In addition to medical history, the range of motion, knee joint malalignment and radiological findings were assessed before surgery. After THA, the type of implant and complications, if any, were recorded, and improvement in joint motion was followed up. Based on the results of Kim et al., flexion contracture equal to or higher than 15 degrees and/or flexion less than 75 degrees were made the criteria of stiffness after THA. Patients with restricted THA motion who had aseptic or septic implant loosening were not included. Of the 796 evaluated patients, 32 (4.14 %) showed restricted motion after total knee arthroplasty, as assessed by the established criteria. In 16 patients, stiffness defined by these criteria had existed before surgery, and three patients showed an excessive production of adhesions and heterotopic ossifications. In three patients, the implantation procedure resulted in an elevated level of the original joint line and subsequent development of patella infera and increased tension of the posterior cruciate ligament. Four patients declined physical therapy and, in six, the main cause of stiffness could not be found. Seventeen patients did not require surgical therapy for restricted motion; TKA provided significant pain relief and they considered the range of motion achieved to be sufficient. One patient underwent redress 3 months after surgery, but with no success. Repeated releases of adhesions, replacement of a polyethylene liner and revision surgery of the extensor knee structures were performed in 15 patients. In these, the average value of knee flexion increased by 17 degrees only and, in the patients suffering from excessive adhesion production, this value remained almost unchanged. Revision TKA was carried out in four patients, in whom knee joint flexion increased on average by 35 degrees to achieve an average flexion of 83 degrees. Restricted motion after TKA has been reported to range from 1.3 % to 12.0 %, but consistent criteria have not been set up. In our study it was 4.14 %. In agreement with the literature data, one of the reasons was pre-operative restricted motion, which was recorded in 16 of 32 patients. Similarly, also in our patients, biological predisposition to excessive production of fibrocartilage associated with adhesions in all knee joint compartments was the major therapeutic problem. Intra-operative fractures, ligament tears requiring post-operative fixation and unremoved dorsal osteophytes lead to the restriction of knee joint motion. By inadequate resection of articular surface, the original joint line may be at a higher level; this results in an increased tension of the posterior cruciate ligament and patella infera development, both influencing knee flexion. In our study, three patients were affected. Knee joint stiffness can also develop in patients declining physical therapy or in whom this is not correctly performed, often for insufficient analgesia. In contrast to the data reported in the literature, 17 of 32 patients in this study had no need for surgical treatment of restricted knee joint motion. Redress under general anesthesia was not effective. For markedly restricted motion of the knee joint, reimplantation can be recommended or, in less severe cases, an intervention on adjacent soft tissues. Restricted motion of the knee joint after TKA is difficult to treat and, therefore, prevention is recommended. This should include thorough conservative treatment of gonarthrosis, early indication for surgery, prevention of elevation in the joint line and consistent rehabilitation with appropriate analgesia. For severe stiffness of the knee joint, as evaluated by the criteria of Kim et al., revision arthroplasty can be recommended.

Meniscal Preservation is Important for the Knee Joint

PubMed Central

Patil, Shantanu Sudhakar; Shekhar, Anshu; Tapasvi, Sachin Ramchandra

2017-01-01

Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing. PMID:28966381

Prosthetic knee design by simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hollerbach, K; Hollister, A

1999-07-30

Although 150,000 total knee replacement surgeries are performed annually in North America, current designs of knee prostheses have mechanical problems that include a limited range of motion, abnormal gait patterns, patellofemoral joint dysfunction, implant loosening or subsidence, and excessive wear. These problems fall into three categories: failure to reproduce normal joint kinematics, which results in altered limb function; bone-implant interface failure; and material failure. Modern computer technology can be used to design, prototype, and test new total knee implants. The design team uses the full range of CAD-CAM to design and produce implant prototypes for mechanical and clinical testing. Closermore » approximation of natural knee kinematics and kinetics is essential for improved patient function and diminished implant loads. Current knee replacement designs are based on 19th Century theories that the knee moves about a variable axis of rotation. Recent research has shown, however, that knee motion occurs about two fixed, offset axes of rotation. These aces are not perpendicular to the long axes of the bones or to each other, and the axes do not intersect. Bearing surfaces of mechanisms that move about axes of rotation are surfaces of revolution of those axes which advanced CAD technology can produce. Solids with surfaces of revolution for the two axes of rotation for the knee have been made using an HP9000 workstation and Structural Ideas Master Series CAD software at ArthroMotion. The implant's CAD model should closely replicate movements of the normal knee. The knee model will have a range of flexion-extension (FE) from -5 to 120 degrees. Movements include varus, valgus, internal and external rotation, as well as flexion and extension. The patellofemoral joint is aligned perpendicular to the FE axis and replicates the natural joint more closely than those of existing prostheses. The bearing surfaces will be more congruent than current designs and should generate lower stresses in the materials.« less

Temporal gene expression profiling of the rat knee joint capsule during immobilization-induced joint contractures.

PubMed

Wong, Kayleigh; Sun, Fangui; Trudel, Guy; Sebastiani, Paola; Laneuville, Odette

2015-05-26

Contractures of the knee joint cause disability and handicap. Recovering range of motion is recognized by arthritic patients as their preference for improved health outcome secondary only to pain management. Clinical and experimental studies provide evidence that the posterior knee capsule prevents the knee from achieving full extension. This study was undertaken to investigate the dynamic changes of the joint capsule transcriptome during the progression of knee joint contractures induced by immobilization. We performed a microarray analysis of genes expressed in the posterior knee joint capsule following induction of a flexion contracture by rigidly immobilizing the rat knee joint over a time-course of 16 weeks. Fold changes of expression values were measured and co-expressed genes were identified by clustering based on time-series analysis. Genes associated with immobilization were further analyzed to reveal pathways and biological significance and validated by immunohistochemistry on sagittal sections of knee joints. Changes in expression with a minimum of 1.5 fold changes were dominated by a decrease in expression for 7732 probe sets occurring at week 8 while the expression of 2251 probe sets increased. Clusters of genes with similar profiles of expression included a total of 162 genes displaying at least a 2 fold change compared to week 1. Functional analysis revealed ontology categories corresponding to triglyceride metabolism, extracellular matrix and muscle contraction. The altered expression of selected genes involved in the triglyceride biosynthesis pathway; AGPAT-9, and of the genes P4HB and HSP47, both involved in collagen synthesis, was confirmed by immunohistochemistry. Gene expression in the knee joint capsule was sensitive to joint immobility and provided insights into molecular mechanisms relevant to the pathophysiology of knee flexion contractures. Capsule responses to immobilization was dynamic and characterized by modulation of at least three reaction pathways; down regulation of triglyceride biosynthesis, alteration of extracellular matrix degradation and muscle contraction gene expression. The posterior knee capsule may deploy tissue-specific patterns of mRNA regulatory responses to immobilization. The identification of altered expression of genes and biochemical pathways in the joint capsule provides potential targets for the therapy of knee flexion contractures.

Expressing the joint moments of drop jumps and sidestep cutting in different reference frames--does it matter?

PubMed

Kristianslund, Eirik; Krosshaug, Tron; Mok, Kam-Ming; McLean, Scott; van den Bogert, Antonie J

2014-01-03

Joint moments help us understand joint loading and muscle function during movement. However, the interpretation depends on the choice of reference frame, but the different reference frames have not been compared in dynamic, high-impact sporting movements. We have compared the magnitude and the resulting ranking of hip and knee joint moments expressed in the laboratory coordinate system, the local system of the distal segment and projected or decomposed to the Joint Coordinate System (JCS) axes. Hip and knee joint moments of drop jumps and sidestep cutting in 70 elite female handball players were calculated based on recordings from an eight-camera 240 Hz system and two force platforms and expressed with the four methods. The greatest variations in magnitude between conditions were seen for drop jump hip internal rotation (range: 0.31-0.71 Nm/kg) and sidestep cutting knee flexion (2.87-3.39 Nm/kg) and hip internal rotation (0.87-2.36 Nm/kg) and knee internal rotation (0.10-0.40 Nm/kg) moments. The rank correlations were highest between conditions for flexion moments (0.88-1.00) and sidestep cutting abduction moments (0.71-0.98). The rank correlations ranged from 0.64 to 0.73 for drop jump knee abduction moments and between -0.17 and 0.67 for hip and knee internal rotation moments. Expression of joint moments in different reference systems affects the magnitude and ranking of athletes. This lack of consistency may complicate the comparison and combination of results. Projection to the JCS is the only method where joint moments correspond to muscle and ligament loading. More widespread adoption of this convention could facilitate comparison of studies and ease the interpretation of results. © 2013 Elsevier Ltd. All rights reserved.

Muscle Activation Profiles and Co-Activation of Quadriceps and Hamstring Muscles around Knee Joint in Indian Primary Osteoarthritis Knee Patients.

PubMed

Sharma, Sanjeev Kumar; Yadav, Shiv Lal; Singh, U; Wadhwa, Sanjay

2017-05-01

Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint stability due to impaired quadriceps strength, pain, and an altered joint structure. There is altered muscle activation in knee OA patients, which interferes with normal load distribution around the knee and facilitates disease progression. Our primary aim was to determine activation patterns of the muscles i.e., quadriceps and hamstrings in knee OA patients during walking. We also studied co-activation of muscles around knee joint in primary OA knee patients including directed medial and lateral co-contractions. This observational study was done at Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. Fourty-four patients with medial compartment primary knee OA were included in study after satisfying inclusion and exclusion criteria. All the patients were assessed for mean, peak and integrated Root Mean Square (RMS), EMG values, muscle activation patterns and co-activation of muscles around knee joint by surface Electromyography (EMG) analysis of Vastus Medialis Obliques (VMO), Vastus Lateralis (VL), Semitendinosus (SMT) and Biceps Femoris (BF) muscles during gait cycle. The EMG waveform for each muscle was amplitude normalized and time normalized to 100% of gait cycle and plotted on graph. Quantitative variables were assessed for normal distribution and accordingly mean±SD or median (range), as appropriate, was computed. For primary OA knee, mean age 61±5 years, mean weight 63.7±10.1 kg, mean height 153.9±7.2 cm, and mean Body Mass Index (BMI) 26.8±3.0 kg/m 2 was found. The muscle activity of hamstrings (SMT muscle and BF) was increased during midstance, late stance and early swing phase of gait cycle as compared to quadriceps (VMO and VL) muscle activity respectively, suggesting co-contraction of opposing muscles around knee joint. Patients with knee OA walk with increased hamstring muscle activity (during late stance and early swing phase) and reduced quadriceps recruitment. Altered neuro-muscular control around knee interferes with normal load distribution and facilitates disease progression in knee joint.

Muscle Activation Profiles and Co-Activation of Quadriceps and Hamstring Muscles around Knee Joint in Indian Primary Osteoarthritis Knee Patients

PubMed Central

Yadav, Shiv Lal; Singh, U; Wadhwa, Sanjay

2017-01-01

Introduction Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint stability due to impaired quadriceps strength, pain, and an altered joint structure. There is altered muscle activation in knee OA patients, which interferes with normal load distribution around the knee and facilitates disease progression. Aim Our primary aim was to determine activation patterns of the muscles i.e., quadriceps and hamstrings in knee OA patients during walking. We also studied co-activation of muscles around knee joint in primary OA knee patients including directed medial and lateral co-contractions. Materials and Methods This observational study was done at Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. Fourty-four patients with medial compartment primary knee OA were included in study after satisfying inclusion and exclusion criteria. All the patients were assessed for mean, peak and integrated Root Mean Square (RMS), EMG values, muscle activation patterns and co-activation of muscles around knee joint by surface Electromyography (EMG) analysis of Vastus Medialis Obliques (VMO), Vastus Lateralis (VL), Semitendinosus (SMT) and Biceps Femoris (BF) muscles during gait cycle. The EMG waveform for each muscle was amplitude normalized and time normalized to 100% of gait cycle and plotted on graph. Quantitative variables were assessed for normal distribution and accordingly mean±SD or median (range), as appropriate, was computed. Results For primary OA knee, mean age 61±5 years, mean weight 63.7±10.1 kg, mean height 153.9±7.2 cm, and mean Body Mass Index (BMI) 26.8±3.0 kg/m2 was found. The muscle activity of hamstrings (SMT muscle and BF) was increased during midstance, late stance and early swing phase of gait cycle as compared to quadriceps (VMO and VL) muscle activity respectively, suggesting co-contraction of opposing muscles around knee joint. Conclusion Patients with knee OA walk with increased hamstring muscle activity (during late stance and early swing phase) and reduced quadriceps recruitment. Altered neuro-muscular control around knee interferes with normal load distribution and facilitates disease progression in knee joint. PMID:28658860

Joint awareness after total knee arthroplasty is affected by pain and quadriceps strength.

PubMed

Hiyama, Y; Wada, O; Nakakita, S; Mizuno, K

2016-06-01

There is a growing interest in the use of patient-reported outcomes to provide a more patient-centered view on treatment. Forgetting the artificial joint can be regarded as the goal in joint arthroplasty. The goals of the study were to describe changes in joint awareness in the artificial joint after total knee arthroplasty (TKA), and to determine which factors among pain, knee range of motion (ROM), quadriceps strength, and functional ability affect joint awareness after TKA. Patients undergoing TKA demonstrate changes in joint awareness and joint awareness is associated with pain, knee ROM, quadriceps strength, and functional ability. This prospective cohort study comprised 63 individuals undergoing TKA, evaluated at 1, 6, and 12 months postoperatively. Outcomes included joint awareness assessed using the Forgotten Joint Score (FJS), pain score, knee ROM, quadriceps strength, and functional ability. Fifty-eight individuals completed all postoperative assessments. All measures except for knee extension ROM improved from 1 to 6 months. However, there were no differences in any measures from 6 to 12 months. FJS was affected most greatly by pain at 1 month and by quadriceps strength at 6 and 12 months. Patients following TKA demonstrate improvements in joint awareness and function within 6 months after surgery, but reach a plateau from 6 to 12 months. Quadriceps strength could contribute to this plateau of joint awareness. Prospective cohort study, IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait.

PubMed

Ota, S; Ueda, M; Aimoto, K; Suzuki, Y; Sigward, S M

2014-06-01

Restrictions in range of ankle dorsiflexion (DF) motion can persist following ankle injuries. Ankle DF is necessary during terminal stance of gait, and its restricted range may affect knee joint kinematics and kinetics. The purpose of this study was to investigate the acute influence of varied levels of restricted ankle DF on knee joint sagittal and frontal plane kinematics and kinetics during gait. Thirty healthy volunteers walked with a custom-designed ankle brace that restricted ankle DF. Kinematics and kinetics were collected using a 7-camera motion analysis system and two force plates. Ankle dorsiflexion was restricted in 10-degree increments, allowing for four conditions: Free, light (LR), moderate (MR) and severe restriction (SR). Knee angles and moments were measured during terminal stance. Real peak ankle DF for Free, LR, MR, and SR were 13.7±4.8°, 11.6±5.0°, 7.5±5.3°, and 4.2±7.2°, respectively. Peak knee extension angles under the same conditions were -6.7±6.7°, -5.4±6.4°, -2.5±7.5°, and 0.6±7.8°, respectively, and the peak knee varus moment was 0.48±0.17 Nm/kg, 0.47±0.17 Nm/kg, 0.53±0.20 Nm/kg, and 0.57±0.20 Nm/kg. The knee varus moment was significantly increased from MR condition with an 8-degree restriction in ankle DF. Knee joint kinematics and kinetics in the sagittal and frontal planes were affected by reduced ankle DF during terminal stance of gait. Differences were observed with restriction in ankle DF range of approximately 8°. level III. Copyright © 2014 Elsevier B.V. All rights reserved.

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

PubMed Central

Simpson, Brad G; Simon, Corey B

2014-01-01

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain. PMID:24976753

Two-staged Bilateral, Femoral Alignment Osteotomy with Concomitant Total Knee Arthroplasty in an Achondroplasia Patient - A Case Report

PubMed Central

Walter, Sebastian G; Schwering, Tobias; Preiss, Stefan

2017-01-01

Introduction: Achondroplasia is the most common form of dwarfism in humans and is orthopedically characterized by shortened extremities and an exaggerated lumbar lordosis. The surgical challenges are maintenance of axial alignment during limb lengthening as well as joint preservation and alignment restoration. Case Report: We present a 46-year-old female suffering from achondroplasia with severe pain in both knees. Severe varus deformities of both femurs and degeneration of both knee joints became apparent on clinical and radiological examination. On each femur, we performed one-staged, lateral closed-wedge osteotomy, and total knee arthroplasty (TKA). Subsequently, the patient was relieved of knee joint pain and gained a greater range of motion. Conclusion: One-staged valgization osteotomy and concomitant TKA represents a challenging, yet reasonable, surgical solution in axially severe malaligned and joint degenerated patients. PMID:28819598

Multi-joint postural behavior in patients with knee osteoarthritis.

PubMed

Turcot, Katia; Sagawa, Yoshimasa; Hoffmeyer, Pierre; Suvà, Domizio; Armand, Stéphane

2015-12-01

Previous studies have demonstrated balance impairment in patients with knee osteoarthritis (OA). Although it is currently accepted that postural control depends on multi-joint coordination, no study has previously considered this postural strategy in patients suffering from knee OA. The objectives of this study were to investigate the multi-joint postural behavior in patients with knee OA and to evaluate the association with clinical outcomes. Eighty-seven patients with knee OA and twenty-five healthy elderly were recruited to the study. A motion analysis system and two force plates were used to investigate the joint kinematics (trunk and lower body segments), the lower body joint moments, the vertical ground reaction force ratio and the center of pressure (COP) during a quiet standing task. Pain, functional capacity and quality of life status were also recorded. Patients with symptomatic and severe knee OA adopt a more flexed posture at all joint levels in comparison with the control group. A significant difference in the mean ratio was found between groups, showing an asymmetric weight distribution in patients with knee OA. A significant decrease in the COP range in the anterior-posterior direction was also observed in the group of patients. Only small associations were observed between postural impairments and clinical outcomes. This study brings new insights regarding the postural behavior of patients with severe knee OA during a quiet standing task. The results confirm the multi-joint asymmetric posture adopted by this population. Copyright © 2014 Elsevier B.V. All rights reserved.

Relative Intensity Influences the Degree of Correspondence of Jump Squats and Push Jerks to Countermovement Jumps.

PubMed

Cushion, Emily J; Goodwin, Jon E; Cleather, Daniel J

2016-05-01

The aim of this study was to determine the mechanical similarity between push jerk (PJ) and jump squat (JS) to countermovement jump (CMJ) and further understand the effect increasing external load may have on this relationship. Eight physically trained men (age 22 ± 3; height 176 ± 7 kg; weight 83 ± 8 kg) performed an unloaded CMJ followed by JS under a range of loads (10, 25, 35, and 50% 1RM back squat) and PJ (30, 50, 65, and 75% 1RM push jerk). A portable force platform and high-speed camera both collecting at 250 Hz were used to establish joint moments and impulse during the propulsive phase of the movements. A standard inverse dynamics model was used to determine joint moment and impulse at the hip, knee, and ankle. Significant correlations (p ≤ 0.05) were shown between CMJ knee joint moment and JS knee joint moment at 25% load and PJ knee joint moment at 30 and 50% load. Significant correlations were also observed between CMJ knee joint impulse and JS knee joint impulse at 10% load and PJ knee joint moment at 30 and 65% load. Significant correlation was also observed between CMJ hip joint impulse and PJ hip joint impulse at 30% load. No significant joint × load interaction was shown as load increased for either PJ or JS. Results from the study suggest partial correspondence between PJ and JS to CMJ, where a greater mechanical similarity was observed between the PJ and CMJ. This interaction is load and joint dependent where lower relative loads showed greatest mechanical similarity. Therefore using lower relative loads when programming may provide a greater transfer of training effect.

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. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed Central

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

2017-01-01

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. PMID:26481256

Low Level Laser Therapy for chronic knee joint pain patients.

PubMed

Nakamura, Takashi; Ebihara, Satoru; Ohkuni, Ikuko; Izukura, Hideaki; Harada, Takashi; Ushigome, Nobuyuki; Ohshiro, Toshio; Musha, Yoshiro; Takahashi, Hiroshi; Tsuchiya, Kazuaki; Kubota, Ayako

2014-12-27

Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

Arthrometric Evaluation of Stabilizing Effect of Knee Functional Bracing at Different Flexion Angles

PubMed Central

Seyed Mohseni, Saeedeh; Moss, Farzam; Karimi, Hossein; Kamali, Mohammad

2009-01-01

Previous in-vivo investigations on the stabilizing efficacy of knee bracing for ACL reconstructed patients have been often limited to 20-30 degrees of knee flexion. In this study, the effectiveness of a uniaxial hinged functional brace to improve the knee stability was assessed at 30, 60 and 90 degrees of knee flexion. Arthrometry tests were conducted on 15 healthy subjects before and following wearing the brace and the tibial displacements were measured at up to 150 N anterior forces. Results indicated that functional bracing has a significant stabilizing effect throughout the range of knee flexion examined (p < 0.05). The rate of effectiveness, however, was not consistent across the flexion range, e.g., 50% at 30 degrees and only 4% at 90 degrees. It was suggested that accurate sizing and fitting as well as attention to correct hinge placement relative to the femoral condyles can limit brace migration and improve its effectiveness in mid and deep knee flexion. With using adaptive limb fittings, through flexible pads, and a polycentric joint a more significant improvement of the overall brace performance and efficacy might be obtained. Key points Functional bracing improves the knee joint stability mostly in extension posture. Unlike the non-braced condition, the least knee joint stability appears in mid and deep flexion angles when using a hinged brace. Accurate sizing and fitting and attention to correct hinge placement relative to the femoral condyles can limit brace migration and improve its effectiveness in mid and deep knee flexion. The overall brace performance and efficacy might be improved significantly using adaptive limb fittings through flexible pads and/or polycentric joints. PMID:24149533

Increased concentrations of bone sialoprotein in joint fluid after knee injury.

PubMed Central

Lohmander, L S; Saxne, T; Heinegård, D

1996-01-01

OBJECTIVE: To detect evidence for localised changes in bone matrix metabolism after joint trauma and in post-traumatic osteoarthritis by quantification of bone sialoprotein in joint fluid and serum after knee injury in a cross sectional study. METHODS: Samples of knee joint fluid and serum were obtained from volunteers with normal knees (n = 19), patients with rupture of the anterior cruciate ligament isolated or combined with tear of a meniscus (n = 114), and patients with isolated meniscus lesions (n = 80). Concentrations of bone sialoprotein were determined by ELISA. Concentrations of other markers of joint tissue metabolism in these samples were determined in previous investigations. RESULTS: The median concentrations of bone sialoprotein in joint fluid from healthy volunteers was 122 ng ml-1 (range 41 to 183). Concentrations of bone sialoprotein were increased in both injury groups compared with the reference group (median for cruciate ligament injury 146 ng ml-1, range 72 to 339; median for meniscus injury 166 ng ml-1, range 75 to 376). After injury, bone sialoprotein increased quickly and remained increased for six months. Bone sialoprotein in joint fluid was increased only in samples from joints with normal or nearly normal (fibrillated) cartilage, and was within reference range in joints with radiographic signs of osteoarthritis. Bone sialoprotein concentrations in joints with cruciate ligament injury were positively correlated with levels of aggrecan and cartilage oligomeric matrix protein fragments, and with levels of stromelysin-1 and tissue inhibitor of metalloproteinase-1. The ratios between the concentrations of bone sialoprotein in joint fluid and serum were > 1 in the majority of the cruciate ligament injury cases. CONCLUSIONS: The release of significant amounts of bone sialoprotein into joint fluid in connection with acute joint trauma may be associated with injury to, and active remodelling of, the cartilage-bone interface and subchondral bone. The findings are consistent with dramatic shifts in cartilage, bone, and synovial metabolism following joint injury. Bone sialoprotein concentrations in synovial fluid may be a useful marker of subchondral injury and remodelling following joint injury. PMID:8882132

Computational knee ligament modeling using experimentally determined zero-load lengths.

PubMed

Bloemker, Katherine H; Guess, Trent M; Maletsky, Lorin; Dodd, Kevin

2012-01-01

This study presents a subject-specific method of determining the zero-load lengths of the cruciate and collateral ligaments in computational knee modeling. Three cadaver knees were tested in a dynamic knee simulator. The cadaver knees also underwent manual envelope of motion testing to find their passive range of motion in order to determine the zero-load lengths for each ligament bundle. Computational multibody knee models were created for each knee and model kinematics were compared to experimental kinematics for a simulated walk cycle. One-dimensional non-linear spring damper elements were used to represent cruciate and collateral ligament bundles in the knee models. This study found that knee kinematics were highly sensitive to altering of the zero-load length. The results also suggest optimal methods for defining each of the ligament bundle zero-load lengths, regardless of the subject. These results verify the importance of the zero-load length when modeling the knee joint and verify that manual envelope of motion measurements can be used to determine the passive range of motion of the knee joint. It is also believed that the method described here for determining zero-load length can be used for in vitro or in vivo subject-specific computational models.

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

The effect of external ankle support on knee and ankle joint movement and loading in netball players.

PubMed

Vanwanseele, Benedicte; Stuelcken, Max; Greene, Andrew; Smith, Richard

2014-09-01

External ankle support has been successfully used to prevent ankle sprains. However, some recent studies have indicated that reducing ankle range of motion can place larger loads on the knee. The aim of this study was to investigate the effect of external ankle support (braces and high-top shoes) on the ankle and knee joint loading during a netball specific landing task. A repeated measure design. High performance netball players with no previously diagnosed severe ankle or knee injury (n=11) were recruited from NSW Institute of Sport netball programme. The kinematic and kinetic data were collected simultaneously using a 3-D Motion Analysis System and one Kistler force plate to measure ground reaction forces. Players performed a single leg landing whilst receiving a pass while wearing a standard netball shoe, the same shoe with a lace-up brace and a high-top shoe. Only the brace condition significantly reduced the ankle range of motion in the frontal plane (in/eversion) by 3.95 ± 3.74 degrees compared to the standard condition. No changes were found for the knee joint loading in the brace condition. The high-top shoes acted to increase the peak knee internal rotation moment by 15%. Both the brace and high-top conditions brought about increases in the peak ankle plantar flexion moment during the landing phase. Lace-up braces can be used by netball players to restrict ankle range of motion during a single leg landing while receiving a pass without increasing the load on the knee joint. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Predicting maximal strength of quadriceps from submaximal performance in individuals with knee joint osteoarthritis.

PubMed

McNair, Peter J; Colvin, Matt; Reid, Duncan

2011-02-01

To compare the accuracy of 12 maximal strength (1-repetition maximum [1-RM]) equations for predicting quadriceps strength in people with osteoarthritis (OA) of the knee joint. Eighteen subjects with OA of the knee joint attended a rehabilitation gymnasium on 3 occasions: 1) a familiarization session, 2) a session where the 1-RM of the quadriceps was established using a weights machine for an open-chain knee extension exercise and a leg press exercise, and 3) a session where the subjects performed with a load at which they could lift for approximately 10 repetitions only. The data were used in 12 prediction equations to calculate 1-RM strength and compared to the actual 1-RM data. Data were examined using Bland and Altman graphs and statistics, intraclass correlation coefficients (ICCs), and typical error values between the actual 1-RM and the respective 1-RM prediction equation data. Difference scores (predicted 1-RM--actual 1-RM) across the injured and control legs were also compared. For the knee extension exercise, the Brown, Brzycki, Epley, Lander, Mayhew et al, Poliquin, and Wathen prediction equations demonstrated the greatest levels of predictive accuracy. All of the ICCs were high (range 0.96–0.99), and typical errors were between 3% and 4%. For the knee press exercise, the Adams, Berger, Kemmler et al, and O'Conner et al equations demonstrated the greatest levels of predictive accuracy. All of the ICCs were high (range 0.95-0.98), and the typical errors ranged from 5.9-6.3%. This study provided evidence supporting the use of prediction equations to assess maximal strength in individuals with a knee joint with OA.

Knee Proprioception and Strength and Landing Kinematics During a Single-Leg Stop-Jump Task

PubMed Central

Nagai, Takashi; Sell, Timothy C; House, Anthony J; Abt, John P; Lephart, Scott M

2013-01-01

Context The importance of the sensorimotor system in maintaining a stable knee joint has been recognized. As individual entities, knee-joint proprioception, landing kinematics, and knee muscles play important roles in functional joint stability. Preventing knee injuries during dynamic tasks requires accurate proprioceptive information and adequate muscular strength. Few investigators have evaluated the relationship between knee proprioception and strength and landing kinematics. Objective To examine the relationship between knee proprioception and strength and landing kinematics. Design Cross-sectional study. Setting University research laboratory. Patients or Other Participants Fifty physically active men (age = 26.4 ± 5.8 years, height = 176.5 ± 8.0 cm, mass = 79.8 ± 16.6 kg). Intervention(s) Three tests were performed. Knee conscious proprioception was evaluated via threshold to detect passive motion (TTDPM). Knee strength was evaluated with a dynamometer. A 3-dimensional biomechanical analysis of a single-legged stop-jump task was used to calculate initial contact (IC) knee-flexion angle and knee-flexion excursion. Main Outcome Measure(s) The TTDPM toward knee flexion and extension, peak knee flexion and extension torque, and IC knee-flexion angle and knee flexion excursion. Linear correlation and stepwise multiple linear regression analyses were used to evaluate the relationships of both proprioception and strength against landing kinematics. The α level was set a priori at .05. Results Enhanced TTDPM and greater knee strength were positively correlated with greater IC knee-flexion angle (r range = 0.281–0.479, P range = .001–.048). The regression analysis revealed that 27.4% of the variance in IC knee-flexion angle could be accounted for by knee-flexion peak torque and TTDPM toward flexion (P = .001). Conclusions The current research highlighted the relationship between knee proprioception and strength and landing kinematics. Individuals with enhanced proprioception and muscular strength had better control of IC knee-flexion angle during a dynamic task. PMID:23672323

Do Changes in Patellofemoral Joint Offset Lead to Adverse Outcomes in Total Knee Arthroplasty With Patellar Resurfacing? A Radiographic Review.

PubMed

Matz, Jacob; Howard, James L; Morden, David J; MacDonald, Steven J; Teeter, Matthew G; Lanting, Brent A

2017-03-01

Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA. A retrospective radiographic review of 970 knees pre-TKA and post-TKA was completed to correlate the radiographic and clinical outcomes of changing the PFO using a posterior-stabilized single knee design with patellar resurfacing. A total of 970 patients were reviewed. Postoperatively, the anterior femoral offset, anteroposterior femoral size, and anterior patellar offset were changed in 40%, 60%, and 71% of knees, respectively, compared to preoperative values. The Western Ontario and McMasters Osteoarthritis Index total score as well as subscale scores for pain and function were not significantly affected by an increase or decrease in PFO. Similarly, Knee Society Scores and range of motion were not significantly affected. Increased anterior patellar offset was, however, associated with increased postoperative patellar tilt. Postoperative patellar tilt was not correlated with adverse patient satisfaction scores or loss of range of motion. Changes in PFO (decreased, maintained, or increased) are common post-TKA and are not associated with a difference in clinical outcomes. Increases in anterior patellar offset led to increased patellar tilt, which was not associated with adverse patient satisfaction scores. Copyright © 2016 Elsevier Inc. All rights reserved.

Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty.

PubMed

Wünschel, Markus; Leasure, Jeremi M; Dalheimer, Philipp; Kraft, Nicole; Wülker, Nikolaus; Müller, Otto

2013-12-01

Posterior cruciate ligament (PCL) retaining (CR) and -sacrificing (PS) total knee arthroplasties (TKA) are widely-used to treat osteoarthritis of the knee joint. The PS design substitutes the function of the PCL with a cam-spine mechanism which may produce adverse changes to joint kinematics and kinetics. CR- and PS-TKA were performed on 11 human knee specimens. Joint kinematics were measured with a dynamic knee simulator and motion tracking equipment. In-situ loads of the PCL and cam-spine were measured with a robotic force sensor system. Partial weight bearing flexions were simulated and external forces were applied. The PS-TKA rotated significantly less throughout the whole flexion range compared to the CR-TKA. Femoral roll back was greater in the PS-TKA; however, this was not correlated with lower quadriceps forces. Application of external loads produced significantly different in-situ force profiles between the TKA systems. Our data demonstrate that the PS-design significantly alters kinematics of the knee joint. Our data also suggest the cam-spine mechanism may have little influence on high flexion kinematics (such as femoral rollback) with most of the load burden shared by supporting implant and soft-tissue structures. Copyright © 2013 Elsevier B.V. All rights reserved.

Joint stiffness and running economy during imposed forefoot strike before and after a long run in rearfoot strike runners.

PubMed

Melcher, Daniel A; Paquette, Max R; Schilling, Brian K; Bloomer, Richard J

2017-12-01

Research has focused on the effects of acute strike pattern modifications on lower extremity joint stiffness and running economy (RE). Strike pattern modifications on running biomechanics have mostly been studied while runners complete short running bouts. This study examined the effects of an imposed forefoot strike (FFS) on RE and ankle and knee joint stiffness before and after a long run in habitual rearfoot strike (RFS) runners. Joint kinetics and RE were collected before and after a long run. Sagittal joint kinetics were computed from kinematic and ground reaction force data that were collected during over-ground running trials in 13 male runners. RE was measured during treadmill running. Knee flexion range of motion, knee extensor moment and ankle joint stiffness were lower while plantarflexor moment and knee joint stiffness were greater during imposed FFS compared with RFS. The long run did not influence the difference in ankle and knee joint stiffness between strike patterns. Runners were more economical during RFS than imposed FFS and RE was not influenced by the long run. These findings suggest that using a FFS pattern towards the end of a long run may not be mechanically or metabolically beneficial for well-trained male RFS runners.

Comparison of Joint Loading in Badminton Lunging between Professional and Amateur Badminton Players

PubMed Central

Fu, Lin

2017-01-01

The knee and ankle are the two most injured joints associated with the sport of badminton. This study evaluates biomechanical factors between professional and amateur badminton players using an injury mechanism model. The aim of this study was to investigate the kinematic motion and kinetic loading differences of the right knee and ankle while performing a maximal right lunge. Amateur players exhibited greater ankle range of motion (p < 0.05, r = 0.89) and inversion joint moment (p < 0.05, r = 0.54) in the frontal plane as well as greater internal joint rotation moment (p < 0.05, r = 0.28) in the horizontal plane. In contrast, professional badminton players presented a greater knee joint moment in the sagittal (p < 0.05, r = 0.59) and frontal (p < 0.05, r = 0.37) planes, which may be associated with increased knee ligamentous injury risk. To avoid injury, the players need to forcefully extend the knee with internal rotation, strengthen the muscles around the ankle ligament, and maximise joint coordination during training. The injuries recorded and the forces responsible for the injuries seem to have developed during training activity. Training programmes and injury prevention strategies for badminton players should account for these findings to reduce potential injury to the ankle and knee. PMID:28694684

Patellofemoral joint contact forces during activities with high knee flexion.

PubMed

Trepczynski, Adam; Kutzner, Ines; Kornaropoulos, Evgenios; Taylor, William R; Duda, Georg N; Bergmann, Georg; Heller, Markus O

2012-03-01

The patellofemoral (PF) joint plays an essential role in knee function, but little is known about the in vivo loading conditions at the joint. We hypothesized that the forces at the PF joint exceed the tibiofemoral (TF) forces during activities with high knee flexion. Motion analysis was performed in two patients with telemetric knee implants during walking, stair climbing, sit-to-stand, and squat. TF and PF forces were calculated using a musculoskeletal model, which was validated against the simultaneously measured in vivo TF forces, with mean errors of 10% and 21% for the two subjects. The in vivo peak TF forces of 2.9-3.4 bodyweight (BW) varied little across activities, while the peak PF forces showed significant variability, ranging from less than 1 BW during walking to more than 3 BW during high flexion activities, exceeding the TF forces. Together with previous in vivo measurements at the hip and knee, the PF forces determined here provide evidence that peak forces across these joints reach values of around 3 BW during high flexion activities, also suggesting that the in vivo loading conditions at the knee can only be fully understood if the forces at the TF and the PF joints are considered together. Copyright © 2011 Orthopaedic Research Society.

[CLINICAL APPLICATION OF OXFORD MOBILE-BEARING BIPOLAR PROSTHESIS UNICOMPARTMENTAL KNEE ARTHROPLASTY FOR SINGLE COMPARTMENTAL KNEE OSTEOARTHRITIS].

PubMed

Wang, Shangzeng; Cheng, Shao; Wang, Yisheng

2016-01-01

To evaluate the effectiveness of Oxford mobile-bearing bipolar prosthesis unicompartmental knee arthroplasty (UKA) in the treatment of single compartmental knee osteoarthritis. Between June 2011 and July 2013, 22 cases of single compartmental knee osteoarthritis were treated by Oxford mobile-bearing bipolar prosthesis UKA. Of 22 cases, 8 were male and 14 were female with an average age of 65 years (range, 45-80 years); the left knee was involved in 12 cases, and the right knee in 10 cases, with a mean disease duration of 32.5 months (range, 8-90 months). The mean weight was 55.2 kg (range, 50-65 kg), and the mean body mass index was 20.8 kg/m2 (range, 17-25 kg/m2). Osteoarthritis involved in the single knee medial compartment in all patients. Knee society score (KSS) and range of motion (ROM) were measured to evaluate the knee joint function. Primary healing of incision was obtained in all patients, and there was no complication of infection, bedsore, or deep venous thrombosis. Postoperative follow-up was 2-4 years (mean, 3.2 years). The X-ray films showed good position of prosthesis, no prosthesis dislocation, or periprosthetic infection during follow-up. Knee ROM, KSS function score, and KSS clinical score were significantly improved at 1 week after operation and at last follow-up when compared with preoperative ones (P < 0.05), but no significant difference was shown between at 1 week and at last follow-up (P > 0.05). Oxford mobile-bearing bipolar prosthesis UKA is an effective method to treat single compartmental knee osteoarthritis, with the advantages of less trauma, earlier rehabilitation exercise, near physiological state in joint function, and less risk of complications.

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 internal rotation in respect to turn radii and ground reaction forces indicated that the knee joint movements are likely one of the key points in alpine skiing techniques. However, the skiing equipment used can still significantly influence the movement strategy. PMID:26336348

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis.

PubMed

O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley

2016-01-01

The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. The moderate/severe pain group demonstrated worse global pain (P<0.01) and physical function scores (P<0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

What makes patients aware of their artificial knee joint?

PubMed

Loth, F L; Liebensteiner, M C; Giesinger, J M; Giesinger, K; Bliem, H R; Holzner, B

2018-01-08

Joint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). Findings from qualitative and psychometric studies suggest that joint awareness is a distinct concept especially relevant to patients with good surgical outcome and patients at late follow-up time points. The aim of this study was to improve the understanding of the concept of joint awareness by identifying situations in which patients are aware of their artificial knee joint and to investigate what bodily sensations and psychological factors raise a patient's awareness of her/his knee. In addition, we evaluated the relative importance of patient-reported outcome parameters that are commonly assessed in orthopaedics. Qualitative interviews were conducted with patients being at least 12 months after TKA. The interviews focused on when, where and for what reasons patients were aware of their artificial knee joint. To evaluate the relative importance of 'joint awareness' after TKA among nine commonly assessed outcome parameters (e.g. pain or stiffness), we collected importance ratings ('0' indicating no importance at all and '10' indicating high importance). We conducted interviews with 40 TKA patients (mean age 69.0 years; 65.0% female). Joint awareness was found to be frequently triggered by kneeling on the floor (30%), climbing stairs (25%), and starting up after resting (25%). Patients reported joint awareness to be related to activities of daily living (68%), specific movements (60%), or meteoropathy (18%). Sensations causing joint awareness included pain (45%) or stiffness (15%). Psychological factors raising a patient's awareness of his/her knee comprised for example feelings of insecurity (15%), and fears related to revision surgeries, inflammations or recurring pain (8%). Patients' importance ratings of outcome parameters were generally high and did not allow differentiating clearly among them. We have identified a wide range of situations, activities, movements and psychological factors contributing to patients' awareness of their artificial knee joints. This improves the understanding of the concept of joint awareness and of a patient's perception of his/her artificial knee joint. The diversity of sensations and factors raising patient's awareness of their joint encourages taking a broader perspective on outcome after TKA.

Biomechanical Evaluation of a Prototype Foot/Ankle Prosthesis

PubMed Central

Quesada, P. M.; Pitkin, M.; Colvin, J.

2016-01-01

In this paper, we report on our pilot evaluation of a prototype foot/ankle prosthesis. This prototype has been designed and fabricated with the intention of providing decreased ankle joint stiffness during the middle portion of the stance phase of gait, and increased (i.e., more normal) knee range of motion during stance. Our evaluation involved fitting the existing prototype foot/ankle prosthesis, as well as a traditional solid ankle cushioned heel (SACH) foot, to an otherwise healthy volunteer with a below-knee (BK) amputation. We measured this individual’s lower extremity joint kinematics and kinetics during walking using a video motion analysis system and force platform. These measurements permitted direct comparison of prosthetic ankle joint stiffness and involved side knee joint motion, as well as prosthetic ankle joint moment and power. PMID:10779119

Clinical and ultrasound findings in patients with calcium pyrophosphate dihydrate deposition disease.

PubMed

Vele, Paulina; Simon, Siao-Pin; Damian, Laura; Felea, Ioana; Muntean, Laura; Filipescu, Ileana; Rednic, Simona

2018-05-02

To evaluate the presence and distribution of calcium pyrophosphate (CPP) deposits in joints commonly affected by CPP deposition (CPPD) disease (acromio-clavicular, gleno-humeral, wrists, hips, knees, ankles, and symphysis pubis joints) using ultrasound (US). Thirty consecutive patients fulfilling McCarty diagnostic criteria for CPPD were consecutively enrolled in the study. The data registered using the US included the affected joints, the calcification site, and the pattern of calcification (thin hyperechoic bands, parallel to the surface of the hyaline cartilage, hyperechoic spots, and hyperechoic nodular or oval deposits). The presence of CPP crystals in knees was confirmed by polarized light microscopy examination of the synovial fluid and radiographs of the knees were performed in all patients. In 30 patients, 390 joints were scanned, (13 joints in every patient). The mean±standard deviation number of joints with US CPPD evidence per patient was 2.93±1.8 (range 1-9). The knee was the most common joint involved both clinically and using US examination. The second US pattern (with hyperechoic spots) was the most frequent. Fibrocartilage calcifications were more common than hyaline calcification. Using radiography as reference method, the sensitivity and specificity of US for diagnosis CPPD in knees was 79.31%, 95CI(66.65%-88.83%), and 14.29%, 95CI(1.78%-42.81%), respectively. The knee is the most frequent joint affected by CPPD. The second ultrasound pattern is the most common. CPPD affects the fibrocartilage to a greater extent than the hyaline cartilage.

Immediate effects of a new microprocessor-controlled prosthetic knee joint: a comparative biomechanical evaluation.

PubMed

Bellmann, Malte; Schmalz, Thomas; Ludwigs, Eva; Blumentritt, Siegmar

2012-03-01

To investigate the immediate biomechanical effects after transition to a new microprocessor-controlled prosthetic knee joint. Intervention cross-over study with repeated measures. Only prosthetic knee joints were changed. Motion analysis laboratory. Men (N=11; mean age ± SD, 36.7±10.2y; Medicare functional classification level, 3-4) with unilateral transfemoral amputation. Two microprocessor-controlled prosthetic knee joints: C-Leg and a new prosthetic knee joint, Genium. Static prosthetic alignment, time-distance parameters, kinematic and kinetic parameters, and center of pressure. After a half-day training and an additional half-day accommodation, improved biomechanical outcomes were demonstrated by the Genium: lower ground reaction forces at weight acceptance during level walking at various velocities, increased swing phase flexion angles during walking on a ramp, and level walking with small steps. Maximum knee flexion angle during swing phase at various velocities was nearly equal for Genium. Step-over-step stair ascent with the Genium knee was more physiologic as demonstrated by a more equal load distribution between the prosthetic and contralateral sides and a more natural gait pattern. When descending stairs and ramps, knee flexion moments with the Genium tended to increase. During quiet stance on a decline, subjects using Genium accepted higher loading of the prosthetic side knee joint, thus reducing same side hip joint loading as well as postural sway. In comparision to the C-Leg, the Genium demonstrated immediate biomechanical advantages during various daily ambulatory activities, which may lead to an increase in range and diversity of activity of people with above-knee amputations. Results showed that use of the Genium facilitated more natural gait biomechanics and load distribution throughout the affected and sound musculoskeletal structure. This was observed during quiet stance on a decline, walking on level ground, and walking up and down ramps and stairs. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Computational Knee Ligament Modeling Using Experimentally Determined Zero-Load Lengths

PubMed Central

Bloemker, Katherine H; Guess, Trent M; Maletsky, Lorin; Dodd, Kevin

2012-01-01

This study presents a subject-specific method of determining the zero-load lengths of the cruciate and collateral ligaments in computational knee modeling. Three cadaver knees were tested in a dynamic knee simulator. The cadaver knees also underwent manual envelope of motion testing to find their passive range of motion in order to determine the zero-load lengths for each ligament bundle. Computational multibody knee models were created for each knee and model kinematics were compared to experimental kinematics for a simulated walk cycle. One-dimensional non-linear spring damper elements were used to represent cruciate and collateral ligament bundles in the knee models. This study found that knee kinematics were highly sensitive to altering of the zero-load length. The results also suggest optimal methods for defining each of the ligament bundle zero-load lengths, regardless of the subject. These results verify the importance of the zero-load length when modeling the knee joint and verify that manual envelope of motion measurements can be used to determine the passive range of motion of the knee joint. It is also believed that the method described here for determining zero-load length can be used for in vitro or in vivo subject-specific computational models. PMID:22523522

[Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia].

PubMed

Wang, Jiang-tao; Liu, Yu-jie; Wang, Jun-liang; Qu, Feng; Yuan, Bang-tuo; Zhao, Gang; Shen, Xue-zhen; Zhu, Juan-li; Liu, Yang

2014-08-01

To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia. From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year. One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation. onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.

[SOMATOTYPE JOINT MOBILITY AND RANGES OF HIP AND KNEE OF COLLEGE STUDENTS].

PubMed

Godoy-Cumillaf, Andrés; Valdés-Badilla, Pablo; García Sandoval, Alan; Grandón Fuentes, Monica; Lagos Del Canto, Loreto; Aravena Turra, Raúl; Herrera-Valenzuela, Tomás; Bruneau Chavez, José; Durán Agüero, Samuel

2015-12-01

several studies indicate a consistency between the physical inactivity and low levels of mobility in hip and knee joint. to determine the differences in the motion range of the hip and knee joint between the different classifications of somatotype in students of Pedagogy in Physical Education of the Universidad Autónoma de Chile, campus Temuco. the sample included 102 physical education students (31.3% female), somatotype was obtained through the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) and the motion range of the hip and knee joint (ROM) using a universal goniometer. the mean somatotype was endo-mesomorphic (4.8 - 3.4 - 2) for the women and meso-endomorphic (3.5 - 5.7 - 2) for the males, while the ROM evaluation indicated that the 50% of the students presented mobility values of joint lower than the normal ones. Furthermore, the endo-mesomorphic women showed lower ROM values of medial rotation of the right hip (45.5 ° ± 10.2 °; P = 0.0125, t = 2.732) and left hip side rotation (41.7 ° ± 10.3 °; P = 0.0256; p = 2.402) than the women meso-endomorphic. the results shows a relationship between the somatotype and hip ROM in the women, showing that in the women the most favorable results of joint mobility are related with a greater muscle mass. In contrasts, no significant differences were observed in men. It is important to encourage the development of joint mobility exercises according to the specific needs of each sex. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

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 (hemi-knee...

Joint angles of the ankle, knee, and hip and loading conditions during split squats.

PubMed

Schütz, Pascal; List, Renate; Zemp, Roland; Schellenberg, Florian; Taylor, William R; Lorenzetti, Silvio

2014-06-01

The aim of this study was to quantify how step length and the front tibia angle influence joint angles and loading conditions during the split squat exercise. Eleven subjects performed split squats with an additional load of 25% body weight applied using a barbell. Each subject's movements were recorded using a motion capture system, and the ground reaction force was measured under each foot. The joint angles and loading conditions were calculated using a cluster-based kinematic approach and inverse dynamics modeling respectively. Increases in the tibia angle resulted in a smaller range of motion (ROM) of the front knee and a larger ROM of the rear knee and hip. The external flexion moment in the front knee/hip and the external extension moment in the rear hip decreased as the tibia angle increased. The flexion moment in the rear knee increased as the tibia angle increased. The load distribution between the legs changed < 25% when split squat execution was varied. Our results describing the changes in joint angles and the resulting differences in the moments of the knee and hip will allow coaches and therapists to adapt the split squat exercise to the individual motion and load demands of athletes.

Landing Mechanics During Side Hopping and Crossover Hopping Maneuvers in Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction

PubMed Central

Ortiz, Alexis; Olson, Sharon; Trudelle-Jackson, Elaine; Rosario, Martin; Venegas, Heidi L.

2011-01-01

Objective To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. Design A case-control study. Setting A 3-dimensional motion analysis laboratory. Participants Twenty-eight young women (range, 21–35 years) (15 control subjects and 13 subjects with ACL reconstruction). Patients and Methods All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. Main Outcome Measurements Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). Results Noninjured women and women with ACL reconstruction exhibited similar hip-and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. Conclusions Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular activation during side-to-side athletic tasks. However, not all biomechanical strategies are restored years after surgery, and women who have undergone a procedure such as ACL reconstruction may continue to exhibit knee-joint abduction moments that increase the risk of additional knee injury. PMID:21257128

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 implanted...

21 CFR 888.3580 - Knee joint patellar (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 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 of...

The effect of different decline angles on the biomechanics of double limb squats and the implications to clinical and training practice.

PubMed

Richards, Jim; Selfe, James; Sinclair, Jonathan; May, Karen; Thomas, Gavin

2016-09-01

Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint.

The effect of different decline angles on the biomechanics of double limb squats and the implications to clinical and training practice

PubMed Central

Richards, Jim; Selfe, James; Sinclair, Jonathan; May, Karen; Thomas, Gavin

2016-01-01

Abstract Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint. PMID:28149400

Co-Graft of Acellular Dermal Matrix and Autogenous Microskin in a Child with Extensive Burns

PubMed Central

Chen, X.L.; Xia, Z.F.; Fang, L.S.; Wang, Y.J.; Wang, C.H.

2008-01-01

Summary A 6-yr-old boy was the victim of a burns accident in a public bathhouse. The burns involved the face, neck, upper and lower extremities, anterior and posterior trunk, and both buttocks, covering 72% of the total body surface area (TBSA). The lesions in the lower extremities and parts of the right upper extremity were deep partial-thickness, comprising 40% TBSA. On day 5 post-burn, the lesions in both lower extremities were excised to the extent of the fascia under general anaesthesia. Meshed J1 Jayya Acellular Dermis®, a kind of acellular allodermal (ADM) matrix, was then placed on the left knee joint. The right knee joint served as control. The wounds in both lower extremities were then overlaid with microskin autografting. At 19 days post-application, the lesions in both lower extremities had almost completely resurfaced. Follow-up at six months revealed well-healed and stable skin of acellular ADM and microskin autografts on the left knee. However, the skin of the right knee was unstable and there was a chronic residual ulcer. Both legs showed some significant hypertrophic scars. The left knee joint (acellular ADM grafted site) showed mild contractures, while the right knee joint developed a significant contracture. The "skin" of the co-graft covered site appeared thicker and more elastic. The movement range of the left knee joint was much larger than that of the right knee joint. These results suggest that co-graft of acellular dermal matrix and autogenous microskin may be an effective way to repair this functional site in children with extensive burns and to improve the functional and cosmetic results. PMID:21991120

Multi-Axis Prosthetic Knee Resembles Alpine Skiing Movements of an Intact Leg

PubMed Central

Demšar, Ivan; Duhovnik, Jože; Lešnik, Blaž; Supej, Matej

2015-01-01

The purpose of the study was to analyse the flexion angles of the ski boot, ankle and knee joints of an above-knee prosthesis and to compare them with an intact leg and a control group of skiers. One subject with an above-knee amputation of the right leg and eight healthy subjects simulated the movement of a skiing turn by performing two-leg squats in laboratory conditions. By adding additional loads in proportion to body weight (BW; +1/3 BW, +2/3 BW, +3/3 BW), various skiing regimes were simulated. Change of Flexion Angle (CoFA) and Range of Motion (RoM) in the ski boot, ankle and knee joints were calculated and compared. An average RoM in the skiing boot on the side of prosthesis (4.4 ± 1.1°) was significantly lower compared to an intact leg (5.9 ± 1.8°) and the control group (6.5 ± 2.3°). In the ankle joint, the average RoM was determined to be 13.2±2.9° in the prosthesis, 12.7 ± 2.8° in an intact leg and 14.8±3.6 in the control group. However, the RoM of the knee joint in the prosthesis (42.2 ± 4.2°) was significantly larger than that of the intact leg (34.7 ± 4.4°). The average RoM of the knee joint in the control group was 47.8 ± 5.4°. The influences of additional loads on the kinematics of the lower extremities were different on the side of the prosthesis and on the intact leg. In contrast, additional loads did not produce any significant differences in the control group. Although different CoFAs in the ski boot, ankle and knee joints were used, an above-knee prosthesis with a built-in multi-axis prosthetic knee enables comparable leg kinematics in simulated alpine skiing. Key points The RoM in the ski boot on the side of the prosthetic leg was smaller than the RoM of the intact leg and the control group of healthy subjects. The RoM in the ankle joint of prosthetic leg was comparable to that of the intact leg and the control group of healthy subjects. The RoM in the prosthetic knee joint was greater than the RoM in the knee joint of the intact leg and smaller than that of the control group. The total knee flexions in the laboratory measurements were comparable with field measurements. Additional load affects the RoM of the ski boot, ankle and knee joints for the amputated skier in both legs. No significant influence from the additional load was found on the RoM in the control group of healthy subjects. The above-knee prosthesis with a multiple-axis prosthetic knee reproduces the alpine skiing kinematics of an intact leg. PMID:26664282

Frontal plane stability following UKA in a biomechanical study.

PubMed

Heyse, Thomas J; Tucker, Scott M; Rajak, Yogesh; Kia, Mohammad; Lipman, Joseph D; Imhauser, Carl W; Westrich, Geoffrey H

2015-06-01

Function and kinematics following unicondylar knee arthroplasty (UKA) have been reported to be close to the native knee. Gait, stair climbing and activities of daily living expose the knee joint to a combination of varus and valgus moments. Replacement of the medial compartment via UKA is likely to change the physiologic knee stability and its ability to respond to varus and valgus moments. It was hypothesized that UKA implantation would stiffen the knee and decrease range of motion in the frontal plane. Six fresh frozen cadaver knees were prepared and mounted in a six-degrees-of-freedom robot. An axial load of 200 N was applied with the knee in 15°, 45° and 90° of flexion. Varus and valgus moments were added, respectively, before and after implantation of medial UKA. Tests were than redone with a thicker polyethylene inlay to simulate overstuffing of the medial compartment. Range of motion in the frontal plane and the tibial response to moments were recorded via the industrial robot. The range of motion in the frontal plane was decreased with both, balanced and overstuffed UKA and shifted towards valgus. When exposed to valgus moments, knees following UKA were stiffer in comparison with the native knee. The effect was even more pronounced with medial overstuffing. In UKA, the compressive anatomy is replaced by much stiffer components. This lack of medial compression and relative overstuffing leads to a tighter medial collateral ligament. This drives the trend towards a stiffer joint as documented by a decrease in frontal plane range of motion. Overstuffing should strictly be avoided when performing UKA.

Human knee joint sound during the Lachman test: Comparison between healthy and anterior cruciate ligament-deficient knees.

PubMed

Tanaka, Kazunori; Ogawa, Munehiro; Inagaki, Yusuke; Tanaka, Yasuhito; Nishikawa, Hitoshi; Hattori, Koji

2017-05-01

The Lachman test is clinically considered to be a reliable physical examination for anterior cruciate ligament (ACL) deficiency. However, the test involves subjective judgement of differences in tibial translation and endpoint quality. An auscultation system has been developed to allow assessment of the Lachman test. The knee joint sound during the Lachman test was analyzed using fast Fourier transformation. The purpose of the present study was to quantitatively evaluate knee joint sounds in healthy and ACL-deficient human knees. Sixty healthy volunteers and 24 patients with ACL injury were examined. The Lachman test with joint auscultation was evaluated using a microphone. Knee joint sound during the Lachman test (Lachman sound) was analyzed by fast Fourier transformation. As quantitative indices of the Lachman sound, the peak sound (Lachman peak sound) as the maximum relative amplitude (acoustic pressure) and its frequency were used. In healthy volunteers, the mean Lachman peak sound of intact knees was 100.6 Hz in frequency and -45 dB in acoustic pressure. Moreover, a sex difference was found in the frequency of the Lachman peak sound. In patients with ACL injury, the frequency of the Lachman peak sound of the ACL-deficient knees was widely dispersed. In the ACL-deficient knees, the mean Lachman peak sound was 306.8 Hz in frequency and -63.1 dB in acoustic pressure. If the reference range was set at the frequency of the healthy volunteer Lachman peak sound, the sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 95.6%, 95.2%, and 85.2%, respectively. Knee joint auscultation during the Lachman test was capable of judging ACL deficiency on the basis of objective data. In particular, the frequency of the Lachman peak sound was able to assess ACL condition. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

The effect of ankle bracing on knee kinetics and kinematics during volleyball-specific tasks.

PubMed

West, T; Ng, L; Campbell, A

2014-12-01

The purpose of this study was to examine the effects of ankle bracing on knee kinetics and kinematics during volleyball tasks. Fifteen healthy, elite, female volleyball players performed a series of straight-line and lateral volleyball tasks with no brace and when wearing an ankle brace. A 14-camera Vicon motion analysis system and AMTI force plate were used to capture the kinetic and kinematic data. Knee range of motion, peak knee anterior-posterior and medial-lateral shear forces, and peak ground reaction forces that occurred between initial contact with the force plate and toe off were compared using paired sample t-tests between the braced and non-braced conditions (P < 0.05). The results revealed no significant effect of bracing on knee kinematics or ground reaction forces during any task or on knee kinetics during the straight-line movement volleyball tasks. However, ankle bracing was demonstrated to reduce knee lateral shear forces during all of the lateral movement volleyball tasks. Wearing the Active Ankle T2 brace will not impact knee joint range of motion and may in fact reduce shear loading to the knee joint in volleyball players. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Modelling the joint torques and loadings during squatting at the Smith machine.

PubMed

Biscarini, Andrea; Benvenuti, Paolo; Botti, Fabio; Mastrandrea, Francesco; Zanuso, Silvano

2011-03-01

An analytical biomechanical model was developed to establish the relevant properties of the Smith squat exercise, and the main differences from the free barbell squat. The Smith squat may be largely patterned to modulate the distributions of muscle activities and joint loadings. For a given value of the included knee angle (θ(knee)), bending the trunk forward, moving the feet forward in front of the knees, and displacing the weight distribution towards the forefoot emphasizes hip and lumbosacral torques, while also reducing knee torque and compressive tibiofemoral and patellofemoral forces (and vice versa). The tibiofemoral shear force φ(t) displays more complex trends that strongly depend on θ(knee). Notably, for 180° ≥ θ(knee) ≥ 130°, φ(t) and cruciate ligament strain forces can be suppressed by selecting proper pairs of ankle and hip angles. Loading of the posterior cruciate ligament increases (decreases) in the range 180° ≥ θ(knee) ≥ 150° (θ(knee) ≤ 130°) with knee extension, bending the trunk forward, and moving the feet forward in front of the knees. In the range 150° > θ(knee) > 130°, the behaviour changes depending on the foot weight distribution. The conditions for the development of anterior cruciate ligament strain forces are explained. This work enables careful use of the Smith squat in strengthening and rehabilitation programmes.

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Tibiofemoral loss of contact area but no changes in peak pressures after meniscectomy in a Lapine in vivo quadriceps force transfer model.

PubMed

Leumann, Andre; Fortuna, Rafael; Leonard, Tim; Valderrabano, Victor; Herzog, Walter

2015-01-01

The menisci are thought to modulate load transfer and to absorb shocks in the knee joint. No study has experimentally measured the meniscal functions in the intact, in vivo joint loaded by physiologically relevant muscular contractions. Right knee joints of seven New Zealand white rabbits were loaded using isometric contractions of the quadriceps femoris muscles controlled by femoral nerve stimulation. Isometric knee extensor torques at the maximal and two submaximal force levels were performed at knee angles of 70°, 90°, 110°, and 130°. Patellofemoral and tibiofemoral contact areas and pressure distributions were measured using Fuji Presensor film inserted above and below the menisci and also with the menisci removed. Meniscectomy was associated with a decrease in tibiofemoral contact area ranging from 30 to 70% and a corresponding increase in average contact pressures. Contact areas measured below the menisci were consistently larger than those measured on top of the menisci. Contact areas in the patellofemoral joint (PFJ), and peak pressures in tibiofemoral and PFJs, were not affected by meniscectomy. Contact areas and peak pressures in all joints depended crucially on knee joint angle and quadriceps force: The more flexed the knee joint was, the larger were the contact areas and the higher were the peak pressures. In agreement with the literature, removal of the menisci was associated with significant decreases in tibiofemoral contact area and corresponding increases in average contact pressures, but surprisingly, peak pressures remained unaffected, indicating that the function of the menisci is to distribute loads across a greater contact area.

Pressure-volume relationships and elastance in the knee joint of the dog.

PubMed

Nade, S; Newbold, P J

1984-12-01

This study has investigated changes in intra-articular hydrostatic pressure in the knee joints of normal dogs in response to continuous and stepwise infusions of fluids. The relationship between pressure and volume in the joint was examined over the pressure range of -8 to +50 mmHg, and also at much higher pressures often associated with joint disease or injury. The effects of joint angle and dog weight on the pressure-volume relationship and on elastance of the dogs' knees were also examined. With liquid paraffin B.P. the pressure was found to increase more with each unit volume infused at subatmospheric pressures than at pressures around atmospheric, and increased more again at higher pressures. The pressure-volume curve with saline infusions was affected by egress of fluid from the joint at supra-atmospheric pressure. Above +5 mmHg the rise in pressure per unit volume infused was less than that for paraffin at the same volume. Elastance and compliance of the normal joint capsule were calculated from the pressure-volume data. Elastance was high at subatmospheric pressures, decreased rapidly as atmospheric pressure was approached and rose as a linear function of pressure above 12 mmHg. The biphasic shape of the elastance-pressure curve is discussed, and explanations for the shape are suggested. After intra-articular pressure in the knee was raised by infusion of paraffin oil the joint was moved through the range of positions from 125 deg extension to 50 deg flexion. Intra-articular pressure did not change across the range 125-110 deg. However, increasing the angle of flexion from 110 to 50 deg resulted in a rise in pressure which became steeper for each volume increment. Increasing intra-articular fluid volume caused a decrease in the total range of movement of the joint. The pressure-volume curves measured at extended angles of 110, 125 and 140 deg, where the starting pressures were subatmospheric, were the same. At flexed joint positions of 80 and 50 deg, where the starting pressures were supra-atmospheric, the pressure-volume curves became steeper with greater flexion. Elastance of the joint tissues increased with flexion. The elastance at each joint angle depended also on the volume or pressure. Significant differences were found to exist between pressure-volume curves for three groups of animals of different weight.(ABSTRACT TRUNCATED AT 400 WORDS)

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.

Use of the dual force system to correct chronic knee deformities due to severe haemophilia.

PubMed

Kale, J S; Ghosh, K; Mohanty, D; Pathare, A V; Jijina, F

2000-05-01

In this study, the use of the dual force system to correct recent or relatively longstanding knee deformities in ten patients is described. (Nine of the patients had severe haemophilia and one had severe von Willebrand's disease.) The mean duration of deformity in these patients was 10 months. The mean range of movement at the affected knee joints increased from 50 degrees at pre-intervention to 110 degrees following 6 weeks of application of the dual force system. In nine of ten patients (90%) the residual flexion deformity ranged from 0 degrees to 10 degrees. The dual force system offers an easily affordable and effective means of correcting a flexion deformity of the knee joint in severely affected haemophilia and allied disorders. More extensive use of this technique in different centres is required to determine its place in the day-to-day management of such patients.

Two-Stage Revision for Infected Total Knee Arthroplasty: Based on Autoclaving the Recycled Femoral Component and Intraoperative Molding Using Antibiotic-Impregnated Cement on the Tibial Side.

PubMed

Lee, Byoung-Joo; Kyung, Hee-Soo; Yoon, Seong-Dae

2015-09-01

The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer. A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria. The mean range of knee joint motion was 70° prior to the first stage operation and 72° prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113° at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip. This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.

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 are...

Joint torques and joint reaction forces during squatting with a forward or backward inclined Smith machine.

PubMed

Biscarini, Andrea; Botti, Fabio M; Pettorossi, Vito E

2013-02-01

We developed a biomechanical model to determine the joint torques and loadings during squatting with a backward/forward-inclined Smith machine. The Smith squat allows a large variety of body positioning (trunk tilt, foot placement, combinations of joint angles) and easy control of weight distribution between forefoot and heel. These distinctive aspects of the exercise can be managed concurrently with the equipment inclination selected to unload specific joint structures while activating specific muscle groups. A backward (forward) equipment inclination decreases (increases) knee torque, and compressive tibiofemoral and patellofemoral forces, while enhances (depresses) hip and lumbosacral torques. For small knee flexion angles, the strain-force on the posterior cruciate ligament increases (decreases) with a backward (forward) equipment inclination, whereas for large knee flexion angles, this behavior is reversed. In the 0 to 60 degree range of knee flexion angles, loads on both cruciate ligaments may be simultaneously suppressed by a 30 degree backward equipment inclination and selecting, for each value of the knee angle, specific pairs of ankle and hip angles. The anterior cruciate ligament is safely maintained unloaded by squatting with backward equipment inclination and uniform/forward foot weight distribution. The conditions for the development of anterior cruciate ligament strain forces are clearly explained.

[Clinical pictures of the osteoarthritis in the knee joint (author's transl)].

PubMed

Iseki, F; Fujikawa, K

1980-06-01

A total of 3,176 osteoarthritic knees are studied for the clinical course, and some of them are analysed for biomechanical development of the gonarthritis. Varus deformity, obesity, female incidence, patellar and medial femoral joint changes, and loss of range of motion are dominant in the clinical pictures of the gonarthritis. Joint effusion and instability are not principal manifestation. Meniscus injury, ligamentous involvement, and hip fusion have much effect on the development of the gonarthritis. Synovial degeneration increases in number by aging but idiopathic haemorrhage is rarely observed.

[Effect of posterior cruciate ligament retaining or not on knee-joint proprioception].

PubMed

Wu, Yansheng; Li, Yongsheng; Chen, Baicheng

2013-07-01

To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P > 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90 degrees of knee flexion) preoperatively and 12 months postoperatively. All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P < 0.05), but no significant difference was found between group A and group B (P > 0.05). Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.

[Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique].

PubMed

Li, Jian-Wen; Ye, Feng; Bi, Da-Wei; Zheng, Xiao-Dong; Chen, Jian-Liang

2018-02-25

To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures. From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case. Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

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.

Results of arthroscopic joint debridement in different stages of chondromalacia of the knee joint.

PubMed

Krüger, T; Wohlrab, D; Birke, A; Hein, W

2000-01-01

A retrospective study was performed of 161 patients who had undergone arthroscopic operation for chondromalacia of the knee joint. After an average follow-up period of 40 (range 10-72) months, patients with severe articular cartilage lesions who had undergone articular lavage alone showed significantly poorer results (P < 0.001). With the same stage of chondromalacia and having undergone the same surgical procedure, younger patients showed better results than older patients. The more effective interruption of the circulus vitiosus during the development of degenerative joint diseases is the primary cause for better results achieved by mechanical debridement of the joint for patients suffering from grade 2 or higher. According to the literature, aggressive subchondral abrasion in severely degenerated knees does not show any benefits. Apparently, the success of the therapy depends to a great extent on the inferiority of the potential degenerative regenerate (lack of capacity of intrinsic regeneration of the hyaline cartilage) as well as on the grade and the progression of chondromalacia. Almost every second patient suffering from grade 4 chondromalacia complained of recurrent pain 1 year postoperatively. One of every 6 patients received a knee joint prosthesis within the 1st year. Therefore, the patients' preoperative expectations have to be clearly objectified. The surgical procedure as an operation with a low complication risk can also be justified as a temporary alternative to total knee arthroplasty in patients suffering from a high-grade degeneration of the joint.

[Surgical technique and clinical results of total knee arthroplasty in treating endstage gonarthrosis combined with valgus knee deformity].

PubMed

Wang, Xingshan; Weng, Xisheng; Lin, Jin; Jin, Jin; Qian, Wenwei

2012-05-01

To investigate the surgical technique and the clinical results of total knee arthroplasty (TKA) in treating end-stage gonarthrosis combined with valgus knee deformity. Between November 1998 and October 2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years), including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The flexion and extension range of motion (ROM) of the knee joint was (82.2 +/- 28.7) degrees; the femur-tibia angle (FTA) was (18.0 +/- 5.8) degrees; according to Knee Society Score (KSS) criterion, the preoperative clinical score was 31.2 +/- 10.1 and functional score was 37.3 +/- 9.0. According to Krackow's classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior cruciate ligament were used in 7 cases (7 knees), posterior stabilize prosthesis in 54 cases (60 knees), constrained prosthesis in 4 cases (5 knees). Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with haemophilic arthritis, severe valgus deformity (FTA was 41 degrees), and flexion contracture (20 degrees), which was cured after 1 year of conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 +/- 2.5) degrees, showing significant difference when compared with preoperative value (t = 15.502, P = 0.000). The KSS clinical score was 83.0 +/- 6.6 and functional score was 85.1 +/- 10.5, the flexion and extension ROM of the knee joint was (106.1 +/- 17.0) degrees, all showing significant differences when compared with preoperative values (P < 0.05). Five patients had 12-15 degrees valgus knee deformity, but the function of the affect knees were good. TKA is an effective way for the patients with end-stage gonarthrosis combined with valgus knee deformity by medial parapatellar approach combined with conventional osteotomy and Ranawat soft tissue release. The correction of deformity and improvement of joint function can be achieved significantly. The clinical result is satisfactory.

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.

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

Does Success Of Arthroscopic Laser Surgery In The Knee Joint Warrant Its Extension To "Non-Knee" Joints?

NASA Astrophysics Data System (ADS)

Smith, Chadwick F.; Johansen, W. Edward; Vangness, C. Thomas; Yamaguchi, Ken; McEleney, Emmett T.; Bales, Peter

1987-03-01

One of the authors has performed 162 arthroscopic laser surgeries in the knee joint without any major complication. Other investigators have recently proposed diagnostic arthroscopy and arthroscopic surgery for "non-knee" joints. The authors have proposed that arthroscopic laser surgery he extended to "non-knee" joints. The authors have performed arthroscopic laser surgery on "non-knee" joints of twelve cadavers. One of the authors have performed one successful arthroscopic surgery on a shoulder joint with only a minor, transient complication of subcutaneous emphysema. Is laser arthroscopic surgery safe and effective in "non-knee" joints? The evolving answer appears to be a qualified "Yes," which needs to be verified by a multicenter trial.

Knee and Ankle Joint Angles Influence the Plantarflexion Torque of the Gastrocnemius.

PubMed

Landin, Dennis; Thompson, Melissa; Reid, Meghan

2015-08-01

The gastrocnemius (GA) is the lone bi-articular muscle of the leg, crossing both the knee and ankle. As with any bi-articular muscle, both joints affect its length/tension curve. The role of the GA as a plantarflexor is firmly established; however, no current research has investigated how changes in knee and ankle joint positions on its ability to generate a plantarflexion (PF) torque. This paper reports on the PF force generated by the GA at specific knee and ankle joint combinations. The right GA of 26 participants was electrically stimulated via surface electrodes following a standardized protocol at 24 knee and ankle joint combinations. Three stimulations were applied at each of the 24 positions. Data were recorded on three dependent measures: the passive moment, which was the PF moment created by the tissue without stimulation, the maximum moment, which was the highest PF moment during the stimulation and included the passive moment, and the stimulated moment, which reflected the PF moment during stimulation minus the passive moment. A straight knee and dorsiflexed ankle create the position in which the GA generates the greatest PF moment, but it is also the position of greatest length. This finding is in contrast to conclusions from previous research with bi-articular muscles, which has consistently shown that the greatest length is not a muscle's optimal length. The full ranges of motion for the knee and ankle apparently do not elongate the GA beyond its optimal length for producing a PF moment. Clinicians commonly evaluate GA status with the patient seated and the foot subject to gravity. The present results indicate that manual testing of the GA in isolation should be performed, whenever possible, with the knee extended and the ankle dorsiflexed to potentially elicit the maximum PF torque from the GA.

Posterior Tibial Slope Angle Correlates With Peak Sagittal and Frontal Plane Knee Joint Loading During Robotic Simulations of Athletic Tasks.

PubMed

Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T; Myer, Gregory D; Hewett, Timothy E

2016-07-01

Tibial slope angle is a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury. However, the mechanical role of varying tibial slopes during athletic tasks has yet to be clinically quantified. To examine the influence of posterior tibial slope on knee joint loading during controlled, in vitro simulation of the knee joint articulations during athletic tasks. Descriptive laboratory study. A 6 degree of freedom robotic manipulator positionally maneuvered cadaveric knee joints from 12 unique specimens with varying tibial slopes (range, -7.7° to 7.7°) through drop vertical jump and sidestep cutting tasks that were derived from 3-dimensional in vivo motion recordings. Internal knee joint torques and forces were recorded throughout simulation and were linearly correlated with tibial slope. The mean (±SD) posterior tibial slope angle was 2.2° ± 4.3° in the lateral compartment and 2.3° ± 3.3° in the medial compartment. For simulated drop vertical jumps, lateral compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee adduction (r = 0.60-0.65), flexion (r = 0.64-0.66), lateral (r = 0.57-0.69), and external rotation torques (r = 0.47-0.72) as well as inverse correlations with peak abduction (r = -0.42 to -0.61) and internal rotation torques (r = -0.39 to -0.79). Only frontal plane torques were correlated during sidestep cutting simulations. For simulated drop vertical jumps, medial compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee flexion torque (r = 0.64-0.69) and lateral knee force (r = 0.55-0.74) as well as inverse correlations with peak external torque (r = -0.34 to -0.67) and medial knee force (r = -0.58 to -0.59). These moderate correlations were also present during simulated sidestep cutting. The investigation supported the theory that increased posterior tibial slope would lead to greater magnitude knee joint moments, specifically, internally generated knee adduction and flexion torques. The knee torques that positively correlated with increased tibial slope angle in this investigation are associated with heightened risk of ACL injury. Therefore, the present data indicated that a higher posterior tibial slope is correlated to increased knee loads that are associated with heightened risk of ACL injury. © 2016 The Author(s).

Joint Moment-Angle Properties of the Hip Extensors in Subjects With and Without Patellofemoral Pain.

PubMed

Kindel, Curtis; Challis, John

2018-04-01

Strength deficits of hip extension in individuals with patellofemoral syndrome are commonly reported in literature. No literature to date has examined these deficits with variable positions of the knee and hip; altering knee angle alters the length and therefore potentially the force produced by the biarticular muscles. Beyond strength, neuromuscular control can also be assessed through the analysis of isometric joint moment steadiness. Subjects consisted of a group of individuals with patellofemoral syndrome (n = 9), and a group of age- and size-matched controls with no symptoms (n = 9). Maximum isometric joint moments for hip extension were measured at 4 points within the joint's range of motion, at 2 different knee positions (0° and 90°) for each group. The joint moment signals were analyzed by computing signal Coefficient of Variation (CV). The results indicate that no significant differences were found between the groups of subjects for the hip extension moments when the knee was extended. However, there was a significant difference between the groups for the joint moments of hip extension with the knee flexed at all 4 hip positions. Results also showed hip extension CV values to be significantly higher in the patellofemoral group compared with the control group, indicating greater signal noise and therefore poorer neuromuscular control of the hip extensor musculature. This study demonstrated that individuals with patellofemoral syndrome have reduced hip extension strength and reduced neuromuscular control with the knee flexed compared with a control group. These results have implications for the etiology of patellofemoral syndrome and its rehabilitation.

Contribution of ankle-foot orthosis moment in regulating ankle and knee motions during gait in individuals post-stroke.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Singer, Madeline L; Gao, Fan; Foreman, K Bo

2017-06-01

Ankle-foot orthosis moment resisting plantarflexion has systematic effects on ankle and knee joint motion in individuals post-stroke. However, it is not known how much ankle-foot orthosis moment is generated to regulate their motion. The aim of this study was to quantify the contribution of an articulated ankle-foot orthosis moment to regulate ankle and knee joint motion during gait in individuals post-stroke. Gait data were collected from 10 individuals post-stroke using a Bertec split-belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant wore an articulated ankle-foot orthosis whose moment resisting plantarflexion was adjustable at four levels. Ankle-foot orthosis moment while walking was calculated under the four levels based on angle-moment relationship of the ankle-foot orthosis around the ankle joint measured by bench testing. The ankle-foot orthosis moment and the joint angular position (ankle and knee) relationship in a gait cycle was plotted to quantify the ankle-foot orthosis moment needed to regulate the joint motion. Ankle and knee joint motion were regulated according to the amount of ankle-foot orthosis moment during gait. The ankle-foot orthosis maintained the ankle angular position in dorsiflexion and knee angular position in flexion throughout a gait cycle when it generated moment from -0.029 (0.011) to -0.062 (0.019) Nm/kg (moment resisting plantarflexion was defined as negative). Quantifying the contribution of ankle-foot orthosis moment needed to regulate lower limb joints within a specific range of motion could provide valuable criteria to design an ankle-foot orthosis for individuals post-stroke. Copyright © 2017 Elsevier Ltd. All rights reserved.

Inter-Observer and Intra-Observer Reliability of Clinical Assessments in Knee Osteoarthritis

PubMed Central

Maricar, Nasimah; Callaghan, Michael J; Parkes, Matthew J; Felson, David T; O’Neill, Terence W

2016-01-01

Background Clinical examination of the knee is subject to measurement error. The aim of this analysis was to determine inter- and intra-observer reliability of commonly used clinical tests in patients with knee osteoarthritis(OA). Methods We studied subjects with symptomatic knee OA who were participants in an open-label clinical trial of intra-articular steroid therapy. Following standardisation of the clinical test procedures, two clinicians assessed 25 subjects independently at the same visit, and the same clinician assessed 88 subjects over an interval period of 2–10 weeks; in both cases prior to the steroid intervention. Clinical examination included assessment of bony enlargement, crepitus, quadriceps wasting, knee effusion, joint-line and anserine tenderness and knee range of movement(ROM). Intra-class correlation coefficients(ICC), estimated kappa(κ), weighted kappa(κω) and Bland and Altman plots were used to determine inter- and intra-observer levels of agreement. Results Using Landis and Koch criteria, inter-observer kappa scores were moderate for patellofemoral joint(κ=0.53) and anserine tenderness(κ=0.48); good for bony enlargement(κ=0.66), quadriceps wasting(κ=0.78), crepitus(κ=0.78), medial tibiofemoral joint tenderness(κ=0.76), and effusion assessed by ballottement(κ=0.73) and bulge sign(κω =0.78); and excellent for lateral tibiofemoral joint tenderness(κ=1.00), flexion(ICC=0.97) and extension(ICC=0.87) ROM. Intra-observer kappa scores were moderate for lateral tibiofemoral joint tenderness(κ=0.60), good for crepitus(κ=0.78), effusion assessed by ballottement test(κ=0.77), patellofemoral joint(κ=0.66), medial tibiofemoral joint(κ=0.64) and anserine(κ=0.73) tenderness and excellent for effusion assessed by bulge sign(κω =0.83), bony enlargement(κ=0.98), quadriceps wasting(κ=0.83), flexion(ICC=0.99) and extension(ICC=0.96) ROM. Conclusion Among individuals with symptomatic knee OA, the reliability of clinical examination of the knee was at least good for the majority of clinical signs of knee OA. PMID:27909143

Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population.

PubMed

Junge, Tina; Henriksen, Peter; Hansen, Sebrina; Østengaard, Lasse; Golightly, Yvonne M; Juul-Kristensen, Birgit

2017-10-27

Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult population. This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. Total response rate was 49% (n = 1006). The prevalence of self-reported GJHk and KJH was 13% and 23%, mostly representing women. More than half of the respondents with GJHk and KJH had knee joint symptoms. The odds for reporting knee joint symptoms, severity of knee joint symptoms and duration of knee joint symptoms were twice as high for respondents with GJHk and KJH. Respondents with GJHk and KJH reported lower HRQoL. GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower HRQoL. The impact of these conditions on HRQoL is comparable with knee osteoarthritis. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Relationships between in vivo dynamic knee joint loading, static alignment and tibial subchondral bone microarchitecture in end-stage knee osteoarthritis.

PubMed

Roberts, B C; Solomon, L B; Mercer, G; Reynolds, K J; Thewlis, D; Perilli, E

2018-04-01

To study, in end-stage knee osteoarthritis (OA) patients, relationships between indices of in vivo dynamic knee joint loads obtained pre-operatively using gait analysis, static knee alignment, and the subchondral trabecular bone (STB) microarchitecture of their excised tibial plateau quantified with 3D micro-CT. Twenty-five knee OA patients scheduled for total knee arthroplasty underwent pre-operative gait analysis. Mechanical axis deviation (MAD) was determined radiographically. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four subregions (anteromedial, posteromedial, anterolateral, posterolateral). Regional differences in STB microarchitecture and relationships between joint loading and microarchitecture were examined. STB microarchitecture differed among subregions (P < 0.001), anteromedially exhibiting highest bone volume fraction (BV/TV) and lowest structure model index (SMI). Anteromedial BV/TV and SMI correlated strongest with the peak external rotation moment (ERM; r = -0.74, r = 0.67, P < 0.01), despite ERM being the lowest (by factor of 10) of the moments considered, with majority of ERM measures below accuracy thresholds; medial-to-lateral BV/TV ratios correlated with ERM, MAD, knee adduction moment (KAM) and internal rotation moment (|r|-range: 0.54-0.74). When controlling for walking speed, KAM and MAD, the ERM explained additional 11-30% of the variations in anteromedial BV/TV and medial-to-lateral BV/TV ratio (R 2  = 0.59, R 2  = 0.69, P < 0.01). This preliminary study suggests significant associations between tibial plateau STB microarchitecture and knee joint loading indices in end-stage knee OA patients. Particularly, anteromedial BV/TV correlates strongest with ERM, whereas medial-to-lateral BV/TV ratio correlates strongest with indicators of medial-to-lateral joint loading (MAD, KAM) and rotational moments. However, associations with ERM should be interpreted with caution. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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.

Ten-Year Follow-Up of Desarthrodesis of the Knee Joint 41 Years after Original Arthrodesis for a Bone Tumor

PubMed Central

Kassem Abdelaal, Ahmed Hamed; Yamamoto, Norio; Hayashi, Katsuhiro; Takeuchi, Akihiko; Miwa, Shinji; Inatani, Hiroyuki; Tsuchiya, Hiroyuki

2015-01-01

Introduction. The main indication for knee arthrodesis in tumor surgery is a tumor that requires an extensive resection in which the joint surface cannot be preserved. We report a patient that had knee desarthrodesis 41 years after giant cell tumor resection followed by a knee arthrodesis. This is the longest reported follow-up after desarthrodesis and conversion to total knee arthroplasty (TKA), almost ten years. Case Report. A 71-year-old man with a distal femoral giant cell tumor had undergone a resection of the distal femur and knee arthrodesis using Kuntscher nail in 1962. In July 2003 he experienced gradually increasing pain of his left knee. We performed a desarthrodesis and conversion to TKA in 2005. The postoperative period passed uneventfully as his pain and gait improved, with gradually increasing range of motion (ROM) and no infection. He now walks independently, with no brace or contractures. Conclusion. Desarthrodesis of the knee joint and conversion to TKA are a difficult surgical choice with a high complication risk. However, our patient's life style has improved, he has no pain, and he can ascend and descend stairs more easily. The surgeon has to be very meticulous in selecting a patient for knee arthrodesis and counseling them to realize that their expectations may not be achievable. PMID:26688766

Ten-Year Follow-Up of Desarthrodesis of the Knee Joint 41 Years after Original Arthrodesis for a Bone Tumor.

PubMed

Kassem Abdelaal, Ahmed Hamed; Yamamoto, Norio; Hayashi, Katsuhiro; Takeuchi, Akihiko; Miwa, Shinji; Inatani, Hiroyuki; Tsuchiya, Hiroyuki

2015-01-01

Introduction. The main indication for knee arthrodesis in tumor surgery is a tumor that requires an extensive resection in which the joint surface cannot be preserved. We report a patient that had knee desarthrodesis 41 years after giant cell tumor resection followed by a knee arthrodesis. This is the longest reported follow-up after desarthrodesis and conversion to total knee arthroplasty (TKA), almost ten years. Case Report. A 71-year-old man with a distal femoral giant cell tumor had undergone a resection of the distal femur and knee arthrodesis using Kuntscher nail in 1962. In July 2003 he experienced gradually increasing pain of his left knee. We performed a desarthrodesis and conversion to TKA in 2005. The postoperative period passed uneventfully as his pain and gait improved, with gradually increasing range of motion (ROM) and no infection. He now walks independently, with no brace or contractures. Conclusion. Desarthrodesis of the knee joint and conversion to TKA are a difficult surgical choice with a high complication risk. However, our patient's life style has improved, he has no pain, and he can ascend and descend stairs more easily. The surgeon has to be very meticulous in selecting a patient for knee arthrodesis and counseling them to realize that their expectations may not be achievable.

MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion.

PubMed

Freedman, Benjamin R; Sheehan, Frances T; Lerner, Amy L

2015-10-01

Several factors are believed to contribute to patellofemoral joint function throughout knee flexion including patellofemoral (PF) kinematics, contact, and bone morphology. However, data evaluating the PF joint in this highly flexed state have been limited. Therefore, the purpose of this study was to evaluate patellofemoral contact and alignment in low (0°), moderate (60°), and deep (140°) knee flexion, and then correlate these parameters to each other, as well as to femoral morphology. Sagittal magnetic resonance images were acquired on 14 healthy female adult knees (RSRB approved) using a 1.5 T scanner with the knee in full extension, mid-flexion, and deep flexion. The patellofemoral cartilage contact area, lateral contact displacement (LCD), cartilage thickness, and lateral patellar displacement (LPD) throughout flexion were defined. Intra- and inter-rater repeatability measures were determined. Correlations between patellofemoral contact parameters, alignment, and sulcus morphology were calculated. Measurement repeatability ICCs ranged from 0.94 to 0.99. Patellofemoral cartilage contact area and thickness, LCD, and LPD were statistically different throughout all levels of flexion (p<0.001). The cartilage contact area was correlated to LPD, cartilage thickness, sulcus angle, and epicondylar width (r=0.47-0.72, p<0.05). This study provides a comprehensive analysis of the patellofemoral joint throughout its range of motion. This study agrees with past studies that investigated patellofemoral measures at a single flexion angle, and provides new insights into the relationship between patellofemoral contact and alignment at multiple flexion angles. The study provides a detailed analysis of the patellofemoral joint in vivo, and demonstrates the feasibility of using standard clinical magnetic resonance imaging scanners to image the knee joint in deep flexion. Copyright © 2015 Elsevier B.V. All rights reserved.

Roller-massager application to the quadriceps and knee-joint range of motion and neuromuscular efficiency during a lunge.

PubMed

Bradbury-Squires, David J; Noftall, Jennifer C; Sullivan, Kathleen M; Behm, David G; Power, Kevin E; Button, Duane C

2015-02-01

Roller massagers are used as a recovery and rehabilitative tool to initiate muscle relaxation and improve range of motion (ROM) and muscular performance. However, research demonstrating such effects is lacking. To determine the effects of applying a roller massager for 20 and 60 seconds on knee-joint ROM and dynamic muscular performance. Randomized controlled clinical trial. University laboratory. Ten recreationally active men (age = 26.6 ± 5.2 years, height = 175.3 ± 4.3 cm, mass = 84.4 ± 8.8 kg). Participants performed 3 randomized experimental conditions separated by 24 to 48 hours. In condition 1 (5 repetitions of 20 seconds) and condition 2 (5 repetitions of 60 seconds), they applied a roller massager to the quadriceps muscles. Condition 3 served as a control condition in which participants sat quietly. Visual analog pain scale, electromyography (EMG) of the vastus lateralis (VL) and biceps femoris during roller massage and lunge, and knee-joint ROM. We found no differences in pain between the 20-second and 60-second roller-massager conditions. During 60 seconds of roller massage, pain was 13.5% (5.7 ± 0.70) and 20.6% (6.2 ± 0.70) greater at 40 seconds and 60 seconds, respectively, than at 20 seconds (P < .05). During roller massage, VL and biceps femoris root mean square (RMS) EMG was 8% and 7%, respectively, of RMS EMG recorded during maximal voluntary isometric contraction. Knee-joint ROM was 10% and 16% greater in the 20-second and 60-second roller-massager conditions, respectively, than the control condition (P < .05). Finally, average lunge VL RMS EMG decreased as roller-massage time increased (P < .05). Roller massage was painful and induced muscle activity, but it increased knee-joint ROM and neuromuscular efficiency during a lunge.

Adaptations in single-leg hop biomechanics following anterior cruciate ligament reconstruction.

PubMed

Orishimo, Karl F; Kremenic, Ian J; Mullaney, Michael J; McHugh, Malachy P; Nicholas, Stephen J

2010-11-01

When a patient performs a clinically normal hop test based on distance, it cannot be assumed that the biomechanics are similar between limbs. The objective was to compare takeoff and landing biomechanics between legs in patients who have undergone anterior cruciate ligament reconstruction. Kinematics and ground reaction forces were recorded as 13 patients performed the single-leg hop on each leg. Distance hopped, joint range of motion, peak joint kinetics and the peak total extensor moment were compared between legs during both takeoff and landing. Average hop distance ratio (involved/noninvolved) was 93 ± 4%. Compared to the noninvolved side, knee motion during takeoff on the involved side was significantly reduced (P = 0.008). Peak moments and powers on the involved side were lower at the knee and higher at the ankle and hip compared with the noninvolved side (Side by Joint P = 0.011; P = 0.003, respectively). The peak total extensor moment was not different between legs (P = 0.305) despite a decrease in knee moment and increases in ankle and hip moments (Side by Joint P = 0.015). During landing, knee motion was reduced (P = 0.043), and peak power absorbed was decreased at the knee and hip and increased at the ankle on the involved side compared to the noninvolved side (P = 0.003). The compensations by other joints may indicate protective adaptations to avoid overloading the reconstructed knee.

The associations between quadriceps muscle strength, power, and knee joint mechanics in knee osteoarthritis: A cross-sectional study.

PubMed

Murray, Amanda M; Thomas, Abbey C; Armstrong, Charles W; Pietrosimone, Brian G; Tevald, Michael A

2015-12-01

Abnormal knee joint mechanics have been implicated in the pathogenesis and progression of knee osteoarthritis. Deficits in muscle function (i.e., strength and power) may contribute to abnormal knee joint loading. The associations between quadriceps strength, power and knee joint mechanics remain unclear in knee osteoarthritis. Three-dimensional motion analysis was used to collect peak knee joint angles and moments during the first 50% of stance phase of gait in 33 participants with knee osteoarthritis. Quadriceps strength and power were assessed using a knee extension machine. Strength was quantified as the one repetition maximum. Power was quantified as the peak power produced at 40-90% of the one repetition maximum. Quadriceps strength accounted for 15% of the variance in peak knee flexion angle (P=0.016). Quadriceps power accounted for 20-29% of the variance in peak knee flexion angle (P<0.05). Quadriceps power at 90% of one repetition maximum accounted for 9% of the variance in peak knee adduction moment (P=0.05). These data suggest that quadriceps power explains more variance in knee flexion angle and knee adduction moment during gait in knee osteoarthritis than quadriceps strength. Additionally, quadriceps power at multiple loads is associated with knee joint mechanics and therefore should be assessed at a variety of loads. Taken together, these results indicate that quadriceps power may be a potential target for interventions aimed at changing knee joint mechanics in knee osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial.

PubMed

Lluch, Enrique; Dueñas, Lirios; Falla, Deborah; Baert, Isabel; Meeus, Mira; Sánchez-Frutos, José; Nijs, Jo

2018-01-01

This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.

Infrapatellar bursitis in children with juvenile idiopathic arthritis: a case series.

PubMed

Alqanatish, Jubran T; Petty, Ross E; Houghton, Kristin M; Guzman, Jaime; Tucker, Lori B; Cabral, David A; Cairns, Robyn A

2011-02-01

Children with juvenile idiopathic arthritis (JIA) may infrequently present with localized anterior knee pain or swelling, in addition to generalize knee pain induced by JIA. We report five cases of deep infrapatellar bursitis in children with JIA. The clinical features, radiological findings, management, and outcome of five children with JIA and deep infrapatellar bursitis are reviewed. Three boys and two girls with a mean age of 9.8 years (range 6-14 years) were reviewed. Four children had persistent oligoarticular JIA, and one child had extended oligoarticular JIA. The presentation of deep infrapatellar bursitis was variable. In only one patient was the bursal swelling painful. Knee magnetic resonance imaging (MRI) was performed in four patients and demonstrated coexistent knee joint synovitis in three. Treatment included targeted corticosteroid injections into the deep infrapatellar bursa in two cases with complete resolution. One case was treated with corticosteroid injection by an outside health care provider with poor clinical response. Two cases are being treated with non-steroidal anti-inflammatory drugs and methotrexate. Deep infrapatellar bursitis can occur as an isolated finding or concurrently with knee joint synovitis in patients with JIA. Awareness of this entity is important because direct injection of the bursa may be needed for treatment, as the bursa does not communicate with the knee joint. Furthermore, when bursitis is suspected in JIA, MRI can be helpful to confirm the diagnosis, detect concurrent knee joint synovitis, and exclude other pathologies.

Impact of hospitalization in an intensive care unit on range of motion of critically ill patients: a pilot study

PubMed Central

Nepomuceno, Balbino Rivail Ventura; Martinez, Bruno Prata; Gomes Neto, Mansueto

2014-01-01

Objective To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. Methods This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. Results The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). Conclusion There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit. PMID:24770691

Osteoarthritis of the knee after meniscal resection: long term radiographic evaluation of disease progression.

PubMed

Paradowski, P T; Lohmander, L S; Englund, M

2016-05-01

To determine prevalence, incidence and progression of radiographic knee osteoarthritis (OA) in a cohort of subjects with previous meniscectomy. We assessed 221 subjects (177 men and 44 women) with weight bearing knee radiography twice (assessment A and B) with a follow-up time ranging from 4 to 10 years. All subjects had undergone meniscectomy 15-22 years before assessment A. At assessment B the mean (SD) age was 60 (11) years. We assessed prevalence and incidence of OA, as well as progression of radiographic features over time. Radiographic OA was defined as approximating Kellgren and Lawrence grade 2 or worse. At assessment A, we found tibiofemoral radiographic OA in 107 subjects' index knee (48%) of which 41 subjects (38%) had bilateral tibiofemoral OA. At assessment B, the corresponding figures were 151 (68%) and 71 (32%). At assessment A, we found patellofemoral OA in 32 subjects' index knee (14%) of which 11 (34%) had bilateral patellofemoral OA. At assessment B, the corresponding figures were 51 (23%) and 19 (37%). There was an increase of the sum of joint space narrowing (JSN) and osteophyte grades in the tibiofemoral joint of 144 subjects' index knee (64%) and in the contralateral tibiofemoral joints of 79 subjects (36%). The corresponding progression in the patellofemoral joint was observed in 66 index knees (30%) and in 41 (19%) contralateral knees. Overall, some 20-30 years after meniscectomy nearly three out of four persons had developed radiographic tibiofemoral OA and one out of four had developed patellofemoral OA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Manual therapy in the treatment of patients with hemophilia B and inhibitor.

PubMed

Cuesta-Barriuso, Rubén; Trelles-Martínez, Roberto O

2018-01-22

The main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor. A 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality. Until now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study.

Effects of hamstring stretching on passive muscle stiffness vary between hip flexion and knee extension maneuvers.

PubMed

Miyamoto, N; Hirata, K; Kanehisa, H

2017-01-01

The purpose of this study was to examine whether the effects of hamstring stretching on the passive stiffness of each of the long head of the biceps femoris (BFl), semitendinosus (ST), and semimembranosus (SM) vary between passive knee extension and hip flexion stretching maneuvers. In 12 male subjects, before and after five sets of 90 s static stretching, passive lengthening measurements where knee or hip joint was passively rotated to the maximal range of motion (ROM) were performed. During the passive lengthening, shear modulus of each muscle was measured by ultrasound shear wave elastography. Both stretching maneuvers significantly increased maximal ROM and decreased passive torque at a given joint angle. Passive knee extension stretching maneuver significantly reduced shear modulus at a given knee joint angle in all of BFl, ST, and SM. In contrast, the stretching effect by passive hip flexion maneuver was significant only in ST and SM. The present findings indicate that the effects of hamstring stretching on individual passive muscles' stiffness vary between passive knee extension and hip flexion stretching maneuvers. In terms of reducing the muscle stiffness of BFl, stretching of the hamstring should be performed by passive knee extension rather than hip flexion. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.

PubMed

Augustsson, J; Thomeé, R; Lindén, C; Folkesson, M; Tranberg, R; Karlsson, J

2006-04-01

A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and knee flexion and generated powers for the knee and ankle joints during take-off, and less hip joint moments during landing under fatigued conditions. The large negative power values observed at the knee joint during the landing phase of the single-leg hop, during which the quadriceps muscle activates eccentrically, indicate that not only hop distance but also the ability to perform successful landings should be investigated when assessing dynamic knee function.

A self-aligning knee joint for walking assistance devices.

PubMed

Byungjune Choi; Younbaek Lee; Jeonghun Kim; Minhyung Lee; Jongwon Lee; Se-Gon Roh; Hyundo Choi; Yong-Jae Kim; Jung-Yun Choi

2016-08-01

This paper presents a novel self-aligning knee mechanism for walking assistance devices for the elderly to provide physical gait assistance. Self-aligning knee joints can assist in flexion/extension motions of the knee joint and compensate the knee's transitional movements in the sagittal plane. In order to compensate the center of rotation, which moves with the flexion/extension motion of the human knee joint, a self-aligning knee joint is proposed that adds redundant degrees of freedom (i.e., 2-DoF) to the 1-DoF revolute joint. The key idea of the proposed mechanism is to decouple joint rotations and translations for use in lower-extremity wearable devices. This paper describes the mechanical design of this self-aligning knee mechanism and its implementation on a wearable robot and in preliminary experiments. The performance of the proposed mechanism is verified by simulations and experiments.

Examination of factors affecting gait properties in healthy older adults: focusing on knee extension strength, visual acuity, and knee joint pain.

PubMed

Demura, Tomohiro; Demura, Shin-ichi; Uchiyama, Masanobu; Sugiura, Hiroki

2014-01-01

Gait properties change with age because of a decrease in lower limb strength and visual acuity or knee joint disorders. Gait changes commonly result from these combined factors. This study aimed to examine the effects of knee extension strength, visual acuity, and knee joint pain on gait properties of for 181 healthy female older adults (age: 76.1 (5.7) years). Walking speed, cadence, stance time, swing time, double support time, step length, step width, walking angle, and toe angle were selected as gait parameters. Knee extension strength was measured by isometric dynamometry; and decreased visual acuity and knee joint pain were evaluated by subjective judgment whether or not such factors created a hindrance during walking. Among older adults without vision problems and knee joint pain that affected walking, those with superior knee extension strength had significantly greater walking speed and step length than those with inferior knee extension strength (P < .05). Persons with visual acuity problems had higher cadence and shorter stance time. In addition, persons with pain in both knees showed slower walking speed and longer stance time and double support time. A decrease of knee extension strength and visual acuity and knee joint pain are factors affecting gait in the female older adults. Decreased knee extension strength and knee joint pain mainly affect respective distance and time parameters of the gait.

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-reported overall physical health significantly favoured exercising only to neutral (p=0.037). No other differences were found between groups and no adverse events occurred. Conclusions Parents perceive improved child psychosocial health when children exercise into the hypermobile range, while exercising to neutral only is perceived to favour the child’s physical health. A physiotherapist prescribed, supervised, individualised and progressed exercise programme effectively reduces knee pain in children with JHS. Trial registration Australia & New Zealand Clinical Trials Registry; ACTRN12606000109505. PMID:23941143

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. Copyright © 2014 Elsevier B.V. All rights reserved.

Epiphyseal osteochondroma of the anterior cruciate ligament.

PubMed

Chekofsky, K M; Scott, W N; Fielding, J W

1979-01-01

An 8-year-old Black boy complained of pain, swelling, and a decreased range of motion in the knee. One arthrotomy operation was reported to show a normal knee joint. Six months later, a second arthrotomy demonstrated an osteochondroma growing from the epiphysis into the anterior cruciate ligament. Epiphyseal osteochondroma should be added to the working differential diagnosis on children with effusion and decrease of knee motion.

The volume of the human knee joint.

PubMed

Matziolis, Georg; Roehner, Eric; Windisch, Christoph; Wagner, Andreas

2015-10-01

Despite its clinical relevance, particularly in septic knee surgery, the volume of the human knee joint has not been established to date. Therefore, the objective of this study was to determine knee joint volume and whether or not it is dependent on sex or body height. Sixty-one consecutive patients (joints) who were due to undergo endoprosthetic joint replacement were enrolled in this prospective study. During the operation, the joint volume was determined by injecting saline solution until a pressure of 200 mmHg was achieved in the joint. The average volume of all knee joints was 131 ± 53 (40-290) ml. The volume was not found to be dependent on sex, but it was dependent on the patients' height (R = 0.312, p = 0.014). This enabled an estimation of the joint volume according to V = 1.6 height - 135. The considerable inter-individual variance of the knee joint volume would suggest that it should be determined or at least estimated according to body height if the joint volume has consequences for the diagnostics or therapy of knee disorders.

Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial.

PubMed

van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; van Roermund, P M; Custers, R J H; Mastbergen, S C; Lafeber, F P J G

2017-03-01

Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. Randomized controlled trial, Level I.

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 device...

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 two-part...

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 device...

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 part...

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 device...

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 intended...

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 two-part...

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 device...

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 intended...

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 two-part...

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 device...

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 device...

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 device...

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 device...

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 intended...

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 intended...

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 intended...

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 device...

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 device...

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 device...

Medical image analysis of knee joint lipoma arborescens and arthroscopic treatment.

PubMed

Zhu, Guangyu; Tian, Xiangdong; Du, Dongfeng; Lei, Ming; Guan, Lei; Wang, Jian; Tan, Yetong; Yang, Chen; Zheng, Xinxin

2018-06-01

Arthroscopy is a minimally invasive surgical procedure on a joint in which examination and treatment of knee damage is performed using a surgical device known as the arthroscope. Lipoma arborescens (LA), an infrequent intra-articular lesion, originates from mature adipose cells under subsynovial tissue. The synovial membrane is pale yellow with large villous projections. It is caused by various underlying factors. We found many patients with LA and processed them appropriately.The research was implemented to investigate therapeutic effect of semi-automated arthroscopic diagnosis and treatment for knee joint. We used the Stryker arthroscopic in surgery that is 4 mm in diameter with angle at 30°. Patients were chosen by biomechanical analysis and scanning mode. All of the patients underwent radiographic imaging examination, Magnetic Resonance Imaging (MRI), Lysholm Score and Visual Analogue Scale (VAS). Arthroscopic limited synovectomy was carried out on these patients. The wound of all patients healed up. The content of follow-up includes: chief complaints, range of motion of knee joint, Visual Analogue Scale (VAS) and Lysholm score. No swollen nor effusion of the infected knee was found in all patients during the follow-up. The postoperative symptom was markedly alleviated in fourteen patients and partially alleviated in one. All patients were satisfied with the therapeutic effect. We performed biomechanical analysis based on knee slight flexion and extension. Arthroscopy is an endoscope for the diagnosis and treatment of joint diseases. Semi-automated arthroscopic debridement is good for early and mid-term osteoarthritis with Lipoma arborescens. Copyright © 2018. Published by Elsevier Ltd.

[Study on the correlation between syndrome differ classification of knee osteoarthritis and X-ray image].

PubMed

Jin, Li-Kun; Zhang, Guo-Zhong; Tang, Ke; Liu, Yang

2010-12-01

To study the correlation between syndrome differ classification of knee osteoarthritis and X-ray image, so as to provide evidence for clinical diagnosis and treatment. From Jun. 2007 to Dec. 2007, 78 patients (108 knees) with knee osteoarthritis were reviewed, including 65 females (89 knees) and 13 males (19 knees), ranging in age from 41 to 77 years. According to the standards for the differentiation of syndrome in the treatment of knee osteoarthritis defined in Principle of Clinical Research for New Traditional Herbs, the patients were divided into three types: Type I, insufficiency of the liver and kidney, with stagnation of tendons and muscles, 43 knees; Type II, insufficiency of the spleen and kidney, with dampness infusion into bone and joints, 26 knees; Type I, deficiency of the liver and kidney, with inter-obstruction of phlegm and stasis 39 knees. Normotopia and lateral plain film of knee joint of weigh loading and in erect position, and patellofemoral Skyline plain flim was taken. Joint space narrow, osteophyte generation, subchondral osteosclerosis and subchondral cystic degeneration were evaluated. All data were analyzed by K independent samples nonparametric test in order to find out the correlation between syndrome differ classification of knee osteoarthritis and X-ray image. It was shown that after K independent samples nonparametric test about syndrome differ classification of knee osteoarthritis and X-ray image: there were significant differences among three types about lateral patella osteophyte, condyles of tibia osteophyte and Type II was the most serious, Type I was secondary, Type II was the lightest. Other index had no obvious difference among the three groups. There is certain correlation between syndrome differ classification of knee osteoarthritis and X-ray image. There are significant differences among three types about lateral patella osteophyte, condyles of tibia osteophyte, the Type II is the most serious,Type I is secondary, Type II is the lightest. Consequently, it can be deduced that worse osteophyte is one of accordances of Type II-insufficiency of the spleen and kidney, with dampness infusion into bone and joints. And, the Type II is more serious stage in radiologic manifestation.

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

PubMed

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

2015-10-01

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. Copyright © 2015 the American Physiological Society.

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

MULTIPLE NONSPECIFIC SITES OF JOINT PAIN OUTSIDE THE KNEES DEVELOP IN PERSONS WITH KNEE PAIN

PubMed Central

Felson, David T.; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara; Lewis, Cora E.; Law, Laura Frey; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

2017-01-01

Objective Many persons with knee pain have joint pain outside the knee but despite the impact and high frequency of this pain, its distribution and causes have not been studied. Those studying gait abnormalities have suggested that knee pain causes pain in adjacent joints but pain adaptation strategies are highly individualized. Methods We studied persons age 50-79 years with or at high risk of knee osteoarthritis drawn from two community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and followed for 5-7 years. We excluded those with knee pain at baseline and compared those who developed and did not develop knee pain at the first follow-up examination (the index visit). We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint specific pain adjusted for age, sex, BMI, depression with sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, there were 693 persons with index visit knee pain vs. 2793 without it. 79.6% of those with bilateral and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee vs. 49.9% of those without knee pain. An increased risk of pain was present in most extremity joint sites without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusions Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. PMID:27589036

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.

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.

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. Copyright © 2010 Elsevier B.V. All rights reserved.

The Effects of Knee Joint Effusion on Quadriceps Electromyography During Jogging

PubMed Central

Torry, Michael R.; Decker, Michael J.; Millett, Peter J.; Steadman, J. Richard; Sterett, William I.

2005-01-01

To investigate and describe the influence of intra-articular effusion on knee joint kinematics and electromyographic (EMG) profiles during jogging. Thirteen individuals underwent a 20 cc 0.9% saline insufflation of the knee joint capsule and completed 8 jogging trials. Stance phase, sagittal plane knee joint kinematics and thigh muscular EMG profiles were compared pre- and post-insufflation utilizing a paired t-test ( = 0.05). Mild knee effusion caused a reduction in vastus medialis (p = 0.005) and lateralis (p = 0.006) EMG activity. The rectus femoris, biceps femoris and medial hamstring muscles did not exhibit changes due to this protocol. There were no changes in the sagittal plane knee joint kinematic pattern. Twenty cc effusion can cause quadriceps inhibition in the vastus medialis and the vastus lateralis in otherwise healthy individuals during jogging. This study provides baseline data for the effects of mild knee joint effusion on thigh musculature during jogging. Key Points 20 cc of knee effusion can cause vastus medialis and lateralis inhibition as noted by decreases in EMG amplitude. This effusion does not appear to alter sagittal plane knee joint kinematics during jogging. This finding if different from previous work investigating knee joint kinematic changes during a less dynamic activity (gait) with 20 cc of effusion. PMID:24431955

Image based weighted center of proximity versus directly measured knee contact location during simulated gait

PubMed Central

Wang, Hongsheng; Chen, Tony; Koff, Matthew F.; Hutchinson, Ian D.; Gilbert, Susannah; Choi, Dan; Warren, Russell F.; Rodeo, Scott A.; Maher, Suzanne A.

2014-01-01

To understand the mechanical consequences of knee injury requires a detailed analysis of the effect of that injury on joint contact mechanics during activities of daily living. Three-dimensional (3D) knee joint geometric models have been combined with knee joint kinematics to dynamically estimate the location of joint contact during physiological activities – using a weighted center of proximity (WCoP) method. However, the relationship between the estimated WCoP and the actual location of contact has not been defined. The objective of this study was to assess the relationship between knee joint contact location as estimated using the image-based WCoP method, and a directly measured weighted center of contact (WCoC) method during simulated walking. To achieve this goal, we created knee specific models of six human cadaveric knees from magnetic resonance imaging. All knees were then subjected to physiological loads on a knee simulator intended to mimic gait. Knee joint motion was captured using a motion capture system. Knee joint contact stresses were synchronously recorded using a thin electronic sensor throughout gait, and used to compute WCoC for the medial and lateral plateaus of each knee. WCoP was calculated by combining knee kinematics with the MRI-based knee specific model. Both metrics were compared throughout gait using linear regression. The anteroposterior (AP) location of WCoP was significantly correlated with that of WCoC on both tibial plateaus in all specimens (P < 0.01, 95% confidence interval of Person’s coefficient r > 0), but the correlation was not significant in the mediolateral (ML) direction for 4/6 knees (P > 0.05). Our study demonstrates that while the location of joint contact obtained from 3D knee joint contact model, using the WCoP method, is significantly correlated with the location of actual contact stresses in the AP direction, that relationship is less certain in the ML direction. PMID:24837219

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 to...

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 to...

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 to...

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 to...

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 to...

Multiple Nonspecific Sites of Joint Pain Outside the Knees Develop in Persons With Knee Pain.

PubMed

Felson, David T; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara L; Lewis, Cora E; Frey Law, Laura; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

2017-02-01

Many persons with knee pain have joint pain outside the knee, but despite the impact and high frequency of this pain, its distribution and causes have not been studied. We undertook this study to test the hypothesis of those studying gait abnormalities who have suggested that knee pain causes pain in adjacent joints but that pain adaptation strategies are highly individualized. We studied persons ages 50-79 years with or at high risk of knee osteoarthritis who were recruited from 2 community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, and we followed them up for 5-7 years. We excluded those with knee pain at baseline and compared those who had developed knee pain at the first follow-up examination (the index visit) with those who had not. We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint-specific pain adjusted for age, sex, body mass index, and symptoms of depression, and we performed sensitivity analyses excluding those with widespread pain. In the combined cohorts, 693 persons had knee pain at the index visit and 2,793 did not. A total of 79.6% of those with bilateral knee pain and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee, compared with 49.9% of those without knee pain. There was an increased risk of pain at most extremity joint sites, without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. © 2016, American College of Rheumatology.

Correlations between iron content in knee joint tissues and chosen indices of peripheral blood morphology.

PubMed

Brodziak-Dopierała, Barbara; Roczniak, Wojciech; Jakóbik-Kolon, Agata; Kluczka, Joanna; Koczy, Bogdan; Kwapuliński, Jerzy; Babuśka-Roczniak, Magdalena

2017-10-01

Iron as a cofactor of enzymes takes part in the synthesis of the bone matrix. Severe deficiency of iron reduces the strength and mineral density of bones, whereas its excess may increase oxidative stress. In this context, it is essential to determine the iron content in knee joint tissues. The study objective was to determine the level of iron in the tissues of the knee joint, i.e., in the femoral bone, tibia and meniscus. Material for analysis was obtained during endoprosthetic surgery of the knee joint. Within the knee joint, the tibia, femur and meniscus were analyzed. Samples were collected from 50 patients, including 36 women and 14 men. The determination of iron content was performed with the ICP-AES method, using Varian 710-ES. The lowest iron content was in the tibia (27.04 μg/g), then in the meniscus (38.68 μg/g) and the highest in the femur (41.93 μg/g). Statistically significant differences were noted in the content of iron in knee joint tissues. In patients who underwent endoprosthesoplasty of the knee joint, statistically significant differences were found in the levels of iron in various components of the knee joint. The highest iron content was found in the femoral bone of the knee joint and then in the meniscus, the lowest in the tibia. The differences in iron content in the knee joint between women and men were not statistically significant.

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.

Change in joint space width: hyaline articular cartilage loss or alteration in meniscus?

PubMed

Hunter, D J; Zhang, Y Q; Tu, X; Lavalley, M; Niu, J B; Amin, S; Guermazi, A; Genant, H; Gale, D; Felson, D T

2006-08-01

To explore the relative contribution of hyaline cartilage morphologic features and the meniscus to the radiographic joint space. The Boston Osteoarthritis of the Knee Study is a natural history study of symptomatic knee osteoarthritis (OA). Baseline and 30-month followup assessments included knee magnetic resonance imaging (MRI) and fluoroscopically positioned weight-bearing knee radiographs. Cartilage and meniscal degeneration were scored on MRI in the medial and lateral tibiofemoral joints using a semiquantitative grading system. Meniscal position was measured to the nearest millimeter. The dependent variable was joint space narrowing (JSN) on the plain radiograph (possible range 0-3). The predictor variables were MRI cartilage score, meniscal degeneration, and meniscal position measures. We first conducted a cross-sectional analysis using multivariate regression to determine the relative contribution of meniscal factors and cartilage morphologic features to JSN, adjusting for body mass index (BMI), age, and sex. The same approach was used for change in JSN and change in predictor variables. We evaluated 264 study participants with knee OA (mean age 66.7 years, 59% men, mean BMI 31.4 kg/m(2)). The results from the models demonstrated that meniscal position and meniscal degeneration each contributed to prediction of JSN, in addition to the contribution by cartilage morphologic features. For change in medial joint space, both change in meniscal position and change in articular cartilage score contributed substantially to narrowing of the joint space. The meniscus (both its position and degeneration) accounts for a substantial proportion of the variance explained in JSN, and the change in meniscal position accounts for a substantial proportion of change in JSN.

Correlation and sex differences between ankle and knee cartilage morphology determined by quantitative magnetic resonance imaging

PubMed Central

Eckstein, F; Siedek, V; Glaser, C; Al-Ali, D; Englmeier, K; Reiser, M; Graichen, H

2004-01-01

Objective: To study the correlation between ankle and knee cartilage morphology to test the hypothesis that knee joint cartilage loss in gonarthritis can be estimated retrospectively using quantitative MRI analysis of the knee and ankle and established regression equations; and to test the hypothesis that sex differences in joint surface area are larger in the knee than the ankle, which may explain the greater incidence of knee osteoarthritis in elderly women than in elderly men. Methods: Sagittal MR images (3D FLASH WE) of the knee and hind foot were acquired in 29 healthy subjects (14 women, 15 men; mean (SD) age, 25 (3) years), with no signs joint disease. Cartilage volume, thickness, and joint surface area were determined in the knee, ankle, and subtalar joint. Results: Knee cartilage volumes and joint surface areas showed only moderate correlations with those of the ankle and subtalar joint (r = 0.33 to 0.81). The correlations of cartilage thickness between the two joints were weaker still (r = –0.05 to 0.53). Sex differences in cartilage morphology at the knee and the ankle were similar, with surface areas being –17.5% to –23.5% lower in women than in men. Conclusions: Only moderate correlations in cartilage morphology of healthy subjects were found between knee and ankle. It is therefore impractical to estimate knee joint cartilage loss a posteriori in cross sectional studies by measuring the hind foot and then applying a scaling factor. Sex differences in cartilage morphology do not explain differences in osteoarthritis incidence between men and women in the knee and ankle. PMID:15479900

Joint instability leads to long-term alterations to knee synovium and osteoarthritis in a rabbit model.

PubMed

Egloff, C; Hart, D A; Hewitt, C; Vavken, P; Valderrabano, V; Herzog, W

2016-06-01

Joint instability is believed to promote early osteoarthritic changes in the knee. Inflammatory reactions are associated with cartilage degradation in osteoarthritis (OA) but their possible synergistic or additive effects remain largely unexplored. The goal of the present study was to investigate the in vivo effects of Botulinum Toxin A (BTX-A) induced joint instability on intraarticular alterations in an otherwise intact rabbit knee joint model. Ten 1-year-old female New Zealand White rabbits (average 5.7 kg, range 4.8-6.6 kg) were randomly assigned to receive three monthly unilateral intramuscular injections of BTX-A (experimental group), or no treatment (control group). After 90 days, all knees were analyzed for specific mRNA levels using RT-qPCR. The synovium and cartilage tissue was assessed for histological alterations using the OARSI scoring system. Cartilage and synovial histology showed significant higher OARSI scores in the BTX-A group animals compared to the untreated controls and contralateral limbs. There were no differences between the untreated control and the contralateral experimental limbs. Gene expression showed significant elevations for collagen I, collagen III, nitric oxide, TGF-β, IL-1 and IL-6 compared to the healthy controls. BTX-A induced joint instability in a muscle weakness model uniquely leads to alterations in gene expression and histological changes in the synovial membranes and cartilage in otherwise intact knee joints. These results lead to the conclusion that joint instability may promote an inflammatory intraarticular milieu, thereby contributing to the development of OA. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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 prosthesis. 888.3570 Section 888.3570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint...

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 prosthesis. 888.3570 Section 888.3570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint...

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 prosthesis. 888.3570 Section 888.3570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint...

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 prosthesis. 888.3570 Section 888.3570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint...

Design, analysis and verification of a knee joint oncological prosthesis finite element model.

PubMed

Zach, Lukáš; Kunčická, Lenka; Růžička, Pavel; Kocich, Radim

2014-11-01

The aim of this paper was to design a finite element model for a hinged PROSPON oncological knee endoprosthesis and to verify the model by comparison with ankle flexion angle using knee-bending experimental data obtained previously. Visible Human Project CT scans were used to create a general lower extremity bones model and to compose a 3D CAD knee joint model to which muscles and ligaments were added. Into the assembly the designed finite element PROSPON prosthesis model was integrated and an analysis focused on the PEEK-OPTIMA hinge pin bushing stress state was carried out. To confirm the stress state analysis results, contact pressure was investigated. The analysis was performed in the knee-bending position within 15.4-69.4° hip joint flexion range. The results showed that the maximum stress achieved during the analysis (46.6 MPa) did not exceed the yield strength of the material (90 MPa); the condition of plastic stability was therefore met. The stress state analysis results were confirmed by the distribution of contact pressure during knee-bending. The applicability of our designed finite element model for the real implant behaviour prediction was proven on the basis of good correlation of the analytical and experimental ankle flexion angle data. Copyright © 2014 Elsevier Ltd. All rights reserved.

Physical therapy intervention for an adolescent with a knee flexion contracture and diagnosis of multiple pterygium syndrome.

PubMed

Bellamy, Sandra Gail; Gibbs, Karen; Lazaro, Rolando

2007-01-01

The purpose of this case report is to describe a course of physical therapy for a client with a rare genetic condition, multiple pterygium syndrome (MPS). MPS is a rare genetic disorder characterized by connective tissue webbing across multiple joints, dysmorphic facies, and various visceral and skeletal deformities. Before the patient commenced physical therapy, surgical amputation was recommended for the client's knee flexion contracture. The client's treatment plan included stretching, manual therapy, and resisted exercise. Long-term outcomes were decreased back and knee pain and improved range of motion, strength, and ambulation. Therapists using techniques to improve joint range of motion in clients with MPS should be aware that pterygia may include contractile tissue, nerves, and blood vessels and there may be underlying skeletal deformity or weakness in these areas. Children with MPS are at high risk of developing scoliosis and should be appropriately assessed in early childhood.

Ten-year follow-up of SpA-related oligoarthritis involving the knee: the presence of psoriasis but not HLA-B27 or baseline MRI bone oedema predicts outcome.

PubMed

Bennett, Alexander N; Marzo-Ortega, Helena; Tan, Ai Lyn; Hensor, Elizabeth M A; Green, Mike; Emery, Paul; McGonagle, Dennis

2012-06-01

Bone marrow oedema (BMO) and HLA-B27 are poor prognostic factors in axial SpA, and psoriasis is a poor prognostic factor in small-joint polyarthropathy. The aim of this study was to investigate the influence of HLA-B27, MRI BMO and psoriasis on long-term outcomes in early SpA-related knee joint oligoarthritis. Patients with SpA-related oligoarthritis with knee involvement were recruited. Baseline assessment included ESSG criteria, RF, HLA-B27 and MRI. The degree of MRI BMO was determined on fat-suppression sequences and scored using the whole-organ magnetic resonance imaging score (WORMS) (range 0-45). Patients were treated at the discretion of their rheumatologist and followed up for 10 years. Outcome assessments included joint counts, functional and symptomatic questionnaire, CRP and radiographic assessment for OA. Forty-four patients were recruited [mean age 32 years (range 15-59 years), 70% male] with a mean disease duration at baseline of 9.75 months (1-48 months). Twenty-six (59%) patients (mean age 43 years, 65% male) returned for follow-up after a mean of 10 years (range 8.4-12.6 years). Ten (38%) patients had persistent clinical synovitis and 31% of knees had secondary radiographic OA. Global outcome was poor/very poor in 69% of cases. The only factor predicting outcome at 10 years was psoriasis, but neither HLA-B27 nor BMO. PsA patients had significantly worse global outcome compared with ReA (P = 0.036), and significantly worse symptomatic (P = 0.001) and functional (P = 0.001) outcome compared with other subtypes. SpA-related knee joint oligoarthritis has significant long-term clinical and radiological morbidity despite standard treatments. HLA-B27 and MRI BMO were not predictors of poor outcome as they are in axial SpA; however, the presence of psoriasis predicted significantly worse outcome.

Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model.

PubMed

Zhang, Quan Bing; Zhou, Yun; Zhong, Hua Zhang; Liu, Yi

2018-05-01

The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism. Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor β1 in the joint capsule. The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor β1 in the joint capsule. Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis.

PubMed

Shirazi, Zahra Rojhani; Shafaee, Razieh; Abbasi, Leila

2014-10-01

To study the effects of transcutaneous electrical nerve stimulation (TENS) on joint position sense (JPS) in knee osteoarthritis (OA) subjects. Thirty subjects with knee OA (40-60 years old) using non-random sampling participated in this study. In order to evaluate the absolute error of repositioning of the knee joint, Qualysis Track Manager system was used and sensory electrical stimulation was applied through the TENS device. The mean errors in repositioning of the joint, in two position of the knee joint with 20 and 60 degree angle, after applying the TENS was significantly decreased (p < 0.05). Application of TENS in subjects with knee OA could improve JPS in these subjects.

No associations between self-reported knee joint instability and radiographic features in knee osteoarthritis patients prior to Total Knee Arthroplasty: A cross-sectional analysis of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis study (LOAS) data.

PubMed

Leichtenberg, Claudia S; Meesters, Jorit J L; Kroon, Herman M; Verdegaal, Suzan H M; Tilbury, Claire; Dekker, Joost; Nelissen, Rob G H H; Vliet Vlieland, Thea P M; van der Esch, Martin

2017-08-01

To describe the prevalence of self-reported knee joint instability in patients with pre-surgery knee osteoarthritis (OA) and to explore the associations between self-reported knee joint instability and radiological features. A cross-sectional study including patients scheduled for primary Total Knee Arthroplasty (TKA). Self-reported knee instability was examined by questionnaire. Radiological features consisted of osteophyte formation and joint space narrowing (JSN), both scored on a 0 to three scale. Scores >1 are defined as substantial JSN or osteophyte formation. Regression analyses were provided to identify associations of radiological features with self-reported knee joint instability. Two hundred and sixty-five patients (mean age 69years and 170 females) were included. Knee instability was reported by 192 patients (72%). Substantial osteophyte formation was present in 78 patients (41%) reporting and 33 patients (46%) not reporting knee joint instability. Substantial JSN was present in 137 (71%) and 53 patients (73%), respectively. Self-reported knee instability was not associated with JSN (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.87 (0.30-2.54), 0.98 (0.38-2.52), 0.68 (0.25-1.86), respectively) or osteophyte formation (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.77 (0.36-1.64), 0.69 (0.23-1.45), 0.89 (0.16-4.93), respectively). Stratified analysis for pain, age and BMI showed no associations between self-reported knee joint instability and radiological features. Self-reported knee joint instability is not associated with JSN or osteophyte formation. Copyright © 2017 Elsevier B.V. All rights reserved.

A Study of Knee Joint Kinematics and Mechanics using a Human FE Model.

PubMed

Kitagawa, Yuichi; Hasegawa, Junji; Yasuki, Tsuyoshi; Iwamoto, Masami; Miki, Kazuo

2005-11-01

Posterior translation of the tibia with respect to the femur can stretch the posterior cruciate ligament (PCL). Fifteen millimeters of relative displacement between the femur and tibia is known as the Injury Assessment Reference Value (IARV) for the PCL injury. Since the anterior protuberance of the tibial plateau can be the first site of contact when the knee is flexed, the knee bolster is generally designed with an inclined surface so as not to directly load the projection in frontal crashes. It should be noted, however, that the initial flexion angle of the occupant knee can vary among individuals and the knee flexion angle can change due to the occupant motion. The behavior of the tibial protuberance related to the knee flexion angle has not been described yet. The instantaneous angle of the knee joint at the timing of restraining the knee should be known to manage the geometry and functions of knee restraint devices. The purposes of this study are first to understand the kinematics of the knee joint during flexion, and second to characterize the mechanics of the knee joint under anterior-posterior loading. A finite element model of the knee joint, extracted from the Total Human Model for Safety (THUMS), was used to analyze the mechanism. The model was validated against kinematics and mechanical responses of the human knee joint. By tracking the relative positions and angles between the patella and the tibia in a knee flexing simulation, the magnitude of the tibial anterior protuberance was described as a function of the knee joint angle. The model revealed that the mechanics of the knee joint was characterized as a combination of stiffness of the patella-femur structure and the PCL It was also found that the magnitude of the tibial anterior protuberance determined the amount of initial stretch of the PCL in anterior-posterior loading. Based on the knee joint kinematics and mechanics, an interference boundary was proposed for different knee flexion angles, so as not to directly load the anterior protuberance of the tibial plateau in restraining of the knee. A frontal crash simulation was performed using a partial vehicle model with the THUMS seated. The performance and effects of the knee airbag, as one of the candidates for knee restraint devices, were evaluated through the simulation.

Anterior cruciate ligament injury about 20 years post-treatment: A kinematic analysis of one-leg hop.

PubMed

Tengman, E; Grip, H; Stensdotter, Ak; Häger, C K

2015-12-01

Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 ± 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R). © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Relationships between the center of pressure and the movements of the ankle and knee joints during the stance phase in patients with severe medial knee osteoarthritis.

PubMed

Fukaya, Takashi; Mutsuzaki, Hirotaka; Okubo, Tomoyuki; Mori, Koichi; Wadano, Yasuyoshi

2016-08-01

The knee joint movement during the stance phase is affected by altered ankle movement and the center of pressure (COP). However the relationships between changes in the center of pressure (COP) and the altered kinematics and kinetics of the ankle and knee joints in patients with osteoarthritis (OA) of the knee are not well understood. The purpose of this study was to determine the relationships between changes in the COP and the altered kinematic and kinetic variables in ankle and knee joints during the stance phase in patients with medial knee OA. Fourteen patients with knee OA (21 knees) and healthy subjects were assessed by gait analysis using an eight-camera motion analysis system to record forward and lateral shifts in the COP and the angle and net internal moments of the knee and ankle joint. Spearman rank-correlation coefficients were used to determine the relationship between these results. In knees with medial OA, lateral shifts in the COP were correlated with knee flexion angle. Lateral shifts in the COP were correlated with the second peak of the knee extensor moment and correlated with the knee abductor moment. In patients with medial knee OA, lateral shifts in the COP were negatively correlated with the kinematic and kinetic variables in the sagittal plane of the knee joints. Controlling such lateral shifts in the COP may thus be an effective intervention for mechanical loads on the knee during the stance phase in patients with knee OA. Copyright © 2016 Elsevier B.V. All rights reserved.

Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.

PubMed

Courtney, Carol A; Steffen, Alana D; Fernández-de-Las-Peñas, César; Kim, John; Chmell, Samuel J

2016-03-01

An experimental laboratory study with a repeated-measures crossover design. Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. To examine the effect of joint mobilization on impaired CPM. An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.

Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee.

PubMed

van der Esch, M; Steultjens, M; Knol, D L; Dinant, H; Dekker, J

2006-12-15

To establish the impact of knee joint laxity on the relationship between muscle strength and functional ability in osteoarthritis (OA) of the knee. A cross-sectional study of 86 patients with OA of the knee was conducted. Tests were performed to determine varus-valgus laxity, muscle strength, and functional ability. Laxity was assessed using a device that measures the angular deviation of the knee in the frontal plane. Muscle strength was measured using a computer-driven isokinetic dynamometer. Functional ability was assessed by observation (100-meter walking test) and self report (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Regression analyses were performed to assess the impact of joint laxity on the relationship between muscle strength and functional ability. In regression analyses, the interaction between muscle strength and joint laxity contributed to the variance in both walking time (P = 0.002) and WOMAC score (P = 0.080). The slope of the regression lines indicated that the relationship between muscle strength and functional ability (walking time, WOMAC) was stronger in patients with high knee joint laxity. Patients with knee OA and high knee joint laxity show a stronger relationship between muscle strength and functional ability than patients with OA and low knee joint laxity. Patients with OA, high knee joint laxity, and low muscle strength are most at risk of being disabled.

Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

PubMed

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

2016-01-01

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). 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. 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. Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.

PubMed

Kim, Kyungsoo; Feng, Jun; Nha, Kyung Wook; Park, Won Man; Kim, Yoon Hyuk

2015-06-01

Accurate measurement of the center of rotation of the knee joint is indispensable for prediction of joint kinematics and kinetics in musculoskeletal models. However, no study has yet identified the knee center of rotations during several daily activities before and after high tibial osteotomy surgery, which is one surgical option for treating knee osteoarthritis. In this study, an estimation method for determining the knee joint center of rotation was developed by applying the optimal common shape technique and symmetrical axis of rotation approach techniques to motion-capture data and validated for typical activities (walking, squatting, climbing up stairs, walking down stairs) of 10 normal subjects. The locations of knee joint center of rotations for injured and contralateral knees of eight subjects with osteoarthritis, both before and after high tibial osteotomy surgery, were then calculated during walking. It was shown that high tibial osteotomy surgery improved the knee joint center of rotation since the center of rotations for the injured knee after high tibial osteotomy surgery were significantly closer to those of the normal healthy population. The difference between the injured and contralateral knees was also generally reduced after surgery, demonstrating increased symmetry. These results indicate that symmetry in both knees can be recovered in many cases after high tibial osteotomy surgery. Moreover, the recovery of center of rotation in the injured knee was prior to that of symmetry. This study has the potential to provide fundamental information that can be applied to understand abnormal kinematics in patients, diagnose knee joint disease, and design a novel implants for knee joint surgeries. © IMechE 2015.

Different knee joint loading patterns in ACL deficient copers and non-copers during walking.

PubMed

Alkjær, Tine; Henriksen, Marius; Simonsen, Erik B

2011-04-01

Rupture of the anterior cruciate ligament (ACL) causes changes in the walking pattern. ACL deficient subjects classified as copers and non-copers have been observed to adopt different post-injury walking patterns. How these different patterns affect the knee compression and shear forces is unresolved. Thus, the aim of the present study was to investigate how different walking patterns observed between copers, non-copers, and controls affect the knee compression and shear forces during walking. Three-dimensional gait analyses were performed in copers (n = 9), non-copers (n = 10), and control subjects (n =19). The net knee joint moment, knee joint reaction forces, and the sagittal knee joint angle were input parameters to a biomechanical model that assessed the knee compression and shear forces. The results showed that the non-copers walked with significantly reduced knee compression and shear forces than the controls. The overall knee compression force pattern was similar between the copers and controls, although this variable was significantly increased at heel strike in the copers compared to both non-copers and controls. The peak shear force was significantly dependent on the peak knee extensor moment. This covariance was significantly different between groups meaning that at a given knee extensor moment the shear force was significantly reduced in the copers compared to controls. The different knee joint loading patterns observed between non-copers and copers reflected the different walking strategies adopted by these groups, which may have implications for the knee joint stability. The strategy adopted by the copers may resemble an effective way to stabilize the knee joint during walking after an ACL rupture and that the knee kinematics may play a key role for this strategy. It is clinically relevant to investigate if gait retraining would enable non-copers to walk as copers and thereby improve their knee joint stability.

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. Georg Thieme Verlag KG Stuttgart.New York.

Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees.

PubMed

Theeven, Patrick; Hemmen, Bea; Rings, Frans; Meys, Guido; Brink, Peter; Smeets, Rob; Seelen, Henk

2011-10-01

To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. Randomised cross-over trial. Forty-one persons with unilateral above-knee or knee disarticulation limb loss, classified as Medicare Functional Classification Level-2 (MFCL-2). Participants were measured in 3 conditions, i.e. using a mechanically controlled knee joint and two types of microprocessor-controlled prosthetic knee joints. Functional performance level was assessed using a test in which participants performed 17 simulated activities of daily living (Assessment of Daily Activity Performance in Transfemoral amputees test). Performance time was measured and self-perceived level of difficulty was scored on a visual analogue scale for each activity. High levels of within-group variability in functional performance obscured detection of any effects of using a microprocessor-controlled prosthetic knee joint. Data analysis after stratification of the participants into 3 subgroups, i.e. participants with a "low", "intermediate" and "high" functional mobility level, showed that the two higher functional subgroups performed significantly faster using microprocessor-controlled prosthetic knee joints. MFCL-2 amputees constitute a heterogeneous patient group with large variation in functional performance levels. A substantial part of this group seems to benefit from using a microprocessor-controlled prosthetic knee joint when performing activities of daily living.

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

2017-08-01

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 FBCS.

Factors determining the level and changes in intra-articular pressure in the knee joint of the dog.

PubMed Central

Nade, S; Newbold, P J

1983-01-01

Intra-articular pressure levels were determined for joint positions throughout the normal physiological range of movement of dogs' knee joints. Change in joint position resulted in change in intra-articular pressure. It was demonstrated that intra-articular pressure is highest with the joint in the fully flexed position. Minimum pressure was recorded at a position between 80 degrees and 120 degrees. Minimum pressures were usually subatmospheric. The rate of change of joint position affected intra-articular pressure. The relationship of intra-articular pressure and joint position before and after full flexion demonstrated a hysteresis effect; the pressures were lower than for the same joint position before flexion. Maintenance of the joint in the fully flexed position for increasing periods of time between repeated movement cycles resulted in a similar reduction, of constant magnitude, in pressure between joint positions before and after each period of flexion. However, there was also a progressive decrease in pressure for all joint angles over the total number of movement cycles. There is a contribution to intra-articular pressure of joint capsular compliance and fluid movement into and out of the joint (both of which are time-dependent). The recording of intra-articular pressure in conscious, upright dogs revealed similar pressure levels to those measured in anaesthetized supine dogs. The major determinants of intra-articular pressure in normal dog knee joints include joint size, synovial fluid volume, position of joint, peri-articular tissue and joint anatomy, membrane permeability, capsular compliance, and movement of fluid into and out of the joint. Images Fig. 1 PMID:6875957

Hip or knee replacement - after - what to ask your doctor

MedlinePlus

... chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain Osteoarthritis Patient Instructions Getting your home ready - knee or hip surgery Hip or knee replacement - before - ...

Hip or knee replacement - before - what to ask your doctor

MedlinePlus

... chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain Osteoarthritis Patient Instructions Getting your home ready - knee or hip surgery Hip or knee replacement - after - ...

Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

PubMed

Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

2014-12-01

Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

Modelling of the Human Knee Joint Supported by Active Orthosis

NASA Astrophysics Data System (ADS)

Musalimov, V.; Monahov, Y.; Tamre, M.; Rõbak, D.; Sivitski, A.; Aryassov, G.; Penkov, I.

2018-02-01

The article discusses motion of a healthy knee joint in the sagittal plane and motion of an injured knee joint supported by an active orthosis. A kinematic scheme of a mechanism for the simulation of a knee joint motion is developed and motion of healthy and injured knee joints are modelled in Matlab. Angles between links, which simulate the femur and tibia are controlled by Simulink block of Model predictive control (MPC). The results of simulation have been compared with several samples of real motion of the human knee joint obtained from motion capture systems. On the basis of these analyses and also of the analysis of the forces in human lower limbs created at motion, an active smart orthosis is developed. The orthosis design was optimized to achieve an energy saving system with sufficient anatomy, necessary reliability, easy exploitation and low cost. With the orthosis it is possible to unload the knee joint, and also partially or fully compensate muscle forces required for the bending of the lower limb.

Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA.

PubMed

Lin, Kun-Jhih; Wei, Hung-Wen; Huang, Chang-Hung; Liu, Yu-Liang; Chen, Wen-Chuan; McClean, Colin Joseph; Cheng, Cheng-Kung

2016-08-01

The primary intent of total knee arthroplasty is the restoration of normal knee kinematics, with ligamentous constraint being a key influential factor. Displacement of the joint line may lead to alterations in ligament attachment sites relative to knee flexion axis and variance of ligamentous constraints on tibiofemoral movement. This study aimed to investigate collaterals strains and tibiofemoral kinematics with different joint line levels. A previously validated knee model was employed to analyse the change in length of the collateral ligaments and tibiofemoral motion during knee flexion. The models shifted the joint line by 3 and 5 mm both proximally and distally from the anatomical level. The data were captured from full extension to flexion 135°. The elevated joint line revealed a relative increase in distance between ligament attachments for both collateral ligaments in comparison with the anatomical model. Also, tibiofemoral movement decreased with an elevation in the joint line. Conversely, lowering the joint line led to a significant decrease in distance between ligament attachments, but greater tibiofemoral motion. Elevation of the joint line would strengthen the capacity of collateral ligaments for knee motion constraint, whereas a distally shifted joint line might have the advantage of improving tibiofemoral movement by slackening the collaterals. It implies that surgeons can appropriately change the joint line position in accordance with patient's requirement or collateral tensions. A lowered joint line level may improve knee kinematics, whereas joint line elevation could be useful to maintain knee stability. V.

Acute effects of static stretching on passive stiffness of the hamstring muscles calculated using different mathematical models.

PubMed

Nordez, Antoine; Cornu, Christophe; McNair, Peter

2006-08-01

The aim of this study was to assess the effects of static stretching on hamstring passive stiffness calculated using different data reduction methods. Subjects performed a maximal range of motion test, five cyclic stretching repetitions and a static stretching intervention that involved five 30-s static stretches. A computerised dynamometer allowed the measurement of torque and range of motion during passive knee extension. Stiffness was then calculated as the slope of the torque-angle relationship fitted using a second-order polynomial, a fourth-order polynomial, and an exponential model. The second-order polynomial and exponential models allowed the calculation of stiffness indices normalized to knee angle and passive torque, respectively. Prior to static stretching, stiffness levels were significantly different across the models. After stretching, while knee maximal joint range of motion increased, stiffness was shown to decrease. Stiffness decreased more at the extended knee joint angle, and the magnitude of change depended upon the model used. After stretching, the stiffness indices also varied according to the model used to fit data. Thus, the stiffness index normalized to knee angle was found to decrease whereas the stiffness index normalized to passive torque increased after static stretching. Stretching has significant effects on stiffness, but the findings highlight the need to carefully assess the effect of different models when analyzing such data.

Relationship between leg extensor muscle strength and knee joint loading during gait before and after total knee arthroplasty.

PubMed

Vahtrik, Doris; Gapeyeva, Helena; Ereline, Jaan; Pääsuke, Mati

2014-01-01

The aim of the present study was to evaluate an isometric maximal voluntary contraction (MVC) force of the leg extensor muscles and its relationship with knee joint loading during gait prior and after total knee arthroplasty (TKA). Custom-made dynamometer was used to assess an isometric MVC force of the leg extensor muscles and 3-D motion analysis system was used to evaluate the knee joint loading during gait in 13 female patients (aged 49-68 years) with knee osteoarthritis. Patients were evaluated one day before, and three and six months following TKA in the operated and non-operated leg. Six months after TKA, MVC force of the leg extensor muscles for the operated leg did not differ significantly as compared to the preoperative level, whereas it remained significantly lower for the non-operated leg and controls. The knee flexion moment and the knee joint power during mid stance of gait was improved six months after TKA, remaining significantly lowered compared with controls. Negative moderate correlation between leg extensor muscles strength and knee joint loading for the operated leg during mid stance was noted three months after TKA. The correlation analysis indicates that due to weak leg extensor muscles, an excessive load is applied to knee joint during mid stance of gait in patients, whereas in healthy subjects stronger knee-surrounding muscles provide stronger knee joint loading during gait. III (correlational study). Copyright © 2013 Elsevier B.V. All rights reserved.

Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

PubMed

Sakamoto, Junya; Manabe, Yoshitaka; Oyamada, Joichi; Kataoka, Hideki; Nakano, Jiro; Saiki, Kazunobu; Okamoto, Keishi; Tsurumoto, Toshiyuki; Okita, Minoru

2018-07-01

Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705-709, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

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 reproducible segmentation of the knee joint bone and cartilage surfaces of the femur, tibia, and patella. As a general segmentation tool, the developed framework can be applied to a broad range of multi-object segmentation problems.

Getting your home ready - knee or hip surgery

MedlinePlus

... Philadelphia, PA: Elsevier; 2017:chap 55. Read More ACL reconstruction Hip fracture surgery Hip joint replacement Knee ... Knee joint replacement Knee microfracture surgery Patient Instructions ACL reconstruction - discharge Hip fracture - discharge Hip or knee ...

The relationship between knee joint loading rate during walking and degenerative changes on magnetic resonance imaging.

PubMed

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

2014-06-01

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. 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. 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). 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. Published by Elsevier Ltd.

Disease activity, knee function, and walking ability in patients with rheumatoid arthritis 10 years after primary total knee arthroplasty.

PubMed

Nishikawa, Masataka; Owaki, Hajime; Takahi, Koichiro; Fuji, Takeshi

2014-04-01

To evaluate disease activity, knee function, and walking ability of patients with rheumatoid arthritis (RA) over 10 years after total knee arthroplasty (TKA). Four men and 26 women (mean age, 59.9 years) underwent 42 TKAs for RA with a mean duration of 151.3 months and were followed up for a mean of 142.3 months. Preoperatively, disease activity was assessed by C-reactive protein (CRP) level only, and the range of knee motion was recorded. At the final follow-up, tender joint count, swollen joint count, visual analogue scale of RA symptoms, and the Modified Health Assessment Questionnaire (MHAQ) score were assessed. Disease activity was evaluated using CRP, matrix metalloproteinase-3, and Disease Activity Score. Range of motion and Knee Society knee and function scores were also assessed. The use of methotrexate increased from 4 patients preoperatively to 20 patients at the final follow-up (p<0.001), and the mean dose increased from 3.9 to 6.3 mg/week (p<0.001). Among the 30 patients, the mean CRP level decreased from 2.63 mg/dl preoperatively to 0.61 mg/dl at the final follow-up (p<0.001). Disease activity was controlled. At the final follow-up, disease activity was in remission in 10 patients, low in 11, and moderate in 9. The mean Knee Society knee score was excellent (91.0), but the mean function score was poor (57.0) and diverse. Severe walking disability (function score, <40) was noted in 8 patients (11 TKAs). Knee and function scores did not correlate. Walking ability in patients with RA after TKA was generally poor. Poor function was associated with a history of spinal or lower extremity fracture surgery and the MHAQ score.

A preliminary case series evaluating the safety and immediate to short-term clinical benefits of joint mobilization in hemophilic arthritis of the lower limb.

PubMed

Scaddan, Emma; Rowell, John; O'Leary, Shaun

2017-09-01

Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy. A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA. There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion ( p  < 0.05) following the joint mobilization intervention. The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy.

DINAMICS OF KNEE JOINT SPACE ASYMMETRY ON X-RAY AS A MARKER OF KNEE OSTEOARTHRITIS REHABILITATION EFFICACY.

PubMed

Sheveleva, N; Minbayeva, L; Belyayeva, Y

2017-03-01

Reducing of articular cartilage functional volume in knee joint osteoarthritis occurs unevenly and accompanied with pathological changes of lower limb axis as a result of connective tissue and muscle structures dysfunction. Evaluation of X-ray knee joint space asymmetry seems to be informative to analyze the dynamics of lower extremities biomechanical imbalances characteristic for knee joint osteoarthritis. However, standardized method of X-ray joint space determining does not include its symmetry calculation. The purpose of the study was optimization of knee joint radiological examination by developing of X-ray knee joint space asymmetry index calculation method. The proposed method was used for comparative analysis of extracorporeal shock-wave therapy efficacy in 30 patients with knee joint osteoarthritis of 2-3 degrees (Kellgren-Lawrence, 1957). As a result of the conducted treatment statistically significant decrease of the X-ray knee joint space asymmetry index was observed (Me(Q1;Q3): Z=5.20, p<0.001) and amounted as 0.22 (0.18;0.24) before treatment and 0.12 (0.10;0.14) after. Also, statistically significant (Z=5.10; p=0.00001) changes of load asymmetry on front and rear foot sections were observed by the results of podometric survey in comparative assessment before (Me(Q1;Q3)=24(12;30)) and after (Me(Q1;Q3)=6(4;30)) course therapy. 30% (n=9) of the patients evaluated the outcome of the treatment as "excellent" (1 point), 63% (n=19) - as "good" (2 points) and only 7% (n=2) - as "acceptable" (3 points) according to the Roles and Maudsley score. The listed above data was regarded as an X-ray positive dynamics comparable with clinical improvement. Thus, the X-ray knee joint space asymmetry index, calculated according to the proposed method, allows to evaluate dynamics of articular surfaces congruency changes and provide differentiated approach to the treatment of knee joint osteoarthritis.

Electromyographic and kinematic analysis of graded treadmill walking and the implications for knee rehabilitation.

PubMed

Lange, G W; Hintermeister, R A; Schlegel, T; Dillman, C J; Steadman, J R

1996-05-01

Muscle activity, joints, angles, and heart rate during uphill walking were compared for application in knee rehabilitation. The objectives of this study were to quantify muscle activation levels at different treadmill grades and to determine the grade(s) at which knee range of motion would not further compromise the joint. Average and peak electromyographic activity of the quadriceps (vastus medialis oblique and vastus lateralis) and hamstrings (biceps femoris and medial hamstrings (semimembranosus/semitendinosus)] was recorded during walking at 0, 12, and 24% grade. Six subjects (age = 28.5 +/- 3.7 years, stature = 1.79 +/- .05 m, and mass = 74.7 +/- 7.9 kg) walked at self-selected speeds at each grade while ankle, knee and hip angles, heart rate, and electromyographic activity (surface electrodes) were recorded. Maximum voluntary contractions provided a relative reference for the electromyographic activity during walking. Average and peak electromyographic activity increased significantly across grades for the vastus medialis oblique (125 and 154%), vastus lateralis (109 and 139%), and biceps femoris (53 and 46%), but remained similar for the medial hamstrings. Maximum knee flexion at heel strike increased significantly with grade. Despite decreased self-selected speeds with increasing grade, there were significant increases in heart rate across grades. The results of this study provide a basic understanding of the quadriceps and hamstrings activity levels, lower extremity joint range of motion, and cardiovascular requirements of graded treadmill walking in normal subjects. The results also suggest that a grade just greater than 12% may be most beneficial for knee rehabilitation to minimize patellofemoral discomfort or potential strain on the anterior cruciate ligament. The benefits achieved through this functional activity encourage its implementation in rehabilitation and provide a basis for comparison with injured patients.

Material Models and Properties in the Finite Element Analysis of Knee Ligaments: A Literature Review

PubMed Central

Galbusera, Fabio; Freutel, Maren; Dürselen, Lutz; D’Aiuto, Marta; Croce, Davide; Villa, Tomaso; Sansone, Valerio; Innocenti, Bernardo

2014-01-01

Knee ligaments are elastic bands of soft tissue with a complex microstructure and biomechanics, which are critical to determine the kinematics as well as the stress bearing behavior of the knee joint. Their correct implementation in terms of material models and properties is therefore necessary in the development of finite element models of the knee, which has been performed for decades for the investigation of both its basic biomechanics and the development of replacement implants and repair strategies for degenerative and traumatic pathologies. Indeed, a wide range of element types and material models has been used to represent knee ligaments, ranging from elastic unidimensional elements to complex hyperelastic three-dimensional structures with anatomically realistic shapes. This paper systematically reviews literature studies, which described finite element models of the knee, and summarizes the approaches, which have been used to model the ligaments highlighting their strengths and weaknesses. PMID:25478560

Soft tissue knee contracture of the knee due to melorheostosis, treated by total knee arthroplasty.

PubMed

Moulder, Elizabeth; Marsh, Clayton

2006-10-01

Melorheostosis is a rare condition which can cause soft tissue joint contractures. We present a case of melorheostosis causing disabling knee joint contracture, treated successfully by total knee arthroplasty.

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 or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

The relationships between instrumented measurements of ankle and knee ligamentous laxity and generalized joint laxity.

PubMed

Pearsall, A W; Kovaleski, J E; Heitman, R J; Gurchiek, L R; Hollis, J M

2006-03-01

The purpose of this study was to evaluate whether lower extremity joint laxity is a function of a particular joint and/or a generalizable characteristic (trait) of the person. Validated instrumented measurements of ankle and knee joint-specific laxity in the same individual were correlated to determine whether a relationship exists. In addition, ankle and knee joint-specific laxity were correlated with generalized joint laxity using the modified Beighton mobility index. Fifty-seven male and female athletes were studied. We examined dominant ankle laxity using an ankle arthrometer and dominate knee anterior laxity using the KT 2000. The dominant ankle was loaded in anteroposterior (AP) drawer and inversion-eversion (I-E) rotation. Laxity was measured as total AP displacement (millimeters) after +/-125 N of applied force and total I-E rotation (degrees) was measured after +/-4 N x m of applied torque. The dominant knee was loaded with an anterior drawer and laxity (millimeters) was measured after manual maximum displacement. Non-significant correlations were observed among the test variables for generalized joint laxity (0.21 to 0.37; P>0.05) and instrumented ankle and knee joint laxity (0.19 to 0.21; P>0.05). When examined by gender, no statistically significant correlations (0.05 to 0.40; P>0.05) were found for either generalized laxity or instrumented ankle and knee joint laxity. These results imply that ankle and knee joint laxity are joint-specific and not generalizable.

Electrical stimulation on joint contracture: an experiment in rat model with direct current.

PubMed

Akai, M; Shirasaki, Y; Tateishi, T

1997-04-01

To examine whether electrical stimulation could decrease the degree of joint stiffness in a rat lower extremity model. Rat knee joints were surgically immobilized in a flexed position for 3 weeks. Two groups of rats were stimulated with 20 microA and 50 microA constant direct current. Another group had surgical intervention and sham electrodes without electricity. The hind leg was extirpated and prepared for a sample with the femur-knee joint-tibia unit. Recording the knee flexion angle with extension torque, the degree of joint contracture was assessed biomechanically by measuring the bone-joint-bone sample as a cantilever. Measurement was performed with (1) spectral analysis of transfer function measurement using random mechanical noise with frequency range from 1 to 50Hz, and (2) dynamic stiffness and loss tangent with steady-state sinusoidal excitation (11 and 35Hz). The results showed that no significant difference or trend was found in vibration analysis among three groups. However, spectral analysis of transfer function measurement revealed more deformation against load, and more viscous nature in the stimulation groups, especially in low frequency band, than in the sham group. Electrical stimulation with constant direct current has a possibility of reducing the degree of joint contracture.

Reliability of a smartphone-based goniometer for knee joint goniometry.

PubMed

Ferriero, Giorgio; Vercelli, Stefano; Sartorio, Francesco; Muñoz Lasa, Susana; Ilieva, Elena; Brigatti, Elisa; Ruella, Carolina; Foti, Calogero

2013-06-01

The aim of this study was to assess the reliability of a smartphone-based application developed for photographic-based goniometry, DrGoniometer (DrG), by comparing its measurement of the knee joint angle with that made by a universal goniometer (UG). Joint goniometry is a common mode of clinical assessment used in many disciplines, in particular in rehabilitation. One validated method is photographic-based goniometry, but the procedure is usually complex: the image has to be downloaded from the camera to a computer and then edited using dedicated software. This disadvantage may be overcome by the new generation of mobile phones (smartphones) that have computer-like functionality and an integrated digital camera. This validation study was carried out under two different controlled conditions: (i) with the participant to measure in a fixed position and (ii) with a battery of pictures to assess. In the first part, four raters performed repeated measurements with DrG and UG at different knee joint angles. Then, 10 other raters measured the knee at different flexion angles ranging 20-145° on a battery of 35 pictures taken in a clinical setting. The results showed that inter-rater and intra-rater correlations were always more than 0.958. Agreement with the UG showed a width of 18.2° [95% limits of agreement (LoA)=-7.5/+10.7°] and 14.1° (LoA=-6.6/+7.5°). In conclusion, DrG seems to be a reliable method for measuring knee joint angle. This mHealth application can be an alternative/additional method of goniometry, easier to use than other photographic-based goniometric assessments. Further studies are required to assess its reliability for the measurement of other joints.

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of knee joint angle on neuromuscular activation of the vastus intermedius muscle during isometric contraction.

PubMed

Watanabe, K; Akima, H

2011-12-01

The purpose of this study was to compare the relationship between surface electromyography (EMG) and knee joint angle of the vastus intermedius muscle (VI) with the synergistic muscles in the quadriceps femoris (QF) muscle group. Fourteen healthy men performed maximal voluntary contractions during isometric knee extension at four knee joint angles from 90°, 115°, 140°, and 165° (180° being full extension). During the contractions, surface EMG was recorded at four muscle components of the QF muscle group: the VI, vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) muscles. The root mean square of the surface EMG at each knee joint angle was calculated and normalized by that at a knee joint angle of 90° for individual muscles. The normalized RMS of the VI muscle was significantly lower than those of the VL and RF muscles at the knee joint angles of 115° and 165° and those of the VL, VM, and RF muscles at the knee joint angle of 140° (P<0.05). The present results suggest that the neuromuscular activation of the VI muscle is regulated in a manner different from the alteration of the knee joint angle compared with other muscle components of the QF muscle group. © 2011 John Wiley & Sons A/S.

Predicting the Functional Roles of Knee Joint Muscles from Internal Joint Moments.

PubMed

Flaxman, Teresa E; Alkjær, Tine; Simonsen, Erik B; Krogsgaard, Michael R; Benoit, Daniel L

2017-03-01

Knee muscles are commonly labeled as flexors or extensors and aptly stabilize the knee against sagittal plane loads. However, how these muscles stabilize the knee against adduction-abduction and rotational loads remains unclear. Our study sought 1) to classify muscle roles as they relate to joint stability by quantifying the relationship between individual muscle activation patterns and internal net joint moments in all three loading planes and 2) to determine whether these roles change with increasing force levels. A standing isometric force matching protocol required subjects to modulate ground reaction forces to elicit various combinations and magnitudes of sagittal, frontal, and transverse internal joint moments. Surface EMG measured activities of 10 lower limb muscles. Partial least squares regressions determined which internal moment(s) were significantly related to the activation of individual muscles. Rectus femoris and tensor fasciae latae were classified as moment actuators for knee extension and hip flexion. Hamstrings were classified as moment actuators for hip extension and knee flexion. Gastrocnemius and hamstring muscles were classified as specific joint stabilizers for knee rotation. Vastii were classified as general joint stabilizers because activation was independent of moment generation. Muscle roles did not change with increasing effort levels. Our findings indicate muscle activation is not dependent on anatomical orientation but perhaps on its role in maintaining knee joint stability in the frontal and transverse loading planes. This is useful for delineating the roles of biarticular knee joint muscles and could have implications in robotics, musculoskeletal modeling, sports sciences, and rehabilitation.

[The impact of dynamic platform exercises on knee joint muscle strength in patients with gonarthrosis treated with microfracture method].

PubMed

Klupiński, Kamil; Krochmalski, Jakub; Woldańska-Okońska, Marta

2017-06-23

Osteoarthritis is the most common joint disease. Gonarthrosis is one of the most serious diseases the highly developed modern medicine must face. The number of patients suffering from joint pain and progressive disability is growing, especially in economically developed countries. Over the years, the disease has been considered merely as a symptom of aging and the effect of "wear and tear" of the cartilage. At present it is known that the degenerative joint disease is of chronic and progressive nature and its pathogenesis is complex. The aim of the study was to determine the impact of dynamic platform exercises on knee joint muscle strength in patients with gonarthrosis treated with microfracture method. The study included 120 patients of both sexes, aged 40 to 65 years, height range1.60-1.90 m., weight 50- 100 kg. Patients were divided into two groups. Group I of 60 patients after knee arthroscopy (with performed microfractures on the articular cartilage) who were subjected to physiotherapy with the use of dynamometric platform and to isometric and dynamic exercises of muscles surrounding the knee joint. Group II (control) of 60 patients after knee arthroscopy (with performed microfractures on the articular cartilage), who were subjected only to isometric and dynamic exercises of muscles surrounding the knee joint. The patients underwent rehabilitation according to the same rehabilitation program suggested by the Medical Magnus Clinic in Lodz, which consisted in performing daily exercises in open and closed kinetic chains. All Group I and II patients were examined three times: before the start of the rehabilitation, after 4th week of rehabilitation (on the average 20 days of the procedures) and 3 months afterwards. The clinical examination included the measurement of muscle strength using Lovett test. It has been demonstrated that the introduction of modern highly specialized physiotherapy contributes to the improvement of the outcome and to the shortening of the treatment duration. A significant improvement was observed in all the examined patients at all stages of rehabilitation in relation to the baseline values. The conducted modern physiotherapy has a significant effect on the condition of patients after surgery. Different exercises on dynamometric platform combined with static and dynamic exercises exert a positive impact on the strengthening of muscles surrounding the knee joint, which in time perspective results in better quality of life of the patients.

Knee extensor dynamics in the volleyball approach jump: the influence of patellar tendinopathy.

PubMed

Sorenson, Shawn C; Arya, Shruti; Souza, Richard B; Pollard, Christine D; Salem, George J; Kulig, Kornelia

2010-09-01

Controlled laboratory study using a cross-sectional design. To evaluate knee joint dynamics in elite volleyball players with and without a history of patellar tendinopathy, focusing on mechanical energy absorption and generation. We hypothesized that tendinopathy would be associated withreduced net joint work and net joint power. Patellar tendinopathy is a common, debilitating injury affecting competitive volleyball players. Thirteen elite male players with and without a history of patellar tendinopathy (mean ± SD age, 27 ± 7 years) performed maximum-effort volleyball approach jumps. Sagittal plane knee joint kinematics, kinetics, and energetics were quantified in the lead limb, using data obtained from a force platform and an 8-camera motion analysis system. Vertical ground reaction forces and pelvis vertical velocity at takeoff were examined. Independent sample t tests were used to evaluate group differences (α = .05). The tendinopathy group, compared to controls, demonstrated significant reductions (approximately 30%) in net joint work and net joint power during the eccentric phase of the jump, with no differences in the concentric phase. Positive to-negative net joint work and net joint power ratios were significantly higher in the tendinopathy group, which had a net joint work ratio of 1.00 (95% CI: 0.77, 1.24) versus 0.76 (95% CI: 0.64, 0.88) for controls, and a net joint power ratio of 1.62 (95% CI: 1.15, 2.10) versus 1.00 (95% CI: 0.80, 1.21) for controls. There were no significant differences in net joint moment, angular velocity, or range of motion. Peak vertical ground reaction forces were lower for the tendinopathy group, while average vertical ground reaction forces and pelvis vertical velocity were similar. Patellar tendinopathy is associated with differences in sagittal plane mechanical energy absorption at the knee during maximum-effort volleyball approach jumps. Net joint work and net joint power may help define underlying mechanisms, adaptive effects, or rehabilitative strategies for individuals with patellar tendinopathy.

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.

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

Principal Component Analysis in Construction of 3D Human Knee Joint Models Using a Statistical Shape Model Method

PubMed Central

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

2013-01-01

The statistical shape model (SSM) method that uses 2D images of the knee joint to predict the 3D joint surface model has been reported in literature. In this study, we constructed a SSM database using 152 human CT knee joint models, including the femur, tibia and patella and analyzed 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 seconds 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. PMID:24156375

[Research progress of larger flexion gap than extension gap in total knee arthroplasty].

PubMed

Zhang, Weisong; Hao, Dingjun

2017-05-01

To summarize the progress of larger flexion gap than extension gap in total knee arthro-plasty (TKA). The domestic and foreign related literature about larger flexion gap than extension gap in TKA, and its impact factors, biomechanical and kinematic features, and clinical results were summarized. During TKA, to adjust the relations of flexion gap and extension gap is one of the key factors of successful operation. The biomechanical, kinematic, and clinical researches show that properly larger flexion gap than extension gap can improve both the postoperative knee range of motion and the satisfaction of patients, but does not affect the stability of the knee joint. However, there are also contrary findings. So adjustment of flexion gap and extension gap during TKA is still in dispute. Larger flexion gap than extension gap in TKA is a new joint space theory, and long-term clinical efficacy, operation skills, and related complications still need further study.

[Operative treatment for complex tibial plateau fractures].

PubMed

Song, Qi-Zhi; Li, Tao

2012-03-01

To explore the surgical methods and clinical evaluation of complex tibial plateau fractures resulted from high-energy injuries. From March 2006 to May 2009,48 cases with complex tibial plateau fractures were treated with open reduction and plate fixation, including 37 males and 11 females, with an average age of 37 years (ranged from 18 to 63 years). According to Schatzker classification, 16 cases were type IV, 20 cases type V and 12 cases type VI. All patients were examined by X-ray flim and CT scan. The function of knee joint were evaluated according to postoperative follow-up X-ray and Knee Merchant Rating. Forty-eight patients were followed up with a mean time of 14 months. According to Knee Merchant Rating, 24 cases got excellent results, 16 cases good, 6 cases fair and 2 cases poor. Appropriate operation time, anatomical reduction, suitable bone graft and reasonable rehabilitation exercises can maximally recovery the function of knee joint.

Anatomical significance of a posterior horn of medial meniscus: the relationship between its radial tear and cartilage degradation of joint surface.

PubMed

Kan, Akinori; Oshida, Midori; Oshida, Shigemi; Imada, Masato; Nakagawa, Takumi; Okinaga, Shuji

2010-01-12

Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Five hundred and forty eight cadaveric knees (290 male and 258 female) were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years). The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS) grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior horn in keeping the hoop strain, when patients' physical activity levels are high and the tear pattern is simple enough to be securely sutured.

CLINICAL AND TREATMENT FEATURES OF OPEN INFECTED FRACTURES IN THE KNEE JOINT REGION IN CONJUNCTION WITH RADIATION SICKNESS (EXPERIMENTAL STUDY)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sakharov, B.V.

1963-08-01

Clinical aspects and the course of treatment of open infected fractures in the knee joint region against a background of moderate and severe radiation sickness are discussed. The experiment involved 35 healthy dogs of both sexes. In all, three experiments were involved: on open infected fractures in the knee joint region in conjunction with radiation sickness; open infected fractures in the knee joint region without radiation sickness; radiation sickness without trauma. Infected open injury to the knee joint against a radiation sickness background is a severe affection. The use of delayed surgical and drug treatment (antibiotics, vitamins, antihistamine preparations) affordedmore » survival of at least one-half of the animals. Oral use of phenoxymethyl-penicillin in large doses established in the blood and synovial fluid of the damaged knee joint a therapeutic concentration of antibiotic of long duration (not less than a day). In radiation damage to knee joint accompanied by fracture of the bone fragment, the best method of surgical treatment is osteosynthesis using metal parts. In open infection of a damaged knee joint against a radiation sickness background, even with proper treatment a tendency toward formation of deforming arthrosis was observed. (OTS)« less

Designs and performance of three new microprocessor-controlled knee joints.

PubMed

Thiele, Julius; Schöllig, Christina; Bellmann, Malte; Kraft, Marc

2018-02-09

A crossover design study with a small group of subjects was used to evaluate the performance of three microprocessor-controlled exoprosthetic knee joints (MPKs): C-Leg 4, Plié 3 and Rheo Knee 3. Given that the mechanical designs and control algorithms of the joints determine the user outcome, the influence of these inherent differences on the functional characteristics was investigated in this study. The knee joints were evaluated during level-ground walking at different velocities in a motion analysis laboratory. Additionally, technical analyses using patents, technical documentations and X-ray computed tomography (CT) for each knee joint were performed. The technical analyses showed that only C-Leg 4 and Rheo Knee 3 allow microprocessor-controlled adaptation of the joint resistances for different gait velocities. Furthermore, Plié 3 is not able to provide stance extension damping. The biomechanical results showed that only if a knee joint adapts flexion and extension resistances by the microprocessor all known advantages of MPKs can become apparent. But not all users may benefit from the examined functions: e.g. a good accommodation to fast walking speeds or comfortable stance phase flexion. Hence, a detailed comparison of user demands and performance of the designated knee joint is mandatory to ensure a maximum in user outcome.

Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.

PubMed

Peeler, Jason; Christian, Mathew; Cooper, Juliette; Leiter, Jeffrey; MacDonald, Peter

2015-11-01

To determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA). Prospective, observational, repeated measures investigation. Community-based, multidisciplinary sports medicine clinic. Thirty-one patients aged between 55 and 75 years, with a body mass index ≥25 kg/m and mild-to-moderate knee OA. Twelve-week LBPP-supported low-load treadmill walking regimen. Acute knee joint pain (visual analog scale) during full weight bearing treadmill walking, chronic knee pain, and joint function [Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire] during normal activities of daily living, and thigh muscle strength (isokinetic testing). Appropriate methods of statistical analysis were used to compare data from baseline and follow-up evaluation. Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. Data suggest that an LBPP-supported low-load exercise regimen can be used to significantly diminish knee pain, enhance joint function, and increase thigh muscle strength, while safely promoting pain-free walking exercise in overweight patients with knee OA. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations. This research suggests that LBPP-supported low-load walking is a safe user-friendly mode of exercise that can be successfully used in the management of day-to-day joint symptoms associated with knee OA, helping to improve the physical health, quality of life, and social well-being of North America's aging population.

Joint Motion Quality in Chondromalacia Progression Assessed by Vibroacoustic Signal Analysis.

PubMed

Bączkowicz, Dawid; Majorczyk, Edyta

2016-11-01

Because of the specific biomechanical environment of the patellofemoral joint, chondral disorders, including chondromalacia, often are observed in this articulation. Chondromalacia via pathologic changes in cartilage may lead to qualitative impairment of knee joint motion. To determine the patellofemoral joint motion quality in particular chondromalacia stages and to compare with controls. Retrospective, comparative study. Voivodship hospitals, university biomechanical laboratory. A total of 89 knees with chondromalacia (25 with stage I; 30 with stage II and 34 with stage III) from 50 patients and 64 control healthy knees (from 32 individuals). Vibroacoustic signal pattern analysis of joint motion quality. For all knees vibroacoustic signals were recorded. Each obtained signal was described by variation of mean square, mean range (R4), and power spectral density for frequency of 50-250 Hz (P1) and 250-450 Hz (P2) parameters. Differences between healthy controls and all chondromalacic knees as well as chondromalacia patellae groups were observed as an increase of analyzed parameters (P < .001) with only one exception. No statistically significant difference between control group and stage I of chondromalacia patellae was found. All chondromalacia groups were differentiated by the use of all analyzed parameters (P < .01), whose values correspond to the progress of chondromalacia. Chondromalacia generates abnormal vibroacoustic signals, and there seems to be a relationship between the level of signal amplitude as well as frequency and cartilage destruction from the superficial layer to the subchondral bone. IV. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Patellar position in weight-bearing radiographs compared with non-weight-bearing: significance for the detection of osteoarthritis.

PubMed

Skou, Nikolaj; Egund, Niels

2017-03-01

Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18-87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.

Relationship between quadriceps strength and patellofemoral joint chondral lesions after anterior cruciate ligament reconstruction.

PubMed

Wang, Hai-Jun; Ao, Ying-Fang; Jiang, Dong; Gong, Xi; Wang, Yong-Jian; Wang, Jian; Yu, Jia-Kuo

2015-09-01

The incidence of the patellofemoral joint chondral lesions after anterior cruciate ligament reconstruction (ACLR) is disturbingly high. Few studies have assessed the factors affecting patellofemoral joint chondral lesions postoperatively. The recovery of quadriceps strength after ACLR could be associated with patellofemoral joint cartilage damage. Cohort study; Level of evidence, 3. A total of 88 patients who underwent arthroscopic anatomic double-bundle ACLR with hamstring autografts received second-look arthroscopy at the time of metal staple removal at an average of 24.1 months (range, 12-51 months) postoperatively. All patients underwent standardized isokinetic strength testing for bilateral quadriceps and hamstrings 1 to 2 days before second-look arthroscopy. The patients were divided into 2 groups: Patients in group 1 had a ≥20% deficit on the peak torque measures for quadriceps compared with that of the contralateral knee, whereas those in group 2 had a <20% deficit on peak torque. Cartilage status at the patellofemoral joint and tibiofemoral joint were evaluated by second-look arthroscopy and the Outerbridge classification. Other assessments included the International Knee Documentation Committee (IKDC) score, Tegner and Lysholm scores, side-to-side difference on KT-2000 arthrometer, and range of motion. There were 42 patients included in group 1 and 46 patients in group 2. The mean postoperative quadriceps peak torque of the involved knee compared with the contralateral knee was 70% (range, 57%-80%) in group 1 and 95% (range, 81%-116%) in group 2. For all patients, a significant worsening was seen in the patellar and trochlear cartilage (P = .030 and <.001, respectively) but not at the medial or lateral tibiofemoral joint after ACLR. A significant worsening in the status of both patellar and trochlear cartilage was seen after ACLR in group 1 (P = .013 and =.011, respectively) and of trochlear cartilage in group 2 (P = .006). Significantly fewer severe chondral lesions of the patella were found in group 2 than in group 1 (proportion of patients whose cartilage grade worsened: 26% vs 48%, P < .05; difference in cartilage grade: 0.09 vs 0.62, P < .05). There was no significant difference for trochlear chondral worsening between the 2 groups. No significant differences were detected between the 2 groups in terms of hamstring strength; Lysholm, Tegner, and IKDC scores; KT-2000 arthrometer anterior laxity; or range of motion. Greater than 80% recovery of quadriceps strength after ACLR is associated with less severe patellar cartilage damage at short-term follow-up. © 2015 The Author(s).

International consensus on the definition and classification of fibrosis of the knee joint.

PubMed

Kalson, N S; Borthwick, L A; Mann, D A; Deehan, D J; Lewis, P; Mann, C; Mont, M A; Morgan-Jones, R; Oussedik, S; Williams, F M K; Toms, A; Argenson, J N; Bellemans, J; Bhave, A; Furnes, O; Gollwitzer, H; Haddad, F S; Hofmann, S; Krenn, V

2016-11-01

The aim of this consensus was to develop a definition of post-operative fibrosis of the knee. An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds. Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, < 70°) or extension deficit (5° to 10°, 11° to 20°, > 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed. The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88. ©2016 The British Editorial Society of Bone & Joint Surgery.

Manipulation under Anesthesia for Stiffness after Total Knee Arthroplasty

PubMed Central

Yoo, Ju-Hyung; Oh, Jin-Cheol; Park, Sang-Hoon

2015-01-01

Purpose This study evaluated the incidence of manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty (TKA) and the degree of joint motion recovery after MUA. Materials and Methods A total of 4,449 TKAs (2,973 patients) were performed between March 2000 and August 2014. Cases that underwent MUA for stiffness after TKA were reviewed. TKAs were performed using the conventional procedure in 329 cases and using the minimally invasive procedure in 4,120 cases. The preoperative range of joint motion, timing of manipulation, diagnosis and the range of joint motion before and after MUA were retrospectively investigated. Results MUA was carried out in 22 cases (16 patients), resulting in the incidence of 0.5%. The incidence after the conventional procedure was 1.2% and 0.4% after the minimally invasive procedure. In the manipulated knees, the preoperative range of motion (ROM) was 102.5°±26.7°, and the preoperative diagnosis was osteoarthritis in 19 cases, rheumatoid arthritis in two, and infection sequela in one. MUA was performed 4.7±3.0 weeks after TKA. The average ROM was 64.5°±13.5° before manipulation. At an average of 64.3±41.3 months after manipulation, the ROM was recovered to 113.4°±31.2°, which was an additional 49.9° improvement in flexion. Conclusions The satisfactory recovery of joint movement was achieved when MUA for stiffness was performed relatively early after TKA. PMID:26676186

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.

Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study

PubMed Central

Lovecchio, Nicola; Zago, Matteo; Sciumè, Luciana; Lopresti, Maurizio; Sforza, Chiarella

2015-01-01

[Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1–3.4%). Angle-angle plot subtended areas decreased from 108° to 40°2 (hip) and from 204° to 85°2 (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60–70° of knee flexion. PMID:26311992

Osteophyte formation after ACL rupture in mice is associated with joint restabilization and loss of range of motion

PubMed Central

Hsia, Allison W.; Anderson, Matthew J.; Heffner, Mollie A.; Lagmay, Earl P.; Zavodovskaya, Regina; Christiansen, Blaine A.

2016-01-01

Osteophytes are a typical radiographic finding during osteoarthritis (OA). Osteophytes are thought to form in response to joint instability, however the time course of osteophyte formation and joint stabilization following joint injury is not well understood. In this study, we investigated the time course of osteophyte formation and joint function following non-invasive knee injury in mice. We hypothesized that initial joint instability following knee injury would initiate osteophyte formation, which would in turn restabilize the joint and reduce range of motion (ROM). Mice were subjected to non-invasive anterior cruciate ligament (ACL) rupture. Anterior-posterior (AP) joint laxity, ROM, and chondro/osteophyte formation were measured immediately after injury, and 2, 4, 6, and 8 weeks post-injury. Chondrophyte areas at each time point were measured with histology, while mineralized osteophyte volume was determined using micro-computed tomography. Immediately after ACL rupture, AP joint laxity was increased 2-fold, while ROM was increased 11.7%. Chondrophytes appeared by 2 weeks post-injury, corresponding with a decrease in AP joint laxity and ROM. By 8 weeks post-injury, considerable osteophyte formation was observed around the joint, AP joint laxity returned to control levels, and joint ROM decreased to 61% of control values. These data support a role for chondro/osteophytes in joint restabilization after injury, and provide crucial insight into the time course and pathology of joint degeneration during OA development in the mouse. PMID:27031945

Gait and balance of transfemoral amputees using passive mechanical and microprocessor-controlled prosthetic knees.

PubMed

Kaufman, K R; Levine, J A; Brey, R H; Iverson, B K; McCrady, S K; Padgett, D J; Joyner, M J

2007-10-01

Microprocessor-controlled knee joints appeared on the market a decade ago. These joints are more sophisticated and more expensive than mechanical ones. The literature is contradictory regarding changes in gait and balance when using these sophisticated devices. This study employed a crossover design to assess the comparative performance of a passive mechanical knee prosthesis compared to a microprocessor-controlled knee joint in 15 subjects with an above-knee amputation. Objective measurements of gait and balance were obtained. Subjects demonstrated significantly improved gait characteristics after receiving the microprocessor-controlled prosthetic knee joint (p<0.01). Improvements in gait were a transition from a hyperextended knee to a flexed knee during loading response which resulted in a change from an internal knee flexor moment to a knee extensor moment. The participants' balance also improved (p<0.01). All conditions of the Sensory Organization Test (SOT) demonstrated improvements in equilibrium score. The composite score also increased. Transfemoral amputees using a microprocessor-controlled knee have significant improvements in gait and balance.

Increased expression of damage-associated molecular patterns (DAMPs) in osteoarthritis of human knee joint compared to hip joint.

PubMed

Rosenberg, John H; Rai, Vikrant; Dilisio, Matthew F; Sekundiak, Todd D; Agrawal, Devendra K

2017-12-01

Osteoarthritis (OA) is a degenerative disease characterized by the destruction of cartilage. The greatest risk factors for the development of OA include age and obesity. Recent studies suggest the role of inflammation in the pathogenesis of OA. The two most common locations for OA to occur are in the knee and hip joints. The knee joint experiences more mechanical stress, cartilage degeneration, and inflammation than the hip joint. This could contribute to the increased incidence of OA in the knee joint. Damage-associated molecular patterns (DAMPs), including high-mobility group box-1, receptor for advanced glycation end products, and alarmins (S100A8 and S100A9), are released in the joint in response to stress-mediated chondrocyte and cartilage damage. This facilitates increased cartilage degradation and inflammation in the joint. Studies have documented the role of DAMPs in the pathogenesis of OA; however, the comparison of DAMPs and its influence on OA has not been discussed. In this study, we compared the DAMPs between OA knee and hip joints and found a significant difference in the levels of DAMPs expressed in the knee joint compared to the hip joint. The increased levels of DAMPs suggest a difference in the underlying pathogenesis of OA in the knee and the hip and highlights DAMPs as potential therapeutic targets for OA in the future.

[Application of radiofrequency vaporization in arthroscopic treatment of patellofemoral joint disorders].

PubMed

Xuan, Tao; Xu, Bin; Xu, Honggang; Wang, Hao

2009-01-01

To explore the treatment of patellofemoral joint disorders with radiofrequency vaporization under arthroscopy. From June 2004 to June 2007, 86 cases of patellofemoral joint disorder (98 knees) were treated by lateral retinacular release or medial retinacular tighten added, and combined with bipolar radiofrequency chondroplasty under arthroscopy. There were 30 males (34 knees) and 56 females (64 knees), aging 15-68 years (mean 40 years). The locations were left in 42 cases, right in 32 cases, both sides in 12 cases. The disease course was 3 months to 6 years (mean 30.5 months). In 98 knees, there were 28 knees of static patellar tilt, 10 knees of static patellar subluxation, 45 knees of dynamic patellar tilt and 15 knees of dynamic patellar subluxation. The Lysholm knee score preoperatively was 57.72 +/- 8.86. The patellofemoral cartilage abnormality were classified according to the Outerbridge grade (18 knees of grade I, 36 knees of grade II, 32 knees of grade III and 12 knees of grade IV). The incisions healed by first intention without complications such as infection or hemarthrosis. Seventy-five cases (82 knees) were followed up 8-37 months (mean 20.6 months). One month after operation, the patellofemoral joint pain was relieved remarkably, the knee joint activity was good and the radiological outcomes was also satisfactory. Six months after operation, the Lysholm knee score was improved significantly in patients of grades I, II and III (P < 0.05), while there was no significant change in patients of grade IV (P > 0.05). The postoperative score was 69.95 +/- 5.42 (P < 0.05). Radiofrequency vaporization chondroplasty and soft tissue balance under arthroscopy are advantageous in terms of easy operation, less injury, slight reaction and have good effect on patellofemoral joint disorders.

Measurement of Posterior Tibial Slope Using Magnetic Resonance Imaging.

PubMed

Karimi, Elham; Norouzian, Mohsen; Birjandinejad, Ali; Zandi, Reza; Makhmalbaf, Hadi

2017-11-01

Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which affects knee joint stability. Posterior tibial slope has impact on flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at Imam Reza hospital in Mashhad, Iran. All patients, selected and enrolled for MRI in this study, were admitted for knee pain with uncertain clinical history. According to initial physical knee examinations the study subjects were reported healthy. The mean posterior tibial slope was 7.78± 2.48 degrees in the medial compartment and 6.85± 2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope ( P ≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Comparison of different studies revealed that the PTS value in our study is different from other communities, which can be associated with genetic and racial factors. The results of our study are useful to PTS reconstruction in surgeries.

Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery?

PubMed

Maderbacher, Günther; Keshmiri, Armin; Zeman, Florian; Grifka, Joachim; Baier, Clemens

2015-11-01

Reconstructing the natural joint line in knee revision surgery improves clinical and functional outcome but may be challenging when both cartilage and bone were removed during previous operations. Assessing joint lines (JLs) by means of bony landmarks is inadvisable because of large variations in human anatomy. Because of the inherent symmetry of the human body, we hypothesised that JLs may be directly assessed by measuring the distances from the bony landmarks to the JL of the contralateral knee by means of radiographic images. Using scaled weight-bearing radiographs in anteroposterior view of both knees, two independent observers measured the distances from the fibular head, the medial and lateral epicondyle, and the adductor tubercle to the JL. A two-sided p value of ≤0.05 was considered statistically significant. Two hundred knees of 100 patients (50 men and 50 women) were examined. For the fibular head, the mean difference between the treated and the control knee was 0.0 mm with narrow confidence limits ranging from -1.1 to 1.1. As a new assessment method, we have suggested to assess the JL by means of radiographs of the contralateral knee. The most precise parameter was found to be the distance between the fibular head and the JL. The level of arthritis, age, gender, visibility of the landmarks, and misalignment did not influence measurement accuracy. This parameter is the first tibia-related landmark for assessing the JL, which advantageously corresponds to the tibia-first technique in revision surgery. Diagnostic Study, Level II.

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 deficits in muscle strength. PMID:27030846

Elastic coupling of limb joints enables faster bipedal walking

PubMed Central

Dean, J.C.; Kuo, A.D.

2008-01-01

The passive dynamics of bipedal limbs alone are sufficient to produce a walking motion, without need for control. Humans augment these dynamics with muscles, actively coordinated to produce stable and economical walking. Present robots using passive dynamics walk much slower, perhaps because they lack elastic muscles that couple the joints. Elastic properties are well known to enhance running gaits, but their effect on walking has yet to be explored. Here we use a computational model of dynamic walking to show that elastic joint coupling can help to coordinate faster walking. In walking powered by trailing leg push-off, the model's speed is normally limited by a swing leg that moves too slowly to avoid stumbling. A uni-articular spring about the knee allows faster but uneconomical walking. A combination of uni-articular hip and knee springs can speed the legs for improved speed and economy, but not without the swing foot scuffing the ground. Bi-articular springs coupling the hips and knees can yield high economy and good ground clearance similar to humans. An important parameter is the knee-to-hip moment arm that greatly affects the existence and stability of gaits, and when selected appropriately can allow for a wide range of speeds. Elastic joint coupling may contribute to the economy and stability of human gait. PMID:18957360

The effect on knee-joint load of instruction in analgesic use compared with neuromuscular exercise in patients with knee osteoarthritis: study protocol for a randomized, single-blind, controlled trial (the EXERPHARMA trial).

PubMed

Clausen, Brian; Holsgaard-Larsen, Anders; Søndergaard, Jens; Christensen, Robin; Andriacchi, Thomas P; Roos, Ewa M

2014-11-15

Knee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression. Treatment modalities that can both relieve pain and reduce knee-joint load would be preferable. The knee-joint load is influenced by functional alignment of the trunk, pelvis, and lower-limb segments with respect to the knee, as well as the ground-reaction force generated during movement. Neuromuscular exercise can influence knee load and decrease knee pain. It includes exercises to improve balance, muscle activation, functional alignment, and functional knee stability. The primary objective of this randomized controlled trial (RCT) is to investigate the efficacy of a NEuroMuscular EXercise (NEMEX) therapy program, compared with optimized analgesics and antiinflammatory drug use, on the measures of knee-joint load in people with mild to moderate medial tibiofemoral knee osteoarthritis. One hundred men and women with mild to moderate medial knee osteoarthritis will be recruited from general medical practices and randomly allocated (1:1) to one of two 8-week treatments, either (a) NEMEX therapy twice a week or (b) information on the recommended use of analgesics and antiinflammatory drugs (acetaminophen and oral NSAIDs) via a pamphlet and video materials. The primary outcome is change in knee load during walking (the Knee Index, a composite score of the first external peak total reaction moment on the knee joint from all three planes based on 3D movement analysis) after 8 weeks of intervention. Secondary outcomes include changes in the external peak knee-adduction moment and impulse and functional performance measures, in addition to changes in self-reported pain, function, health status, and quality of life. These findings will help determine whether 8 weeks of neuromuscular exercise is superior to optimized use of analgesics and antiinflammatory drugs regarding knee-joint load, pain and physical function in people with mild to moderate knee osteoarthritis. ClinicalTrials.gov Identifier: NCT01638962 (July 3, 2012).

The importance of position and path repeatability on force at the knee during six-DOF joint motion.

PubMed

Darcy, Shon P; Gil, Jorge E; Woo, Savio L-Y; Debski, Richard E

2009-06-01

Mechanical devices, such as robotic manipulators have been designed to measure joint and ligament function because of their ability to position a diarthrodial joint in six degrees-of-freedom with fidelity. However, the precision and performance of these testing devices vary. Therefore, the objective of this study was to determine the effect of systematic errors in position and path repeatability of two high-payload robotic manipulators (Manipulators 1 and 2) on the resultant forces at the knee. Using a porcine knee, the position and path repeatability of these manipulators were determined during passive flexion-extension with a coordinate measuring machine. The position repeatability of Manipulator 1 was 0.3 mm in position and 0.2 degrees in orientation while Manipulator 2 had a better position repeatability of 0.1 mm in position and 0.1 degrees in orientation throughout the range of positions examined. The corresponding variability in the resultant force at the knee for these assigned positions was 32+/-33 N for Manipulator 1 and 4+/-1 N for Manipulator 2. Furthermore, the repeatability of the trajectory of each manipulator while moving between assigned positions (path repeatability) was 0.8 mm for Manipulator 1 while the path repeatability for Manipulator 2 was improved (0.1 mm). These path discrepancies produced variability in the resultant force at the knee of 44+/-24 and 21+/-8 N, respectively, for Manipulators 1 and 2 primarily due to contact between the articular surfaces of the tibia and femur. Therefore, improved position and path repeatability yields lower variability in the resultant forces at the knee. Although position repeatability has been the most common criteria for evaluating biomechanical testing devices, the current study has clearly demonstrated that path repeatability can have an even larger effect on the variability in resultant force at the knee. Consequently, the repeatability of the path followed by the joint throughout its prescribed trajectory is as important as the repeatability of the joint at reaching positions making up its trajectory, particularly when joint contact occurs.

Effects of Therapeutic Exercise and Hydrotherapy on Pain Severity and Knee Range of Motion in Patients with Hemophilia: A Randomized Controlled Trial

PubMed Central

Mazloum, Vahid; Rahnama, Nader; Khayambashi, Khalil

2014-01-01

Background: Pain and limited range of motion (ROM) are the crucial subsequent results of joint hemorrhages in individuals with bleeding disorders and hemophilia. Exercise interventions are particularly recommended in treatment of such patients. The purpose of this study was to detect the influences of conventional exercise therapy and hydrotherapy on the knee joint complications in patients with hemophilia. Methods: A total of 40 patients engaging hemophilia A were randomized into one of three groups: Therapeutic exercise (N = 13), hydrotherapy (N = 14) or control (N = 13). While the first two groups followed their specific programs for 4 weeks, routine life-style was maintained by subjects in the control group in this period. To evaluate the pain level and knee ROM the visual analog scale and standard goniometer were utilized, respectively. The outcome was measured at baseline and after completing the prescribed protocols. Data analysis was performed using one-way analysis of variance and Scheffe statistical tests (P < 0.05). Results: Both experimental groups experienced more significant decreasing in pain level (P < 0.001) and knee flexion and extension ROM (P < 0.001) in comparison to the control group. Although the pain was significantly (P < 0.01) more alleviated in participants treated through hydrotherapy in comparison to exercise therapy, the difference in ROM improvement was not statistically significant (P > 0.05). Conclusions: Using hydrotherapy in addition to usual rehabilitation training can result in beneficial effect in terms of pain and knee joint ROM. However, it appears that hydrotherapy is more effective in reducing pain. PMID:24554996

Effects of therapeutic exercise and hydrotherapy on pain severity and knee range of motion in patients with hemophilia: a randomized controlled trial.

PubMed

Mazloum, Vahid; Rahnama, Nader; Khayambashi, Khalil

2014-01-01

Pain and limited range of motion (ROM) are the crucial subsequent results of joint hemorrhages in individuals with bleeding disorders and hemophilia. Exercise interventions are particularly recommended in treatment of such patients. The purpose of this study was to detect the influences of conventional exercise therapy and hydrotherapy on the knee joint complications in patients with hemophilia. A total of 40 patients engaging hemophilia A were randomized into one of three groups: Therapeutic exercise (N = 13), hydrotherapy (N = 14) or control (N = 13). While the first two groups followed their specific programs for 4 weeks, routine life-style was maintained by subjects in the control group in this period. To evaluate the pain level and knee ROM the visual analog scale and standard goniometer were utilized, respectively. The outcome was measured at baseline and after completing the prescribed protocols. Data analysis was performed using one-way analysis of variance and Scheffe statistical tests (P < 0.05). Both experimental groups experienced more significant decreasing in pain level (P < 0.001) and knee flexion and extension ROM (P < 0.001) in comparison to the control group. Although the pain was significantly (P < 0.01) more alleviated in participants treated through hydrotherapy in comparison to exercise therapy, the difference in ROM improvement was not statistically significant (P > 0.05). Using hydrotherapy in addition to usual rehabilitation training can result in beneficial effect in terms of pain and knee joint ROM. However, it appears that hydrotherapy is more effective in reducing pain.

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

Dissecting the contribution of knee joint NGF to spinal nociceptive sensitization in a model of OA pain in the rat.

PubMed

Sagar, D R; Nwosu, L; Walsh, D A; Chapman, V

2015-06-01

Although analgesic approaches targeting nerve growth factor (NGF) for the treatment of osteoarthritis (OA) pain remain of clinical interest, neurophysiological mechanisms by which NGF contribute to OA pain remain unclear. We investigated the impact of local elevation of knee joint NGF on knee joint, vs remote (hindpaw), evoked responses of spinal neurones in a rodent model of OA pain. In vivo spinal electrophysiology was carried out in anaesthetised rats with established pain behaviour and joint pathology following intra-articular injection of monosodium iodoacetate (MIA), vs injection of saline. Neuronal responses to knee joint extension and flexion, mechanical punctate stimulation of the peripheral receptive fields over the knee and at a remote site (ipsilateral hind paw) were studied before, and following, intra-articular injection of NGF (10 μg/50 μl) or saline. MIA-injected rats exhibited significant local (knee joint) and remote (lowered hindpaw withdrawal thresholds) changes in pain behaviour, and joint pathology. Intra-articular injection of NGF significantly (P < 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. The facilitatory effects of intra-articular injection of NGF on spinal neurones receiving input from the knee joint provide a mechanistic basis for NGF mediated augmentation of OA knee pain, however additional mechanisms may contribute to the spread of pain to remote sites. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

An acoustic startle alters knee joint stiffness and neuromuscular control.

PubMed

DeAngelis, A I; Needle, A R; Kaminski, T W; Royer, T R; Knight, C A; Swanik, C B

2015-08-01

Growing evidence suggests that the nervous system contributes to non-contact knee ligament injury, but limited evidence has measured the effect of extrinsic events on joint stability. Following unanticipated events, the startle reflex leads to universal stiffening of the limbs, but no studies have investigated how an acoustic startle influences knee stiffness and muscle activation during a dynamic knee perturbation. Thirty-six individuals were tested for knee stiffness and muscle activation of the quadriceps and hamstrings. Subjects were seated and instructed to resist a 40-degree knee flexion perturbation from a relaxed state. During some trials, an acoustic startle (50 ms, 1000 Hz, 100 dB) was applied 100 ms prior to the perturbation. Knee stiffness, muscle amplitude, and timing were quantified across time, muscle, and startle conditions. The acoustic startle increased short-range (no startle: 0.044 ± 0.011 N·m/deg/kg; average startle: 0.047 ± 0.01 N·m/deg/kg) and total knee stiffness (no startle: 0.036 ± 0.01 N·m/deg/kg; first startle 0.027 ± 0.02 N·m/deg/kg). Additionally, the startle contributed to decreased [vastus medialis (VM): 13.76 ± 33.6%; vastus lateralis (VL): 6.72 ± 37.4%] but earlier (VM: 0.133 ± 0.17 s; VL: 0.124 ± 0.17 s) activation of the quadriceps muscles. The results of this study indicate that the startle response can significantly disrupt knee stiffness regulation required to maintain joint stability. Further studies should explore the role of unanticipated events on unintentional injury. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Influence of Joint Loading on Bone Marrow Lesions in the Knee: A Systematic Review With Meta-analysis.

PubMed

Beckwée, David; Vaes, Peter; Shahabpour, Maryam; Muyldermans, Ronald; Rommers, Nikki; Bautmans, Ivan

2015-12-01

Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood. To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint. Meta-analysis. Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible. A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found. Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions. It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load. © 2015 The Author(s).

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

2017-08-01

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 35:1634-1643, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Body mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis.

PubMed

Harding, Graeme T; Hubley-Kozey, Cheryl L; Dunbar, Michael J; Stanish, William D; Astephen Wilson, Janie L

2012-11-01

Obesity is a highly cited risk factor for knee osteoarthritis (OA), but its role in knee OA pathogenesis and progression is not as clear. Excess weight may contribute to an increased mechanical burden and altered dynamic movement and loading patterns at the knee. The objective of this study was to examine the interacting role of moderate knee OA disease presence and obesity on knee joint mechanics during gait. Gait analysis was performed on 104 asymptomatic and 140 individuals with moderate knee OA. Each subject group was divided into three body mass categories based on body mass index (BMI): healthy weight (BMI<25), overweight (25≤BMI≤30), and obese (BMI>30). Three-dimensional knee joint angles and net external knee joint moments were calculated and waveform principal component analysis (PCA) was applied to extract major patterns of variability from each. PC scores for major patterns were compared between groups using a two-factor ANOVA. Significant BMI main effects were found in the pattern of the knee adduction moment, the knee flexion moment, and the knee rotation moment during gait. Two interaction effects between moderate OA disease presence and BMI were also found that described different changes in the knee flexion moment and the knee flexion angle with increased BMI with and without knee OA. Our results suggest that increased BMI is associated with different changes in biomechanical patterns of the knee joint during gait depending on the presence of moderate knee OA. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Early signs of osteoarthritis in professional ballet dancers: a preliminary study.

PubMed

Angioi, Manuela; Maffulli, Gayle D; McCormack, Moira; Morrissey, Dylan; Chan, Otto; Maffulli, Nicola

2014-09-01

To investigate a cohort of professional ballet dancers for evidence of early signs of osteoarthritis (OA). One radiologist and 1 orthopedic surgeon specialized in musculoskeletal disorders analyzed magnetic resonance imaging scans independently. University Teaching Hospital. Fifteen professional ballet dancers (4 males and 11 females; age range, 19-36 years) experiencing chronic pain in the hip, knee, spine, ankle, or foot joints. Presence of osteophytes, subchondral sclerosis, joint space narrowing, cysts, and bone marrow changes; the Kellgren and Lawrence scale was used to quantify the knee OA. In the knee, there was thinning and irregularity of the articular cartilage over the medial femoral condyle and bone marrow changes within the lateral femoral condyle. In the hip, there was a loss of joint space and a frayed labrum with deep recess. The first metatarsophalangeal joint showed evidence of osteophytic development. Early signs of OA, in different joints, were present in a small but highly selected cohort of professional ballet dancers. In future, prospective studies among a number of ballet companies should control for medical and natural history alongside the visual analysis of images and plain radiographs to confirm these preliminary results.

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. Copyright © 2011 Elsevier Inc. All rights reserved.

Patellofemoral Joint Loads During Running at the Time of Return to Sport in Elite Athletes With ACL Reconstruction.

PubMed

Herrington, Lee; Alarifi, Saud; Jones, Richard

2017-10-01

Patellofemoral joint pain and degeneration are common in patients who undergo anterior cruciate ligament reconstruction (ACLR). The presence of patellofemoral joint pain significantly affects the patient's ability to continue sport participation and may even affect participation in activities of daily living. The mechanisms behind patellofemoral joint pain and degeneration are unclear, but previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear whether this process occurs after ACLR. To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to the noninjured knee and matched control knees. Controlled laboratory study. Thirty-four elite sports practitioners who had undergone ACLR and 34 age- and sex-matched controls participated in the study. The participants' running gait was assessed via 3D motion capture, and knee loads and forces were calculated by use of inverse dynamics. A significance difference was found in knee extensor moment, knee flexion angles, patellofemoral contact force (about 23% greater), and patellofemoral contact pressure (about 27% greater) between the ACLR and the noninjured limb ( P ≤ .04) and between the ACLR and the control limb ( P ≤ .04); no significant differences were found between the noninjured and control limbs ( P ≥ .44). Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared with the noninjured and control knees. Altered levels of patellofemoral stress in the ACLR knee during running may predispose individuals to patellofemoral joint pain.

Experimental cryo-irrigation of the knee joint.

PubMed

Chen, S C; Helal, B; Revell, P A; Brocklehurst, R; Currey, H L

1986-10-01

Experiments have been carried out to test the feasibility of using cryo-irrigation as a means of ablating the synovium in the rheumatoid knee joint. Cryo-irrigation was performed by a cooling machine and pump, which circulated cold 200/10 centistoke (cSt) silicone through the knee joint of rabbits anaesthetised with intravenous (IV) 'Saffan'. Fluid left the joint at -5 to -10 degrees C. Sixteen normal New Zealand rabbits received cryo-irrigation of one knee joint for 10-20 minutes and were killed at one day, and one, two, and 12 weeks thereafter. Judged by radioactive sulphate incorporation there was no impairment of chondrocyte function in the articular cartilage of irrigated joints. Histological examination showed mild synovitis and some loss of staining of superficial cartilage in 6/16 irrigated joints (v 1/16 control joints). Similar treatment of rabbit joints in which the Glynn model of synovitis had been induced showed marked reduction of synovitis 14-45 days after silicone treatment. Nine of 26 animals in which synovitis was induced in both knees and cryo-irrigation performed in one knee died either immediately postoperatively or during the next week. These deaths remain unexplained. A single dog received cryo-irrigation of one knee (-6 to -9 degrees C for 22 min) and remained perfectly well up to sacrifice at six months, when the joint appeared histologically completely normal.

The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function.

PubMed

Hicks-Little, Charlie A; Peindl, Richard D; Hubbard-Turner, Tricia J; Cordova, Mitchell L

2016-08-01

Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lower-extremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear. To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures. Case control. Sports-medicine research laboratory. 18 participants with knee OA and 18 healthy matched controls. Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN). WOMAC scores, A-P (mm), and ALIGN (°). A significant multivariate main effect for group (Wilks' Λ = 0.30, F7,26 = 8.58, P < .0001) was found. Knee-OA participants differed in WOMAC scores (P < .0001) but did not differ from healthy controls on ALIGN (P = .49) or total A-P (P = .66). No significant relationships were identified among main outcome measures. These data demonstrate that participants with early-stage knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants' subjective scores, ALIGN, or A-P measures in this study.

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.

Can combined use of low-level lasers and hyaluronic acid injections prolong the longevity of degenerative knee joints?

PubMed Central

Ip, David; Fu, Nga Yue

2015-01-01

Background This study evaluated whether half-yearly hyaluronic acid injection together with low-level laser therapy in addition to standard conventional physical therapy can successfully postpone the need for joint replacement surgery in elderly patients with bilateral symptomatic tricompartmental knee arthritis. Methods In this prospective, double-blind, placebo-controlled study, 70 consecutive unselected elderly patients with bilateral tricompartmental knee arthritis were assigned at random to either one of two conservative treatment protocols to either one of the painful knees. Protocol A consisted of conventional physical therapy plus a sham light source plus saline injection, and protocol B consisted of protocol A with addition of half-yearly hyaluronic acid injection as well as low-level laser treatment instead of using saline and a sham light source. Treatment failure was defined as breakthrough pain necessitating joint replacement. Results Among the 140 painful knees treated with either protocol A or protocol B, only one of the 70 painful knees treated by protocol B required joint replacement, whereas 15 of the 70 painful knees treated by protocol A needed joint replacement surgery (P<0.05). Conclusion We conclude that half-yearly hyaluronic acid injections together with low-level laser therapy should be incorporated into the standard conservative treatment protocol for symptomatic knee arthritis, because it may prolong the longevity of the knee joint without the need for joint replacement. PMID:26346122

Arthroscopic evaluation of patellofemoral congruence with rotation of the knee joint and electrical stimulation of the quadriceps.

PubMed

Suganuma, Jun; Mochizuki, Ryuta; Inoue, Yutaka; Kitamura, Kazuya; Honda, Akio

2014-02-01

The aim of this study was to investigate the pathoanatomic features of patellar instability by arthroscopically comparing patellofemoral congruence with rotation of the knee joint and/or electrical stimulation of the quadriceps (ESQ) between knees with and without patellar instability. We retrospectively examined 83 knee joints in 83 patients. The joints were classified into 2 groups: group 1 comprised those without a history of patellar dislocation and included 59 patients (25 male and 34 female patients), and group 2 comprised those with a history of patellar dislocation and included 24 patients (9 male and 15 female patients). Evaluation of patellofemoral congruence at 30° of flexion of the knee joint was conducted based on an axial radiograph and arthroscopic findings. The congruence angle was measured on the radiograph. The position of the patellar central ridge (PPCR) on the trochlear groove during arthroscopy was measured using still video frames of knee joints with rotational stress and/or ESQ. Statistical differences in the measurements between the 2 groups were assessed with the unpaired t test and the area under the receiver operating characteristic curve of each measurement. There were significant differences (P < .0001) between the 2 groups in the congruence angle on radiographs and PPCR in knee joints with rotational stress and/or ESQ on arthroscopy. External and internal rotation of the knee joint caused lateral and medial patellar shift, respectively, in both groups, but the shift was significantly larger in group 2. ESQ in addition to rotation caused further patellar shift in group 2 but reduced patellar shift in group 1. Measurement of PPCR with external rotation of the knee and ESQ was the only method to show an area under the receiver operating characteristic curve of 1. There were significant differences in the effects of rotation of the knee joint and/or ESQ on patellofemoral congruence at 30° of flexion of the knee joint on arthroscopy between knees with and without patellar instability. Level III, diagnostic study of nonconsecutive patients. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

PubMed

Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

2014-05-01

To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001). Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

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.

Radiologic changes of ankle joint after total knee arthroplasty.

PubMed

Lee, Jung Hee; Jeong, Bi O

2012-12-01

The authors noticed that ankle joint osteoarthritis was not uncommon when lower extremity malalignment, such as a knee varus deformity, was present as a result of severe osteoarthritis of the knee. The purpose of this study was to analyze radiologic changes of the ankle joint after total knee arthroplasty. This study included 142 cases in 110 patients who underwent total knee arthroplasty and were followed for at least 3 years. The varus knee group included 128 cases and the valgus knee group included 14 cases. On anteroposterior standing lower extremity radiographs, varus and valgus angles of the knee were measured preoperatively and at the last follow-up. The angle between the ground surface and the distal tibial plafond as well as the upper talus was also measured. In addition, tibial anterior surface angle, talar tilt, space between the medial malleolar distal tip and the medial articular surface of the talus, and medial tibiotalar joint space of the ankle joint were measured. Out of 142 cases, 50 (35.2%) had arthritis in the ankle before total knee arthroplasty and 31 (21.8%) had newly developed or progressive arthritis after surgery. In particular, the varus knee group demonstrated statistically significant differences in preoperative varus deformity, preoperative talar tilt, and postoperative correction angle between the cases that developed or had progressive arthritis and those that did not show any changes (p < .05). After total knee arthroplasty, arthritis developed or progressed in the ankle of many cases radiographically. In particular, when the preoperative talar tilt increased medial to the ankle or the postoperative correction angle was large, the incidence of arthritis in the ankle joint increased. The authors recommend more cautious follow-up on the symptoms of the ankle joint after total knee arthroplasty.

Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial.

PubMed

Henriksen, M; Hunter, D J; Dam, E B; Messier, S P; Andriacchi, T P; Lohmander, L S; Aaboe, J; Boesen, M; Gudbergsen, H; Bliddal, H; Christensen, R

2013-12-01

To investigate whether increased knee joint loading due to improved ambulatory function and walking speed following weight loss achieved over 16 weeks accelerates symptomatic and structural disease progression over a subsequent 1 year weight maintenance period in an obese population with knee osteoarthritis (OA). Data from a prospective study of weight loss in obese patients with knee OA (the CARtilage in obese knee OsteoarThritis (CAROT) study) were used to determine changes in knee joint compressive loadings (model estimated) during walking after a successful 16 week weight loss intervention. The participants were divided into 'Unloaders' (participants that reduced joint loads) and 'Loaders' (participants that increased joint loads). The primary symptomatic outcome was changes in knee symptoms, measured with the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire, during a subsequent 52 weeks weight maintenance period. The primary structural outcome was changes in tibiofemoral cartilage loss assessed semi-quantitatively (Boston Leeds Knee Osteoarthritis Score (BLOKS) from MRI after the 52 weight maintenance period. 157 participants (82% of the CAROT cohort) with medial and/or lateral knee OA were classified as Unloaders (n = 100) or Loaders (n = 57). The groups showed similar significant changes in symptoms (group difference: -2.4 KOOS points [95% CI -6.8:1.9]) and cartilage loss (group difference: -0.06 BLOKS points [95% CI -0.22:0.11) after 1 year, with no statistically significant differences between Loaders and Unloaders. For obese patients undergoing a significant weight loss, increased knee joint loading for 1 year was not associated with accelerated symptomatic and structural disease progression compared to a similar weight loss group that had reduced ambulatory compressive knee joint loads. NCT00655941. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Knee joint effusion following ipsilateral hip surgery.

PubMed

Christodoulou, A G; Givissis, P; Antonarakos, P D; Petsatodis, G E; Hatzokos, I; Pournaras, J D

2010-12-01

To correlate patellar reflex inhibition with sympathetic knee joint effusion. 65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n = 49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n = 38) or hip hemiarthroplasty using the posterior approach (n = 18) for subcapital femoral fractures (n = 28) or osteoarthritis (n = 28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested. In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion (r = 0.843, p = 0.035). These 2 factors correlated significantly for all 3 surgical approaches (p < 0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p = 0.033) and knee joint effusion on day 2 (p = 0.051). Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.

Knee joint replacement

MedlinePlus

... Knee joint replacement - series References American Academy of Orthopedic Surgeons (AAOS) website. Treatment of osteoarthritis of the knee: evidence-based guideline 2nd edition (summary) . www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf . Updated May 18, 2013. Accessed ...

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 the course of rehabilitation or preventive therapies. PMID:28319145

Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants.

PubMed

Kutzner, Ines; Richter, Anja; Gordt, Katharina; 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 the course of rehabilitation or preventive therapies.

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 were not significantly associated with abnormal KJLO after OWHTO. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Normal axial alignment of the lower extremity and load-bearing distribution at the knee.

PubMed

Hsu, R W; Himeno, S; Coventry, M B; Chao, E Y

1990-06-01

Based on a series of 120 normal subjects of different gender and age, the geometry of the knee joint was analyzed using a full-length weight-bearing roentgenogram of the lower extremity. A special computer program based on the theory of a rigid body spring model was applied to calculate the important anatomic and biomechanical factors of the knee joint. The tibiofemoral mechanical angle was 1.2 degrees varus. Hence, it is difficult to rationalize the 3 degree varus placement of the tibial component in total knee arthroplasty suggested by some authors. The distal femoral anatomic valgus (measured from the lower one-half of the femur) was 4.2 degrees in reference to its mechanical axis. This angle became 4.9 degrees when the full-length femoral anatomic axis was used. When simulating a one-legged weight-bearing stance by shifting the upper-body gravity closer to the knee joint, 75% of the knee joint load passed through the medial tibial plateau. The knee joint-line obliquity was more varus in male subjects. The female subjects had a higher peak joint pressure and a greater patello-tibial Q angle. Age had little effect on the factors relating to axial alignment of the lower extremity and load transmission through the knee joint.

Contribution of tibiofemoral joint contact to net loads at the knee in gait.

PubMed

Walter, Jonathan P; Korkmaz, Nuray; Fregly, Benjamin J; Pandy, Marcus G

2015-07-01

Inverse dynamics analysis is commonly used to estimate the net loads at a joint during human motion. Most lower-limb models of movement represent the knee as a simple hinge joint when calculating muscle forces. This approach is limited because it neglects the contributions from tibiofemoral joint contact forces and may therefore lead to errors in estimated muscle forces. The aim of this study was to quantify the contributions of tibiofemoral joint contact loads to the net knee loads calculated from inverse dynamics for multiple subjects and multiple gait patterns. Tibiofemoral joint contact loads were measured in four subjects with instrumented implants as each subject walked at their preferred speed (normal gait) and performed prescribed gait modifications designed to treat medial knee osteoarthritis. Tibiofemoral contact loads contributed substantially to the net knee extension and knee adduction moments in normal gait with mean values of 16% and 54%, respectively. These findings suggest that knee-contact kinematics and loads should be included in lower-limb models of movement for more accurate determination of muscle forces. The results of this study may be used to guide the development of more realistic lower-limb models that account for the effects of tibiofemoral joint contact at the knee. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Does metaphyseal cement augmentation in fracture management influence the adjacent subchondral bone and joint cartilage?: an in vivo study in sheep stifle joints.

PubMed

Goetzen, Michael; Hofmann-Fliri, Ladina; Arens, Daniel; Zeiter, Stephan; Stadelmann, Vincent; Nehrbass, Dirk; Richards, R Geoff; Blauth, Michael

2015-01-01

Augmentation of implants with polymethylmethacrylate (PMMA) bone cement in osteoporotic fractures is a promising approach to increase implant purchase. Side effects of PMMA for the metaphyseal bone, particularly for the adjacent subchondral bone plate and joint cartilage, have not yet been studied. The following experimental study investigates whether subchondral PMMA injection compromises the homeostasis of the subchondral bone and/or the joint cartilage.Ten mature sheep were used to simulate subchondral PMMA injection. Follow-ups of 2 (4 animals) and 4 (6 animals) months were chosen to investigate possible cartilage damage and subchondral plate alterations in the knee. Evaluation was completed by means of high-resolution peripheral quantitative computed tomography (HRpQCT) imaging, histopathological osteoarthritis scoring, and determination of glycosaminoglycan content in the joint cartilage. Results were compared with the untreated contralateral knee and statistically analyzed using nonparametric tests.Evaluation of the histological osteoarthritis score revealed no obvious cartilage damage for the treated knee; median histological score after 2 months 0 (range 4), after 4 months 1 (range 5). There was no significant difference when compared with the untreated control site after 2 and 4 months (P = 0.23 and 0.76, respectively). HRpQCT imaging showed no damage to the metaphyseal trabeculae. Glycosaminoglycan measurements of the treated joint cartilage after 4 months revealed no significant difference compared with the untreated cartilage (P = 0.24).The findings of this study support initial clinical observation that PMMA implant augmentation of metaphyseal fractures appears to be a safe procedure for fixation without harming the subchondral bone plate and adjacent joint cartilage.

Brief communication: Hip joint mobility in free-ranging rhesus macaques

PubMed Central

Hammond, Ashley S.; Johnson, Victoria P.; Higham, James P.

2016-01-01

Objectives We aimed to test for differences in hip joint range of motion (ROM) between captive and free-ranging rhesus macaques (Macaca mulatta), particularly for hip joint abduction, which previous studies of captive macaques have found to be lower than predicted. Materials and Methods Hip ROM was assessed following standard joint measurement methodology in anesthetized adult free-ranging rhesus macaques (n=39) from Cayo Santiago, and compared to published ROM data from captive rhesus macaques (n=16) (Hammond 2014a, American Journal of Physical Anthropology). Significant differences between populations were detected using one-way analysis of variance (p<0.05). Results In a sample of pooled sexes and ages, free-ranging macaques are capable of increased hip abduction, flexion, and internal rotation compared to captive individuals. These differences in joint excursion resulted in free-ranging individuals having significantly increased ROM for hip adduction-abduction, rotation, flexion-extension, and the distance spanned by the knee during hip abduction. When looking at data for a smaller sample of age-matched males, fewer ROM differences are significant, but free-ranging males have significantly increased hip abduction, internal rotation, range of flexion-extension, and distance spanned by the knee during hip abduction compared to captive males of similar age. Discussion Our results suggest that a spatially restrictive environment results in decreased hip mobility in cage-confined animals and ultimately limits the potential limb postures in captive macaques. These results have implications for selection of animal samples in model validation studies, as well as laboratory animal husbandry practices. PMID:27731892

Soreness-related changes in three-dimensional running biomechanics following eccentric knee extensor exercise.

PubMed

Paquette, Max R; Peel, Shelby A; Schilling, Brian K; Melcher, Dan A; Bloomer, Richard J

2017-06-01

Runners often experience delayed onset muscle soreness (DOMS), especially of the knee extensors, following prolonged running. Sagittal knee joint biomechanics are altered in the presence of knee extensor DOMS but it is unclear how muscle soreness affects lower limb biomechanics in other planes of motion. The purpose of this study was to assess the effects of knee extensor DOMS on three-dimensional (3D) lower limb biomechanics during running. Thirty-three healthy men (25.8 ± 6.8 years; 84.1 ± 9.2 kg; 1.77 ± 0.07 m) completed an isolated eccentric knee extensor damaging protocol to elicit DOMS. Biomechanics of over-ground running at a set speed of 3.35 m s -1 ±5% were measured before eccentric exercise (baseline) and, 24 h and 48 h following exercise in the presence of knee extensor DOMS. Knee flexion ROM was reduced at 48 h (P = 0.01; d = 0.26), and peak knee extensor moment was reduced at 24 h (P = 0.001; d = 0.49) and 48 h (P < 0.001; d = 0.68) compared to baseline. Frontal and transverse plane biomechanics were unaffected by the presence of DOMS (P > 0.05). Peak positive ankle and knee joint powers and, peak negative knee joint power were all reduced from baseline to 24 h and 48 h (P < 0.05). These findings suggest that knee extensor DOMS greatly influences sagittal knee joint angular kinetics and, reduces sagittal power production at the ankle joint. However, knee extensor DOMS does not affect frontal and transverse plane lower limb joint biomechanics during running.

Kinematically aligned TKA can align knee joint line to horizontal.

PubMed

Ji, Hyung-Min; Han, Jun; Jin, Dong San; Seo, Hyunseok; Won, Ye-Yeon

2016-08-01

The joint line of the native knee is horizontal to the floor and perpendicular to the vertical weight-bearing axis of the patient in a bipedal stance. The purposes of this study were as follows: (1) to find out the distribution of the native joint line in a population of normal patients with normal knees; (2) to compare the native joint line orientation between patients receiving conventional mechanically aligned total knee arthroplasty (TKA), navigated mechanically aligned TKA, and kinematically aligned TKA; and (3) to determine which of the three TKA methods aligns the postoperative knee joint perpendicular to the weight-bearing axis of the limb in bipedal stance. To determine the joint line orientation of a native knee, 50 full-length standing hip-to-ankle digital radiographs were obtained in 50 young, healthy individuals. The angle between knee joint line and the line parallel to the floor was measured and defined as joint line orientation angle (JLOA). JLOA was also measured prior to and after conventional mechanically aligned TKA (65 knees), mechanically aligned TKA using imageless navigation (65 knees), and kinematically aligned TKA (65 knees). The proportion of the knees similar to the native joint line was calculated for each group. The mean JLOA in healthy individuals was parallel to the floor (0.2° ± 1.1°). The pre-operative JLOA of all treatment groups slanted down to the lateral side. Postoperative JLOA slanted down to the lateral side in conventional mechanically aligned TKA (-3.3° ± 2.2°) and in navigation mechanically aligned TKA (-2.6° ± 1.8°), while it was horizontal to the floor in kinematically aligned TKA (0.6° ± 1.7°). Only 6.9 % of the conventional mechanically aligned TKA and 16.9 % of the navigation mechanically aligned TKA were within one SD of the mean JLOA of the native knee, while the proportion was significantly higher (50.8 %) in kinematically aligned TKA. The portion was statistically greater in mechanically aligned TKA group than the other two. Postoperative joint line orientation after kinematically aligned TKA was more similar to that of native knees than that of mechanically aligned TKA and horizontal to the floor. Kinematically aligned TKA can restore pre-arthritic knee joint line orientation, while mechanically aligned TKA is inefficient in achieving the purpose even if navigation TKA is employed. III.

Smartphone versus knee ligament arthrometer when size does not matter.

PubMed

Ferretti, Andrea; Andrea, Ferretti; Valeo, Luigi; Luigi, Valeo; Mazza, Daniele; Daniele, Mazza; Muliere, Luca; Luca, Muliere; Iorio, Paolo; Paolo, Iorio; Giovannetti, Giovanni; Giovanni, Giovannetti; Conteduca, Fabio; Fabio, Conteduca; Iorio, Raffaele; Raffaele, Iorio

2014-10-01

The use of available mechanical methods to measure anterior tibial translation (ATT) in anterior cruciate ligament (ACL)-deficient knees are limited by size and costs. This study evaluated the performance of a portable device based on a downloadable electronic smartphone application to measure ATT in ACL-deficient knees. A specific smartphone application (SmartJoint) was developed for this purpose. Two independent observers nonsequentially measured the amount of ATT during execution of a maximum manual Lachman test in 35 patients with an ACL-deficient knee using KT 1000 and SmartJoint on both involved and uninvolved knees. As each examiner performed the test three times on each knee, a total of 840 measurements were collected. Statistical analysis compared intertest, interobserver and intra-observer reliability using the interclass correlation coefficient (ICC). An ICC > 0.75 indicates excellent reproducibility among measurements. Mean amount of ATT on uninvolved knees was 6.1 mm [standard deviation (SD = 2)] with the KT 1000 and 6.4 mm (SD = 2) with SmartJoint. Mean side-to-side difference was 8.1 mm. (SD = 4) with KT 1000 and 8.3 mm (SD = 3) with SmartJoint. Intertest reliability between the two methods yielded an ICC 0.797 [95 % confidence interval (CI) 0.717-0.857] for the uninvolved knee and of 0.987 (CI 0.981-0.991) for the involved knee. Interobserver ICC for SmartJoint and KT 1000 was 0.957 (CI 0.927-0.976) for the uninvolved knee and 0.992 (CI 0.986-0.996) for the involved knee and 0.973 (CI 0.954-0.985) for the uninvolved knee and 0.989 (CI 0.981-0.994) for involved knee, respectively. The performance of SmartJoint is comparable and highly correlated with measurements obtained from KT 1000. SmartJoint may provide a truly portable, noninvasive, accurate, reliable, inexpensive and widely accessible method to characterize ATT in ACL-deficient knee.

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2014-01-01

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 (1.0 m/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. PMID:24768278

Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study.

PubMed

Holm, Bente; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

2012-08-01

To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty. A prospective, single-blinded, randomized, cross-over study. A fast-track orthopaedic arthroplasty unit at a university hospital. Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty. The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30 minutes of elbow icing (control treatment). The order of treatments was randomized. Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments by an assessor blinded for active or control treatment. The change in knee extension strength associated with knee icing was not significantly different from that of elbow icing (knee icing change (mean (1 SD)) -0.01 (0.07) Nm/kg, elbow icing change -0.02 (0.07) Nm/kg, P = 0.493). Likewise, the changes in knee pain at rest (P = 0.475), or knee pain during the knee extension strength measurements (P = 0.422) were not different between treatments. In contrast to observations in experimental knee effusion models and inflamed knee joints, knee joint icing for 30 minutes shortly after total knee arthroplasty had no acute effect on knee extension strength or knee pain.

Knee Osteoarthritis Treatment with the KineSpring Knee Implant System: A Report of Two Cases

PubMed Central

Hayes, David A.; Miller, Larry E.; Block, Jon E.

2012-01-01

Osteoarthritis (OA) is a leading cause of disability in middle-aged and older adults with the prevalence expected to increase by 40% by 2025. This dramatic projected increase in OA reflects, in large part, the alarming obesity epidemic. Indeed, it is now well understood that abnormal loading across the knee joint due to malalignment and/or excessive weight gain is responsible for accelerating OA progression. Consequently, there is a therapeutic need for alternative knee OA treatments that directly address joint overload to fill the gap between ineffective conservative care and invasive joint-modifying surgical procedures. We describe two cases that presented with bilateral knee OA resistant to conservative treatments, each with one knee previously and unsuccessfully treated with high tibial osteotomy to improve alignment and the contralateral knee successfully treated with a joint-preserving, load-absorbing implant (KineSpring Knee Implant System). PMID:23304590

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

PubMed

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

2014-10-01

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.

Design, simulation and modelling of auxiliary exoskeleton to improve human gait cycle.

PubMed

Ashkani, O; Maleki, A; Jamshidi, N

2017-03-01

Exoskeleton is a walking assistance device that improves human gait cycle through providing auxiliary force and transferring physical load to the stronger muscles. This device takes the natural state of organ and follows its natural movement. Exoskeleton functions as an auxiliary device to help those with disabilities in hip and knee such as devotees, elderly farmers and agricultural machinery operators who suffer from knee complications. In this research, an exoskeleton designed with two screw jacks at knee and hip joints. To simulate extension and flexion movements of the leg joints, bearings were used at the end of hip and knee joints. The generated torque and motion angles of these joints obtained as well as the displacement curves of screw jacks in the gait cycle. Then, the human gait cycle was simulated in stance and swing phases and the obtained torque curves were compared. The results indicated that they followed the natural circle of the generated torque in joints with a little difference from each other. The maximum displacement obtained 4 and 6 cm in hip and knee joints jack respectively. The maximum torques in hip and knee joints were generated in foot contact phase. Also the minimum torques in hip and knee joints were generated in toe off and heel off phases respectively.

Mobile ankle and knee perturbator.

PubMed

Andersen, Jacob Buus; Sinkjaer, Thomas

2003-10-01

A mobile ankle and knee perturbator has been developed. It consists of a functional joint with an integrated clutch. Four Bowden wires connect the joint to a powerful motor and a double pneumatic cylinder. When needed during any time of the gait cycle, it is possible to impose an ankle rotation by engaging the clutch and rotating the ankle or knee joint with a predefined displacement. The system is designed to investigate electrophysiological and biomechanical features of the human ankle or knee joint during gait.

The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study.

PubMed

Rice, David Andrew; McNair, Peter John; Lewis, Gwyn Nancy; Dalbeth, Nicola

2015-07-28

Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis. Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee joint aspiration alone and 5 ± 2 and 15 ± 2 days after knee joint aspiration and the injection of 40 mg of methylprednisolone acetate. Compared to baseline, knee pain was significantly reduced 5 (p = 0.001) and 15 days (p = 0.009) post intervention. Flexion reflex threshold increased immediately after joint aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after joint aspiration (p = 0.004) and 5 (p = 0.001) and 15 days (p <0.001) post intervention. The findings from this study suggest that altered sensory output from an inflamed joint may increase flexion reflex excitability in humans, as has previously been shown in animals. Joint aspiration and corticosteroid injection may be a clinically useful intervention to reverse quadriceps muscle weakness in individuals with knee synovitis.

A new distraction arthroplasty device using magnetic force; a cadaveric study.

PubMed

Kamei, Goki; Ochi, Mitsuo; Okuhara, Atsushi; Fujimiya, Mineko; Deie, Masataka; Adachi, Nobuo; Nakamae, Atsuo; Nakasa, Tomoyuki; Ohkawa, Shingo; Takazawa, Kobun; Eguchi, Akio; Katou, Tomohiro; Takada, Tsuyoshi; Usman, Muhammad Andry

2013-04-01

It is difficult for an articular cartilage injury to repair spontaneously. There are many procedures for treating cartilage injury, however there is no standard procedure for middle-aged patients who have diffuse knee osteoarthritis, especially of the lateral compartment. Therefore, Ochi developed a new distraction device that uses magnetic power to enlarge a joint space and promote cartilage regeneration with microfracture. The purpose of this study is to evaluate this new distraction arthroplasty system by using the cadaveric knee. This study used ten knees from six cadavers that were embalmed by Thiel's methods. The medial and lateral joint space was measured by AP radiographic view before and after distraction, and after weight-bearing to evaluate the joint distraction. The contact pressure of the medial and lateral compartments at the knee extension position by using a prescale film system was measured before and after weight-bearing with a 15 or 30-kg weight-bearing load to evaluate the effectiveness of this device. The lateral joint space significantly increased from the pre-distraction to the post-distraction; however, it did not change significantly between post-distraction and post-weight-bearing. With a 15 or 30-kg weight-bearing load, the contact pressure of the lateral compartment significantly decreased from the pre-distraction to the post-distraction. The most important advantage of this device is that it maintains a continuous distraction tension and enables almost the full range of motion of the knee. We believe that joint distraction by using magnetic force can be a promising option for cartilage injury in middle-aged patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

The influence of minimalist footwear and stride length reduction on lower-extremity running mechanics and cumulative loading.

PubMed

Firminger, Colin R; Edwards, W Brent

2016-12-01

To examine the effects of shoe type and stride length reduction on lower-extremity running mechanics and cumulative loading. Within-subject with four conditions: (1) control shoe at preferred stride length; (2) control shoe at 90% preferred stride length; (3) minimalist shoe at preferred stride length; (4) minimalist shoe at 90% preferred stride length. Fourteen young healthy males ran overground at their preferred speed while motion capture, force platform, and plantar pressure data were collected. Peak moments, impulse, mechanical work, and cumulative impulse were calculated at the metatarsophalangeal, ankle, and knee joint, and compared between conditions using a 2×2 factor repeated measures ANOVA. In general, running in minimalist footwear increased measures of loading at the metatarsophalangeal joint and ankle joint (mean increases of 7.3% and 5.9%, respectively), but decreased measures of loading at the knee (mean decrease of 7.3%). Conversely, running with reduced stride length decreased single-stance measures of loading at the ankle and knee joint (ranging from -0.9% to -20.5%), though cumulative impulse was higher at the ankle and lower at the knee. Running in minimalist shoes increased loads at the metatarsophalangeal and ankle joint, which may explain some of the incidence of overuse injuries observed in minimalist shoe users. Decreased ankle loads at 90% preferred stride length were not necessarily sufficient to reduce cumulative loads when impulse and loading cycles were weighted equally. Knee loads decreased more when running at 90% preferred stride length (16.2% mean reduction) versus running in a minimalist shoe (7.3% mean reduction), but both load reduction mechanisms appeared to have an additive effect (22.2% mean reduction). Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effect of Reduced Stiffness Dance Flooring on Lower Extremity Joint Angular Trajectories During a Ballet Jump.

PubMed

Hackney, James; Brummel, Sara; Newman, Mary; Scott, Shannon; Reinagel, Matthew; Smith, Jennifer

2015-09-01

We carried out a study to investigate how low stiffness flooring may help prevent overuse injuries of the lower extremity in dancers. It was hypothesized that performing a ballet jump (sauté) on a reduced stiffness dance floor would decrease maximum joint flexion angles and negative angular velocities at the hips, knees, or ankles compared to performing the same jump on a harder floor. The participants were 15 young adult female dancers (age range 18 to 28, mean = 20.89 ± 2.93 years) with at least 5 years of continuous ballet experience and without history of serious lower body injury, surgery, or recent pain. They performed sautés on a (low stiffness) Harlequin ® WoodSpring Floor and on a vinyl-covered hardwood on concrete floor. Maximum joint flexion angles and negative velocities at bilateral hips, knees, and ankles were measured with the "Ariel Performance Analysis System" (APAS). Paired one-tailed t-tests yielded significant decreases in maximum knee angle (average decrease = 3.4° ± 4.2°, p = 0.026) and angular negative velocity of the ankles (average decrease = 18.7°/sec ± 27.9°/sec, p = 0.009) with low stiffness flooring. If the knee angle is less acute, then the length of the external knee flexion moment arm will also be shorter and result in a smaller external knee flexion moment, given an equal landing force. Also, high velocities of eccentric muscle contraction, which are necessary to control negative angular velocity of the ankle joint, are associated with higher risk of musculotendinous injury. Hence, our findings indicate that reduced floor stiffness may indeed help decrease the likelihood of lower extremity injuries.

Assessment of tibial rotation and meniscal movement using kinematic magnetic resonance imaging

PubMed Central

2014-01-01

Objective This work aimed to assess tibial rotations, meniscal movements, and morphological changes during knee flexion and extension using kinematic magnetic resonance imaging (MRI). Methods Thirty volunteers with healthy knees were examined using kinematic MRI. The knees were imaged in the transverse plane with flexion and extension angles from 0° to 40° and 40° to 0°, respectively. The tibial interior and exterior rotation angles were measured, and the meniscal movement range, height change, and side movements were detected. Results The tibia rotated internally (11.55° ± 3.20°) during knee flexion and rotated externally (11.40° ± 3.0°) during knee extension. No significant differences were observed between the internal and external tibial rotation angles (P > 0.05), between males and females (P > 0.05), or between the left and right knee joints (P > 0.05). The tibial rotation angle with a flexion angle of 0° to 24° differed significantly from that with a flexion angle of 24° to 40° (P < 0.01). With knee flexion, the medial and lateral menisci moved backward and the height of the meniscus increased. The movement range was greater in the anterior horn than in the posterior horn and greater in the lateral meniscus than in the medial meniscus (P < 0.01). During backward movements of the menisci, the distance between the anterior and posterior horns decreased, with the decrease more apparent in the lateral meniscus (P < 0.01). The side movements of the medial and lateral menisci were not obvious, and a smaller movement range was found than that of the forward and backward movements. Conclusion Knee flexion and extension facilitated internal and external tibial rotations, which may be related to the ligament and joint capsule structure and femoral condyle geometry. PMID:25142267

The effects of knee direction, physical activity and age on knee joint position sense.

PubMed

Relph, Nicola; Herrington, Lee

2016-06-01

Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18-82years to evaluate the effects of age, physical activity and knee direction. A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15-29, 30-44, 45-59, 60-74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability. Copyright © 2016 Elsevier B.V. All rights reserved.

The alignment of the knee joint in relationship to age and osteoarthritis: the Copenhagen Osteoarthritis Study.

PubMed

Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K; Sonne-Holm, Stig

2013-04-01

The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort. From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured. The prevalence of knee joint OA in males was 27.9% and 27.5%, for the left and right knees respectively. In females this was 32.8% and 36.4%. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°-0.76° per level of OA. Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.

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.

Thermal imaging in screening of joint inflammation and rheumatoid arthritis in children.

PubMed

Lasanen, R; Piippo-Savolainen, E; Remes-Pakarinen, T; Kröger, L; Heikkilä, A; Julkunen, P; Karhu, J; Töyräs, J

2015-02-01

Potential of modern thermal imaging for screening and differentiation of joint inflammation has not been assessed in child and juvenile patient populations, typically demanding groups in diagnostics of musculoskeletal disorders. We hypothesize that thermal imaging can detect joint inflammation in patients with juvenile idiopathic arthritis or autoimmune disease with arthritis such as systemic lupus erythematosus. To evaluate the hypothesis, we studied 58 children exhibiting symptoms of joint inflammation. First, the patients' joints were examined along clinical procedure supplemented with ultrasound imaging when deemed necessary by the clinician. Second, thermal images were acquired from patients' knees and ankles. Results of thermal imaging were compared to clinical evaluations in knee and ankle. The temperatures were significantly (pmax = 0.044, pmean < 0.001) higher in inflamed ankle joints, but not in inflamed knee joints. No significant difference was found between the skin surface temperatures of medial and lateral aspects of ankle joints. In knee joints the mean temperatures of medial and lateral aspect differed significantly (p = 0.004). We have demonstrated that thermal imaging may have potential for detecting joint inflammation in ankle joints of children. For knee joints our results are inconclusive and further research is warranted.

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament-Reconstructed Individuals.

PubMed

Sugimoto, Dai; LeBlanc, Jessica C; Wooley, Sarah E; Micheli, Lyle J; Kramer, Dennis E

2016-05-01

It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients' return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

Static knee alignment and its association with radiographic knee osteoarthritis.

PubMed

Teichtahl, A J; Cicuttini, F M; Janakiramanan, N; Davis, S R; Wluka, A E

2006-09-01

Although knee alignment is associated with the progression of knee osteoarthritis (OA), it is unclear which features that characterize radiographic OA are related to alignment. The aim of this study was to examine the relationship between static knee joint alignment (measured as a continuous variable) and the radiographic features of knee OA (joint space narrowing and osteophytes). One hundred and twenty one adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. X-rays were performed to classify the severity of disease and to determine static knee alignment. Increasing varus knee alignment was associated with increasing risk of medial compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.005). Increasing valgus knee alignment was associated with an increased risk for lateral compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.002). This study has demonstrated that the static knee angle, measured as a continuous variable, is an important determinant of the compartment-specific features of radiographic knee OA. Further work is required to determine whether interventions aimed at correcting these relatively minor levels of varus and valgus angulation will have an effect on the risk of tibiofemoral OA.

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.

Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases

PubMed Central

Khemka, Aditya; Frossard, Laurent; Lord, Sarah J; Bosley, Belinda; Al Muderis, Munjed

2015-01-01

Background and purpose — Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment. Patients and methods — We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1–3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test. Results — There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29–52 and a 6-minute walk test improvement range of 37–84 meters. Interpretation — It is possible to combine TKR with osseointegrated implants. PMID:26145721

The use of synthetic ligaments in the design of an enhanced stability total knee joint replacement.

PubMed

Stokes, Michael D; Greene, Brendan C; Pietrykowski, Luke W; Gambon, Taylor M; Bales, Caroline E; DesJardins, John D

2018-03-01

Current total knee replacement designs work to address clinically desired knee stability and range of motion through a balance of retained anatomy and added implant geometry. However, simplified implant geometries such as bearing surfaces, posts, and cams are often used to replace complex ligamentous constraints that are sacrificed during most total knee replacement procedures. This article evaluates a novel total knee replacement design that incorporates synthetic ligaments to enhance the stability of the total knee replacement system. It was hypothesized that by incorporating artificial cruciate ligaments into a total knee replacement design at specific locations and lengths, the stability of the total knee replacement could be significantly altered while maintaining active ranges of motion. The ligament attachment mechanisms used in the design were evaluated using a tensile test, and determined to have a safety factor of three with respect to expected ligamentous loading in vivo. Following initial computational modeling of possible ligament orientations, a physical prototype was constructed to verify the function of the design by performing anterior/posterior drawer tests under physiologic load. Synthetic ligament configurations were found to increase total knee replacement stability up to 94% compared to the no-ligament case, while maintaining total knee replacement flexion range of motion between 0° and 120°, indicating that a total knee replacement that incorporates synthetic ligaments with calibrated location and lengths should be able to significantly enhance and control the kinematic performance of a total knee replacement system.

[Generalised Form of Synovial Chondromatosis of the Knee Joint].

PubMed

Vališ, P; Vyskočil, R

2016-01-01

This study describes a diagnostic and therapeutic algorithm in a 53-year-old male patient who was diagnosed with a synovial chondromatosis of the knee joint extending to the popliteal fossa and soft tissues around the knee. Because of the presence of massive nodules, the patient was indicated for total synovectomy, with removal of pathologically changed cartilaginous tissue, performed by combined anterior and posterior approaches to the knee joint. Despite complete removal of the synovium and loose cartilage bodies and the patient's pain relief in the post-operative time, three years after the operation new problems appeared. Magnetic resonance imaging (MRI) confirmed a relapse of synovial chondromatosis and the patient was indicated for revision surgery of the knee joint. The results of physical examination and MRI scans, and intra-operative findings in the patient are reported. synovial chondromatosis, total synovectomy, direct anterior and posterior approaches to the knee joint.

Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

PubMed Central

Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

2014-01-01

Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during the single-legged squat. Assessment of ankle DF-ROM using the WBL provided important insight into compensatory movement patterns during squatting, whereas nonweight-bearing passive ankle DF-ROM did not. Improving ankle DF-ROM during the WBL may be an important intervention for altering high-risk movement patterns commonly associated with noncontact anterior cruciate ligament injury. PMID:25144599

Altered knee and ankle kinematics during squatting in those with limited weight-bearing-lunge ankle-dorsiflexion range of motion.

PubMed

Dill, Karli E; Begalle, Rebecca L; Frank, Barnett S; Zinder, Steven M; Padua, Darin A

2014-01-01

Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Cross-sectional study. Sports medicine research laboratory. Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during the single-legged squat. Assessment of ankle DF-ROM using the WBL provided important insight into compensatory movement patterns during squatting, whereas nonweight-bearing passive ankle DF-ROM did not. Improving ankle DF-ROM during the WBL may be an important intervention for altering high-risk movement patterns commonly associated with noncontact anterior cruciate ligament injury.

Repeat Manipulation Under Anesthesia For Persistent Stiffness After Total Knee Arthroplasty Achieves Functional Range of Motion.

PubMed

Ferrel, Jason R; Davis, Richard L; Agha, Obiajulu A J C; Politi, Joel R

2015-05-01

Poor range of motion may decrease a patient's ability to participate in activities of daily living after total knee arthroplasty. Manipulation under anesthesia has been shown to improve range of motion; however, some patients have persistent stiffness even after manipulation. The goal of this study was to evaluate the outcomes and complications of patients who underwent a second manipulation under anesthesia for persistent stiffness after total knee arthroplasty. The review of surgical records of two joint arthroplasty surgeons identified 226 knees in 210 patients who underwent a manipulation under anesthesia for poor range of motion after total knee arthroplasty. Of these patients, 16 patients underwent a second manipulation under anesthesia. For patients undergoing two manipulations under anesthesia procedures, at latest follow up (mean 539 days), mean extension improved from 10.50° to 2.50° (p=0.001) and mean flexion improved from 87.50° to 112.69° (p=0.001) respectively. SF-12 scores were available for 12 of 16 knees with a mean score of 34.42. Two of 16 patients (12.5%) experienced a complication. Three of 16 (18.8%) patients who underwent a second manipulation required a revision arthroplasty procedure. In conclusion, a second manipulation under anesthesia can achieve functional range of motion that is sustained after total knee arthroplasty.

Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints.

PubMed

Bellmann, Malte; Schmalz, Thomas; Blumentritt, Siegmar

2010-04-01

To investigate and identify functional differences of 4 microprocessor-controlled prosthetic knee joints (C-Leg, Hybrid Knee [also called Energy Knee], Rheo Knee, Adaptive 2). Tested situations were walking on level ground, on stairs and ramps; additionally, the fall prevention potentials for each design were examined. The measuring technology used included an optoelectronic camera system combined with 2 forceplates as well as a mobile spiroergometric system. The study was conducted in a gait laboratory. Subjects with unilateral transfemoral amputations (N=9; mobility grade, 3-4; age, 22-49y) were tested. Participants were fitted and tested with 4 different microprocessor-controlled knee joints. Static prosthetic alignment, time distance parameters, kinematic and kinetic data and metabolic energy consumption. Compared with the Hybrid Knee and the Adaptive 2, the C-Leg offers clear advantages in the provision of adequate swing phase flexion resistances and terminal extension damping during level walking at various speeds, especially at higher walking speeds. The Rheo Knee provides sufficient terminal extension; however, swing phase flexion resistances seem to be too low. The values for metabolic energy consumption show only slight differences during level walking. The joint resistances generated for descending stairs and ramps relieve the contralateral side to varying degrees. When walking on stairs, safety-relevant technical differences between the investigated joint types can be observed. Designs with adequate internal resistances offer stability advantages when the foot is positioned on the step. Stumble recovery tests reveal that the different knee joint designs vary in their effectiveness in preventing the patient from falling. The patient benefits provided by the investigated electronic prosthetic knee joints differ considerably. The C-Leg appears to offer the amputee greater functional and safety-related advantages than the other tested knee joints. Reduced loading of the contralateral side has been demonstrated during ramp and stair descent. Metabolic energy consumption does not vary significantly between the tested knees. Hence, this parameter seems not to be a suitable criterion for assessing microprocessor-controlled knee components. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A mathematical model of forces in the knee under isometric quadriceps contractions.

PubMed

Huss, R A; Holstein, H; O'Connor, J J

2000-02-01

To predict the knee's response to isometric quadriceps contractions against a fixed tibial restraint.Design. Mathematical modelling of the human knee joint. Isometric quadriceps contraction is commonly used for leg muscle strengthening following ligament injury or reconstruction. It is desirable to know the ligament forces induced but direct measurement is difficult. The model, previously applied to the Lachmann or 'drawer' tests, combines an extensible fibre-array representation of the cruciate ligaments with a compressible 'thin-layer' representation of the cartilage. The model allows the knee configuration and force system to be calculated, given flexion angle, restraint position and loading. Inclusion of cartilage deformation increases relative tibio-femoral translation and decreases the ligament forces generated. For each restraint position, a range of flexion angles is found in which no ligament force is required, as opposed to a single flexion angle in the case of incompressible cartilage layers. Knee geometry and ligament elasticity are found to be the most important factors governing the joint's response to isometric quadriceps contractions, but cartilage deformation is found to be more important than in the Lachmann test. Estimation of knee ligament forces is important when devising exercise regimes following ligament injury or reconstruction. The finding of a 'neutral zone' of zero ligament force may have implications for rehabilitation of the ligament-injured knee.

Analysis of Balance Ability Dependent on the Angle of the Knee Joint in Females in Their 20s

PubMed Central

Yoon, Se-Won; Lee, Jeong-Woo; Cho, Woon-Su; Kim, An-Na; Lee, Kyung-Hee

2013-01-01

The aim of this study was to investigate how balance ability according to angle of the knee joint changes in young female adults wearing a knee orthosis. [Methods] This study was conducted with 11 healthy female adults. The subjects used a knee brace that could be set to angles of 0°, 15°, and 30° of knee flexion. The ability to balance was evaluated by balance assessment. A total of four postures were used for measurements: a forward-facing posture with the eyes open on a stable surface (NO), a forward-facing posture with the eyes closed on a stable surface (NC), a forward-facing posture with the eyes open on an unstable surface (PO), and a forward-facing posture with the eyes closed on an unstable surface (PC). [Results] Regarding the weight distribution index and stability index on a stable surface, there was no interaction according to whether there was visual deprivation or not or according to knee flexion angle. Furthermore, the stability index on an unstable surface showed no interaction according to whether there was visual deprivation or not or according to knee flexion angle. But the WDI on a stable surface showed no interaction according to whether there was visual deprivation or not or according to knee flexion angle. [Conclusion] There were significant differences in the knee extension range of motion of normal elderly people and knee osteoarthritis, and the quadriceps femoris played an important role in knee function in individuals with knee osteoarthritis. PMID:24259902

Clinical assessment of effusion in knee osteoarthritis—A systematic review

PubMed Central

Maricar, Nasimah; Callaghan, Michael J.; Parkes, Matthew J.; Felson, David T.; O׳Neill, Terence W.

2016-01-01

Objective The aim of this systematic review was to determine the validity and inter- and intra-observer reliability of the assessment of knee joint effusion in osteoarthritis (OA) of the knee. Methods MEDLINE, Web of Knowledge, CINAHL, EMBASE, and AMED were searched from their inception to February 2015. Articles were included according to a priori defined criteria: samples containing participants with knee OA; prospective evaluation of clinical tests and assessments of knee effusion that included reliability, sensitivity, and specificity of these tests. Results A total of 10 publications were reviewed. Eight of these considered reliability and four on validity of clinical assessments against ultrasound effusion. It was not possible to undertake a meta-analysis of reliability or validity because of differences in study designs and the clinical tests. Intra-observer kappa agreement for visible swelling ranged from 0.37 (suprapatellar) to 1.0 (prepatellar); for bulge sign 0.47 and balloon sign 0.37. Inter-observer kappa agreement for visible swelling ranged from −0.02 (prepatellar) to 0.65 (infrapatellar), the balloon sign −0.11 to 0.82, patellar tap −0.02 to 0.75 and bulge sign kappa −0.04 to 0.14 or reliability coefficient 0.97. Reliability and diagnostic accuracy tended to be better in experienced observers. Very few data looked at performance of individual clinical tests with sensitivity ranging 18.2–85.7% and specificity 35.3–93.3%, both higher with larger effusions. Conclusion The majority of unstandardized clinical tests to assess joint effusion in knee OA had relatively low intra- and inter-observer reliability. There is some evidence experience improved reliability and diagnostic accuracy of tests. Currently there is insufficient evidence to recommend any particular test in clinical practice. PMID:26581486

Clinical assessment of effusion in knee osteoarthritis-A systematic review.

PubMed

Maricar, Nasimah; Callaghan, Michael J; Parkes, Matthew J; Felson, David T; O'Neill, Terence W

2016-04-01

The aim of this systematic review was to determine the validity and inter- and intra-observer reliability of the assessment of knee joint effusion in osteoarthritis (OA) of the knee. MEDLINE, Web of Knowledge, CINAHL, EMBASE, and AMED were searched from their inception to February 2015. Articles were included according to a priori defined criteria: samples containing participants with knee OA; prospective evaluation of clinical tests and assessments of knee effusion that included reliability, sensitivity, and specificity of these tests. A total of 10 publications were reviewed. Eight of these considered reliability and four on validity of clinical assessments against ultrasound effusion. It was not possible to undertake a meta-analysis of reliability or validity because of differences in study designs and the clinical tests. Intra-observer kappa agreement for visible swelling ranged from 0.37 (suprapatellar) to 1.0 (prepatellar); for bulge sign 0.47 and balloon sign 0.37. Inter-observer kappa agreement for visible swelling ranged from -0.02 (prepatellar) to 0.65 (infrapatellar), the balloon sign -0.11 to 0.82, patellar tap -0.02 to 0.75 and bulge sign kappa -0.04 to 0.14 or reliability coefficient 0.97. Reliability and diagnostic accuracy tended to be better in experienced observers. Very few data looked at performance of individual clinical tests with sensitivity ranging 18.2-85.7% and specificity 35.3-93.3%, both higher with larger effusions. The majority of unstandardized clinical tests to assess joint effusion in knee OA had relatively low intra- and inter-observer reliability. There is some evidence experience improved reliability and diagnostic accuracy of tests. Currently there is insufficient evidence to recommend any particular test in clinical practice. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Chaperonin containing T-complex polypeptide subunit eta is a potential marker of joint contracture: an experimental study in the rat.

PubMed

He, Ronghan; Wang, Zhe; Lu, Yunxiang; Huang, Junqi; Ren, Jianhua; Wang, Kun

2015-11-01

Joint contracture is a fibroproliferative disorder that restricts joint mobility, resulting in tissue degeneration and deformity. However, the etiology of joint contracture is still unknown. Chaperonin containing T-complex polypeptide subunit eta (CCT-eta) is reported to increase in fibrotic diseases. The purpose of this study was to investigate whether CCT-eta is implicated in joint contracture and to determine the role of CCT-eta in the progression of joint contracture by analyzing a rat model. We immobilized the left knee joint of rat by internal fixation for 8 weeks. The non-immobilized right leg served as a control. The range of motion (ROM) of the knee was investigated. Fibroblasts were obtained from the posterior joint capsule of the joints. The outcome was followed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, fibroblast migration assay, and collagen assay. The effect of CCT-eta on the functions of fibroblasts was observed by utilizing a short inhibitory RNA (siRNA) targeting CCT-eta. The ROM of the immobilized joints was significantly limited compared to the contralateral joints (p < 0.05). Fibroblasts derived from the contractive joints showed higher mRNA and protein expressions of CCT-eta in parallel with alpha-smooth muscle actin (α-SMA) compared to the cells from the contralateral knees (p < 0.05). siRNA-mediated downregulation of CCT-eta inhibited the expressions of both CCT-eta and α-SMA. Moreover, the reduction of CCT-eta also significantly decreased fibroblast functions such as cell mobility and collagen synthesis (all p < 0.05). Our findings indicate that CCT-eta appears to be a potential marker of joint contracture disease.

Automatic locking orthotic knee device

NASA Technical Reports Server (NTRS)

Weddendorf, Bruce C. (Inventor)

1993-01-01

An articulated tang in clevis joint for incorporation in newly manufactured conventional strap-on orthotic knee devices or for replacing such joints in conventional strap-on orthotic knee devices is discussed. The instant tang in clevis joint allows the user the freedom to extend and bend the knee normally when no load (weight) is applied to the knee and to automatically lock the knee when the user transfers weight to the knee, thus preventing a damaged knee from bending uncontrollably when weight is applied to the knee. The tang in clevis joint of the present invention includes first and second clevis plates, a tang assembly and a spacer plate secured between the clevis plates. Each clevis plate includes a bevelled serrated upper section. A bevelled shoe is secured to the tank in close proximity to the bevelled serrated upper section of the clevis plates. A coiled spring mounted within an oblong bore of the tang normally urges the shoes secured to the tang out of engagement with the serrated upper section of each clevic plate to allow rotation of the tang relative to the clevis plate. When weight is applied to the joint, the load compresses the coiled spring, the serrations on each clevis plate dig into the bevelled shoes secured to the tang to prevent relative movement between the tang and clevis plates. A shoulder is provided on the tang and the spacer plate to prevent overextension of the joint.

[Separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire in the treatment of displaced inferior pole fractures of the patella].

PubMed

Zhang, J; Jiang, X Y; Huang, X W

2016-06-18

To investigate the clinical efficacy and outcomes of two separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire in the treatment of displaced inferior pole fractures of the patella. From January 2013 to January 2015, 15 consecutive patients (mean age 54.5 years) with inferior pole fractures of the patella were retrospectively included in this study. All the patients underwent open reduction and internal fixation by separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire through longitudinal incision, 4.5 d (range: 3.1-5.9 d) after initial injury. A safety check for early knee range of motion was performed before wound closure. The complications including infection, nonunion, loss of fixation and any wire breakage or irritation from implant were recorded. Anteroposterior and lateral views of the knee joint obtained during the follow-up were used to assess bony union based on the time when the fracture line disappeared. At the time of the final outpatient follow up, functional evaluation of the knee joint was conducted by Bostman system. The follow-up time was 13.1 months (range: 12-19 months) after surgery on average, immediate motion without immobilization in all the cases was allowed and there was no case of reduction loss of the fracture and wire breakage. There was no case of irritation from the implant. At the final follow-up, the average range of motion (ROM) arc was 126.7° (range: 115°-140°), the average ROM lag versus contralateral healthy leg was 10.3° (range: 0°-35°). The mean Bostman score at the last follow-up was 28.9 (range: 27-30), and graded excellent in most cases. Two separate vertical wiring is an easy and effective method to reduce the displaced inferior pole fracture of patella. Augmentation of separate vertical wiring with tension band and Kirschner-wire plus cerclage wire in these patients provides enough strength to protected the early exercise of the knee joint and uneventful healing. By this surgical treatment, excellent results in knee function can be expected for cases of displaced inferior pole fractures of the patella.

Tracking control of time-varying knee exoskeleton disturbed by interaction torque.

PubMed

Li, Zhan; Ma, Wenhao; Yin, Ziguang; Guo, Hongliang

2017-11-01

Knee exoskeletons have been increasingly applied as assistive devices to help lower-extremity impaired people to make their knee joints move through providing external movement compensation. Tracking control of knee exoskeletons guided by human intentions often encounters time-varying (time-dependent) issues and the disturbance interaction torque, which may dramatically put an influence up on their dynamic behaviors. Inertial and viscous parameters of knee exoskeletons can be estimated to be time-varying due to unexpected mechanical vibrations and contact interactions. Moreover, the interaction torque produced from knee joint of wearers has an evident disturbance effect on regular motions of knee exoskeleton. All of these points can increase difficultly of accurate control of knee exoskeletons to follow desired joint angle trajectories. This paper proposes a novel control strategy for controlling knee exoskeleton with time-varying inertial and viscous coefficients disturbed by interaction torque. Such designed controller is able to make the tracking error of joint angle of knee exoskeletons exponentially converge to zero. Meanwhile, the proposed approach is robust to guarantee the tracking error bounded when the interaction torque exists. Illustrative simulation and experiment results are presented to show efficiency of the proposed controller. Additionally, comparisons with gradient dynamic (GD) approach and other methods are also presented to demonstrate efficiency and superiority of the proposed control strategy for tracking joint angle of knee exoskeleton. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Reconstruction of juxta-articular huge defects of distal femur with vascularized fibular bone graft and Ilizarov's distraction osteogenesis.

PubMed

Lai, Davy; Chen, Chuan-Mu; Chiu, Fang-Yao; Chang, Ming-Chau; Chen, Tain-Hsiung

2007-01-01

We evaluate the effect of reconstructing huge defects (mean, 15.8 cm) of the distal femur with Ilizarov's distraction osteogenesis and free twin-barreled vascularized fibular bone graft (TVFG). We retrospectively reviewed a consecutive series of five patients who had cases of distal femoral fractures with huge defects and infection that were treated by the Ilizarov's distraction osteogenesis. After radical debridement, two of the five cases had free TVFG and monolocal distraction osteogenesis, and another two cases had multilocal distraction osteogenesis with knee fusion because of loss of the joint congruity. The other case with floating knee injury had bilocal distraction osteogenesis and a preserved knee joint. The mean defect of distal femur was 15.8 cm (range, 14-18 cm) in length. The mean length of distraction osteogenesis by Ilizarov's apparatus was 8.2 cm. The mean length of TVFG was 8 cm. The average duration from application of Ilizarov's apparatus to achievement of bony union was 10.2 months (range, 8-13 months). At the end of the follow-up, ranges of motion of three knees were 0 to 45 degrees, 0 to 60 degrees, and 0 to 90 degrees. Two cases had knee arthrodesis with bony fusion because of loss of the joint congruity. There were no leg length discrepancies in all five patients. In addition, three patients had pin tract infections and one case had a 10 degree varus deformity of the femur. Juxta-articular huge defect (>10 cm) of distal femur remains a challenge to orthopedic surgeons. Ilizarov's technique provides the capability to maintain stability, eradicate infection, restore leg length, and to perform adjuvant reconstructive procedure easily. In this study, we found that combining Ilizarov's distraction osteogenesis with TVFG results in improved patient outcome for patients with injuries such as supracondylar or intercondylar infected fractures or nonunion of distal femur with huge bone defect.

The influence of muscles on knee flexion during the swing phase of gait.

PubMed

Piazza, S J; Delp, S L

1996-06-01

Although the movement of the leg during swing phase is often compared to the unforced motion of a compound pendulum, the muscles of the leg are active during swing and presumably influence its motion. To examine the roles of muscles in determining swing phase knee flexion, we developed a muscle-actuated forward dynamic simulation of the swing phase of normal gait. Joint angles and angular velocities at toe-off were derived from experimental measurements, as were pelvis motions and muscle excitations. Joint angles and joint moments resulting from the simulation corresponded to experimental measurements made during normal gait. Muscular joint moments and initial joint angular velocities were altered to determine the effects of each upon peak knee flexion in swing phase. As expected, the simulation demonstrated that either increasing knee extension moment or decreasing toe-off knee flexion velocity decreased peak knee flexion. Decreasing hip flexion moment or increasing toe-off hip flexion velocity also caused substantial decreases in peak knee flexion. The rectus femoris muscle played an important role in regulating knee flexion; removal of the rectus femoris actuator from the model resulted in hyperflexion of the knee, whereas an increase in the excitation input to the rectus femoris actuator reduced knee flexion. These findings confirm that reduced knee flexion during the swing phase (stiff-knee gait) may be caused by overactivity of the rectus femoris. The simulations also suggest that weakened hip flexors and stance phase factors that determine the angular velocities of the knee and hip at toe-off may be responsible for decreased knee flexion during swing phase.

Normal anatomy and biomechanics of the knee.

PubMed

Flandry, Fred; Hommel, Gabriel

2011-06-01

Functionally, the knee comprises 2 articulations-the patellofemoral and tibiofemoral. Stability of the joint is governed by a combination of static ligaments, dynamic muscular forces, meniscocapsular aponeurosis, bony topography, and joint load. The surgeon is ill equipped to undertake surgical treatment of a dislocated knee without a sound footing in the anatomic complexities of this joint. We review the normal anatomy of the knee, emphasizing connective tissue structures and common injury patterns.

Analysis of light incident location and detector position in early diagnosis of knee osteoarthritis by Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Chen, Yanping; Chen, Yisha; Yan, Huangping; Wang, Xiaoling

2017-01-01

Early detection of knee osteoarthritis (KOA) is meaningful to delay or prevent the onset of osteoarthritis. In consideration of structural complexity of knee joint, position of light incidence and detector appears to be extremely important in optical inspection. In this paper, the propagation of 780-nm near infrared photons in three-dimensional knee joint model is simulated by Monte Carlo (MC) method. Six light incident locations are chosen in total to analyze the influence of incident and detecting location on the number of detected signal photons and signal to noise ratio (SNR). Firstly, a three-dimensional photon propagation model of knee joint is reconstructed based on CT images. Then, MC simulation is performed to study the propagation of photons in three-dimensional knee joint model. Photons which finally migrate out of knee joint surface are numerically analyzed. By analyzing the number of signal photons and SNR from the six given incident locations, the optimal incident and detecting location is defined. Finally, a series of phantom experiments are conducted to verify the simulation results. According to the simulation and phantom experiments results, the best incident location is near the right side of meniscus at the rear end of left knee joint and the detector is supposed to be set near patella, correspondingly.

Effects of load carriage and footwear on lower extremity kinetics and kinematics during overground walking.

PubMed

Dames, Kevin D; Smith, Jeremy D

2016-10-01

Kinetic and kinematic responses during walking vary by footwear condition. Load carriage also influences gait patterns, but it is unclear how an external load influences barefoot walking. Twelve healthy adults (5 women, 7 men) with no known gait abnormalities participated in this study (age=23±3years, height=1.73±0.11m, and mass=70.90±12.67kg). Ground reaction forces and 3D motion were simultaneously collected during overground walking at 1.5ms -1 in four conditions: Barefoot Unloaded, Shod Unloaded, Barefoot Loaded, and Shod Loaded. Barefoot walking reduced knee and hip joint ranges of motion, as well as stride length, stance time, swing time, and double support time. Load carriage increased stance and double support times. The 15% body weight load increased GRFs ∼15%. Walking barefoot reduced peak anteroposterior GRFs but not peak vertical GRFs. Load carriage increased hip, knee, and ankle joint moments and powers, while walking barefoot increased knee and hip moments and powers. Thus, spatiotemporal and kinematic adjustments to walking barefoot decrease GRFs but increase knee and hip kinetic measures during overground walking. The ankle seems to be less affected by these footwear conditions. Regardless of footwear, loading requires larger GRFs, joint loads, and joint powers. Copyright © 2016 Elsevier B.V. All rights reserved.

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,…

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

Injuries in Female Dancers Aged 8 to 16 Years

PubMed Central

Steinberg, Nili; Siev-Ner, Itzhak; Peleg, Smadar; Dar, Gali; Masharawi, Youssef; Zeev, Aviva; Hershkovitz, Israel

2013-01-01

Context Most studies of injured dancers have been carried out on professional adult dancers; data on young, nonprofessional injured dancers are sparse. Objective To identify the types of injuries sustained by recreational dancers and to examine their association with age, joint range of motion, body structure, age at menarche, presence of anatomic anomalies, and physical burden (ie, practice hours en pointe). Design Descriptive epidemiology study. Setting The Israel Performing Arts Medicine Center, Tel Aviv. Patients or Other Participants A total of 569 injured female dancers, aged 8 to 16 years. Main Outcome Measure(s) Dependent variables were 61 types of current injuries that were later classified into 4 major categories: knee injuries, foot and ankle tendinopathy, back injuries, and other injuries. Independent variables were age, joint range of motion, body size and shape, age at menarche, anatomic anomalies, and dance discipline (eg, hours of practice per week en pointe). Results At least 1 previous injury had been sustained by 42.4% of the dancers. The most common injuries involved the knee (40.4%), followed by other injuries (23.4%). The relative frequency of back injuries and tendinopathy decreased with age, whereas knee injuries increased. Types of injuries were significantly associated with ankle plantar flexion, hip external rotation, hip abduction, and knee flexion. Multinomial regression analysis revealed only 3 predictive variables (with other as baseline), all for back injury: scoliosis, age, and hip external rotation. Conclusions Joint range of motion and scoliosis may signal the potential for future injury. Young dancers (less than 10 years of age) should not be exposed to overload (especially of the back) or extensive stretching exercises. PMID:23672333

Tenascin-C levels in synovial fluid are elevated after injury to the human and canine joint and correlate with markers of inflammation and matrix degradation.

PubMed

Chockalingam, P S; Glasson, S S; Lohmander, L S

2013-02-01

We have previously shown the capacity of tenascin-C (TN-C) to induce inflammatory mediators and matrix degradation in vitro in human articular cartilage. The objective of the present study was to follow TN-C release into knee synovial fluid after acute joint injury or in joint disease, and to correlate TN-C levels with markers of cartilage matrix degradation and inflammation. Human knee synovial fluid samples (n = 164) were from a cross-sectional convenience cohort. Diagnostic groups were knee healthy reference, knee anterior cruciate ligament rupture, with or without concomitant meniscus lesions, isolated knee meniscus injury, acute inflammatory arthritis (AIA) and knee osteoarthritis (OA). TN-C was measured in synovial fluid samples using an enzyme-linked immunosorbent assay (ELISA) and results correlated to other cartilage markers. TN-C release was also monitored in joints of dogs that underwent knee instability surgery. Statistically significantly higher levels of TN-C compared to reference subjects were observed in the joint fluid of all human disease groups and in the dogs that underwent knee instability surgery. Statistically significant correlations were observed between the TN-C levels in the synovial fluid of the human patients and the levels of aggrecanase-dependent Ala-Arg-Gly-aggrecan (ARG-aggrecan) fragments and matrix metalloproteinases 1 and 3. We find highly elevated levels of TN-C in human knee joints after injury, AIA or OA that correlated with markers of cartilage degradation and inflammation. TN-C in synovial fluid may serve dual roles as a marker of joint damage and a stimulant of further joint degradation. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Modulation of joint moments and work in the goat hindlimb with locomotor speed and surface grade

PubMed Central

Arnold, Allison S.; Lee, David V.; Biewener, Andrew A.

2013-01-01

SUMMARY Goats and other quadrupeds must modulate the work output of their muscles to accommodate the changing mechanical demands associated with locomotion in their natural environments. This study examined which hindlimb joint moments goats use to generate and absorb mechanical energy on level and sloped surfaces over a range of locomotor speeds. Ground reaction forces and the three-dimensional locations of joint markers were recorded as goats walked, trotted and galloped over 0, +15 and −15 deg sloped surfaces. Net joint moments, powers and work were estimated at the goats' hip, knee, ankle and metatarsophalangeal joints throughout the stance phase via inverse dynamics calculations. Differences in locomotor speed on the level, inclined and declined surfaces were characterized and accounted for by fitting regression equations to the joint moment, power and work data plotted versus non-dimensionalized speed. During level locomotion, the net work generated by moments at each of the hindlimb joints was small (less than 0.1 J kg−1 body mass) and did not vary substantially with gait or locomotor speed. During uphill running, by contrast, mechanical energy was generated at the hip, knee and ankle, and the net work at each of these joints increased dramatically with speed (P<0.05). The greatest increases in positive joint work occurred at the hip and ankle. During downhill running, mechanical energy was decreased in two main ways: goats generated larger knee extension moments in the first half of stance, absorbing energy as the knee flexed, and goats generated smaller ankle extension moments in the second half of stance, delivering less energy. The goats' hip extension moment in mid-stance was also diminished, contributing to the decrease in energy. These analyses offer new insight into quadrupedal locomotion, clarifying how the moments generated by hindlimb muscles modulate mechanical energy at different locomotor speeds and grades, as needed to accommodate the demands of variable terrain. PMID:23470662

Stair ascent with an innovative microprocessor-controlled exoprosthetic knee joint.

PubMed

Bellmann, Malte; Schmalz, Thomas; Ludwigs, Eva; Blumentritt, Siegmar

2012-12-01

Climbing stairs can pose a major challenge for above-knee amputees as a result of compromised motor performance and limitations to prosthetic design. A new, innovative microprocessor-controlled prosthetic knee joint, the Genium, incorporates a function that allows an above-knee amputee to climb stairs step over step. To execute this function, a number of different sensors and complex switching algorithms were integrated into the prosthetic knee joint. The function is intuitive for the user. A biomechanical study was conducted to assess objective gait measurements and calculate joint kinematics and kinetics as subjects ascended stairs. Results demonstrated that climbing stairs step over step is more biomechanically efficient for an amputee using the Genium prosthetic knee than the previously possible conventional method where the extended prosthesis is trailed as the amputee executes one or two steps at a time. There is a natural amount of stress on the residual musculoskeletal system, and it has been shown that the healthy contralateral side supports the movements of the amputated side. The mechanical power that the healthy contralateral knee joint needs to generate during the extension phase is also reduced. Similarly, there is near normal loading of the hip joint on the amputated side.

Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.

PubMed

Zdzieblik, Denise; Oesser, Steffen; Gollhofer, Albert; König, Daniel

2017-06-01

The aim of the study was to evaluate the use of specific collagen peptides in reducing pain in athletes with functional knee problems during sport. Athletic subjects (n = 139) with functional knee pain ingested 5 g of bioactive collagen peptides (BCP) or a placebo per day for 12 weeks. The primary outcome of the study was a change in pain intensity during activity, which was evaluated by the participants and the attending physicians using a visual analogue scale (VAS). As secondary endpoints, pain intensity under resting conditions, the range of motion of the knee joint, and the use of additional therapeutic options were assessed. The results revealed a statistically significant improvement in activity-related pain intensity in the verum group compared with placebo. (ΔVAS BCP = 19.5 ± 2.4; ΔVAS Placebo = 13.9 ± 2.1; p = 0.046). The results were confirmed by the physician's assessment. (ΔVAS BCP = 16.7 ± 1.8; ΔVAS Placebo = 12.2 ± 1.8; p = 0.021). Pain under resting conditions was also improved, but no significance compared with placebo was detected (ΔVAS BCP = 10.2 ± 18.4; ΔVAS Placebo = 7.4 ± 15.2; p = 0.209). Due to the high joint mobility at baseline, no significant changes of this parameter could be detected. The use of additional treatment options was significantly reduced after BCP intake. The study demonstrated that the supplementation of specific collagen peptides in young adults with functional knee problems led to a statistically significant improvement of activity-related joint pain.

Effect of Preactivation on Torque Enhancement by the Stretch-Shortening Cycle in Knee Extensors

PubMed Central

Fukutani, Atsuki; Misaki, Jun; Isaka, Tadao

2016-01-01

The stretch-shortening cycle is one of the most interesting topics in the field of sport sciences, because the performance of human movement is enhanced by the stretch-shortening cycle (eccentric contraction). The purpose of the present study was to examine whether the influence of preactivation on the torque enhancement by stretch-shortening cycle in knee extensors. Twelve men participated in this study. The following three conditions were conducted for knee extensors: (1) concentric contraction without preactivation (CON), (2) concentric contraction with eccentric preactivation (ECC), and (3) concentric contraction with isometric preactivation (ISO). Muscle contractions were evoked by electrical stimulation to discard the influence of neural activity. The range of motion of the knee joint was set from 80 to 140 degrees (full extension = 180 degrees). Angular velocities of the concentric and eccentric contractions were set at 180 and 90 degrees/s, respectively. In the concentric contraction phase, joint torques were recorded at 85, 95, and 105 degrees, and they were compared among the three conditions. In the early phase (85 degrees) of concentric contraction, the joint torque was larger in the ECC and ISO conditions than in the CON condition. However, these clear differences disappeared in the later phase (105 degrees) of concentric contraction. The results showed that joint torque was clearly different among the three conditions in the early phase whereas this difference disappeared in the later phase. Thus, preactivation, which is prominent in the early phase of contractions, plays an important role in torque enhancement by the stretch-shortening cycle in knee extensors. PMID:27414804

A double-blind randomized comparative study of triamcinolone hexacetonide and dexamethasone intra-articular injection for the treatment of knee joint arthritis in rheumatoid arthritis.

PubMed

Hajialilo, Mehrzad; Ghorbanihaghjo, Amir; Valaee, Leyla; Kolahi, Sousan; Rashtchizadeh, Naderh; Amirkhiz, Maryam Bannazadeh; Malekmahdavi, Ida; Khabbazi, Alireza

2016-12-01

Intra-articular glucocorticoid (GC) injection has been used for more than half a century in the treatment of refractory synovitis in patients with rheumatoid arthritis (RA). There are limited data about the efficacy of intra-articular injection of various preparations of GCs on inflamed joint. The aim of this study was to compare the efficacy and side effects of intra-articular injection of dexamethasone (DEX) and triamcinolone hexacetonide (TH) in the treatment of knee joint arthritis in RA. In a double-blind randomized clinical trial, 70 patients with RA and knee joint arthritis were recruited to the study. Swelled knee joints were injected with 40 mg TH or 8 mg DEX randomly. The primary outcome measures were reduction of knee joint swelling and pain 1 and 3 weeks after joint injection. The secondary outcome measures were relapse of knee arthritis at 2, 4, and 6 months after injection and side effects of intra-articular injection. Difference in the knee circumferences between DEX and TH groups at weeks 1 and 3 was not significant. The average times of pain reduction after injection were 3.4 ± 2.3 and 2.3 ± 1.8 days in TH and DEX, respectively. There were no differences of knee pain between the two groups. Relapse of knee arthritis was occurred in two (6.7 %) and three (9.4 %) patients in the DEX and TH groups, respectively. Intra-articular injection of DEX like TH causes rapid and long-term reduction of knee pain and swelling in patients with RA and is safe.

Satisfactory results at 8 years mean follow-up after ADVANCE® medial-pivot total knee arthroplasty.

PubMed

Chinzei, Nobuaki; Ishida, Kazunari; Tsumura, Nobuhiro; Matsumoto, Tomoyuki; Kitagawa, Atsushi; Iguchi, Tetsuhiro; Nishida, Kotaro; Akisue, Toshihiro; Kuroda, Ryosuke; Kurosaka, Masahiro

2014-03-01

Although good overall results have been reported with TKA, certain problems and limitations remain, primarily due to postoperative differences in joint kinematics, when compared with the normal knee. ADVANCE® Medial-Pivot TKA involves replicating the medial pivoting behavior observed in normal knees. Here, we aimed to investigate the clinical and radiological results and complications of TKA using this implant, at mid-term follow-up. From January 2001 to March 2012, we retrospectively selected 76 patients (85 knees; mean age at operation, 70.2±8.1 years; range, 51-88 years) with a mean follow-up period of 93.1±14.3 months (range, 72-132 months). Indications for TKA included primary degenerative osteoarthritis (60 knees), rheumatoid arthritis (22 knees), osteonecrosis (two knees), and osteoarthritis following high tibial osteotomy (one knee). The clinical and radiographic results were evaluated. Kaplan-Meier survivorship analysis indicated a success rate of 98.3% (95% confidence interval, 96.6-99.9%). Comparison of pre- and postoperative knee extension angles and ranges of motion showed significant improvement postoperatively, in both the Knee Society Scores (KSS) and Knee Society Functional Scores (KSFS) (p<0.05). In one case, radiographic assessment indicated implant loosening due to infection; however, despite this complication, significant improvement of postoperative varus or valgus deformity angles were noted in all cases (p<0.05). Patients undergoing ADVANCE® Medial-Pivot TKA achieved excellent clinical and radiographic results without any implant-related failures at mid-term follow-up. Level IV. © 2013.

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

No Exacerbation of Knee Joint Pain and Effusion Following Preoperative Progressive Resistance Training in Patients Scheduled for Total Knee Arthroplasty: Secondary Analyses From a Randomized Controlled Trial.

PubMed

Skoffer, Birgit; Dalgas, Ulrik; Maribo, Thomas; Søballe, Kjeld; Mechlenburg, Inger

2017-11-09

Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion. To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength. Secondary analyses from a randomized controlled trial. University Hospital and a Regional Hospital. A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group. Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally. Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion. The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001). PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded. To be determined. Copyright © 2017. Published by Elsevier Inc.

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

PubMed

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Femoro-tibial kinematics after TKA in fixed- and mobile-bearing knees in the sagittal plane.

PubMed

Daniilidis, Kiriakos; Höll, Steffen; Gosheger, Georg; Dieckmann, Ralf; Martinelli, Nicolo; Ostermeier, Sven; Tibesku, Carsten O

2013-10-01

Lack of the anterior cruciate ligament in total knee arthroplasty results in paradoxical movement of the femur as opposed to the tibia under deep flexion. Total knee arthroplasty with mobile-bearing inlays has been developed to provide increased physiological movement of the knee joint and to reduce polyethylene abrasion. The aim of this study was to perform an in vitro analysis of the kinematic movement in the sagittal plane in order to show differences between fixed- and mobile-bearing TKA in comparison with the natural knee joint. Seven knee joints of human cadaver material were used in a laboratory experiment. Fixed- and mobile-bearing inlays were tested in sequences under isokinetic extension in so-called kinemator for knee joints, which can simulate muscular traction power by the use of hydraulic cylinders, which crossover the knee joint. As a target parameter, the a.p. translation of the tibio-femoral relative movement was measured in the sagittal plane under ultrasound (Zebris) control. The results show a reduced tibial a.p. translation in relation to the femur in the bearing group compared to the natural joint. In the Z-axis, between 110° and 50° of flexion, linear movement decreases towards caudal movement under extension. Admittedly, the study did not show differences in the movement pattern between "mobile-bearing" and "fixed-bearing" prostheses. Results of this study cannot prove functional advantages of mobile-bearing prostheses for the knee joint kinematic after TKA. Both types of prostheses show typical kinematics of an anterior instability, hence they were incapable of performing physiological movement.

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. © 2013 Published by Elsevier Ltd.

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

Arthrodesis with a short Huckstep nail as a salvage procedure for failed total knee arthroplasty.

PubMed

Lai, K A; Shen, W J; Yang, C Y

1998-03-01

Arthrodesis of the knee with use of a short Huckstep nail was performed in thirty-three patients (thirty-three knees) after failure of a non-constrained total knee arthroplasty. The indication for the arthrodesis was an infection in thirty-one knees and a Charcot joint in two. Three knees had had a failed attempt at arthrodesis with use of external fixation. The Huckstep nail was inserted through the knee, retrograde into the femur, and then antegrade into the tibia. The duration of the operation averaged 104 minutes (range, sixty-five to 155 minutes). Local bone graft was used in all knees. At the time of follow-up, at an average of forty-seven months (range, eighteen to ninety-four months), thirty knees (91 per cent) had radiographic evidence of union. The average time to union was 5.2 months (range, two to ten months) after the arthrodesis. Eight knees that had a grossly purulent infection were treated with debridement, which was followed by the arthrodesis as a second-stage procedure; the other knees had a one-stage arthrodesis. Only one of the thirty-one knees that had had an infection before the arthrodesis had a recurrence after it. Arthrodesis with a short Huckstep nail provides immediate axial and rotational stability and allows weight-bearing without use of external support as well as placement of the knee in a slightly flexed and valgus position. In addition, the nail does not migrate and it may be used even when there is a standard-size prosthesis in the ipsilateral hip.

Finite Element Model of the Knee for Investigation of Injury Mechanisms: Development and Validation

PubMed Central

Kiapour, Ali; Kiapour, Ata M.; Kaul, Vikas; Quatman, Carmen E.; Wordeman, Samuel C.; Hewett, Timothy E.; Demetropoulos, Constantine K.; Goel, Vijay K.

2014-01-01

Multiple computational models have been developed to study knee biomechanics. However, the majority of these models are mainly validated against a limited range of loading conditions and/or do not include sufficient details of the critical anatomical structures within the joint. Due to the multifactorial dynamic nature of knee injuries, anatomic finite element (FE) models validated against multiple factors under a broad range of loading conditions are necessary. This study presents a validated FE model of the lower extremity with an anatomically accurate representation of the knee joint. The model was validated against tibiofemoral kinematics, ligaments strain/force, and articular cartilage pressure data measured directly from static, quasi-static, and dynamic cadaveric experiments. Strong correlations were observed between model predictions and experimental data (r > 0.8 and p < 0.0005 for all comparisons). FE predictions showed low deviations (root-mean-square (RMS) error) from average experimental data under all modes of static and quasi-static loading, falling within 2.5 deg of tibiofemoral rotation, 1% of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strains, 17 N of ACL load, and 1 mm of tibiofemoral center of pressure. Similarly, the FE model was able to accurately predict tibiofemoral kinematics and ACL and MCL strains during simulated bipedal landings (dynamic loading). In addition to minimal deviation from direct cadaveric measurements, all model predictions fell within 95% confidence intervals of the average experimental data. Agreement between model predictions and experimental data demonstrates the ability of the developed model to predict the kinematics of the human knee joint as well as the complex, nonuniform stress and strain fields that occur in biological soft tissue. Such a model will facilitate the in-depth understanding of a multitude of potential knee injury mechanisms with special emphasis on ACL injury. PMID:24763546

Wide step width reduces knee abduction moment of obese adults during stair negotiation.

PubMed

Yocum, Derek; Weinhandl, Joshua T; Fairbrother, Jeffrey T; Zhang, Songning

2018-05-15

An increased likelihood of developing obesity-related knee osteoarthritis may be associated with increased peak internal knee abduction moments (KAbM). Increases in step width (SW) may act to reduce this moment. The purpose of this study was to determine the effects of increased SW on knee biomechanics during stair negotiation of healthy-weight and obese participants. Participants (24: 10 obese and 14 healthy-weight) used stairs and walked over level ground while walking at their preferred speed in two different SW conditions - preferred and wide (200% preferred). A 2 × 2 (group × condition) mixed model analysis of variance was performed to analyze differences between groups and conditions (p < 0.05). Increased SW increased the loading-response peak knee extension moment during descent and level gait, decreased loading-response KAbMs, knee extension and abduction range of motion (ROM) during ascent, and knee adduction ROM during descent. Increased SW increased loading-response peak mediolateral ground reaction force (GRF), increased peak knee abduction angle during ascent, and decreased peak knee adduction angle during descent and level gait. Obese participants experienced disproportionate changes in loading-response mediolateral GRF, KAbM and peak adduction angle during level walking, and peak knee abduction angle and ROM during ascent. Increased SW successfully decreased loading-response peak KAbM. Implications of this finding are that increased SW may decrease medial compartment knee joint loading, decreasing pain and reducing joint deterioration. Increased SW influenced obese and healthy-weight participants differently and should be investigated further. Copyright © 2018. Published by Elsevier Ltd.

Correlation between knee and hindfoot alignment in patients with rheumatoid arthritis: The effects of subtalar joint destruction.

PubMed

Nakada, Izumi; Nakamura, Ichiro; Juji, Takuo; Ito, Katsumi; Matsumoto, Takumi

2015-09-01

Compensatory hindfoot alignment for deformities at the knee level has been demonstrated in patients with knee osteoarthritis. However, this phenomenon has not been elucidated in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the relationship between knee deformity and hindfoot alignment and the effect of subtalar joint destruction in patients with RA. We retrospectively investigated RA patients (110 patients, 205 limbs) using radiographs in the standing anteroposterior knee, standing lateral foot, and hindfoot alignment views. The grade of destruction at the knee and subtalar joints was assigned using Larsen's grading system. The correlation between the femorotibial and tibiocalcaneal angles and the effect of joint destruction on this correlation were analyzed using Pearson's correlation coefficients. There was moderate correlation between the femorotibial and tibiocalcaneal angles in a group of knees with a Larsen grade of ≥ 4 (r = 0.544, p = 0.0239). This correlation was stronger in a group with less damaged subtalar joints with a Larsen grade of ≤ 3 (r = 0.705, p = 0.0049). These findings emphasized the importance of examining foot and ankles in patients with RA who undergo total knee arthroplasty.

Prediction of Knee Joint Contact Forces From External Measures Using Principal Component Prediction and Reconstruction.

PubMed

Saliba, Christopher M; Clouthier, Allison L; Brandon, Scott C E; Rainbow, Michael J; Deluzio, Kevin J

2018-05-29

Abnormal loading of the knee joint contributes to the pathogenesis of knee osteoarthritis. Gait retraining is a non-invasive intervention that aims to reduce knee loads by providing audible, visual, or haptic feedback of gait parameters. The computational expense of joint contact force prediction has limited real-time feedback to surrogate measures of the contact force, such as the knee adduction moment. We developed a method to predict knee joint contact forces using motion analysis and a statistical regression model that can be implemented in near real-time. Gait waveform variables were deconstructed using principal component analysis and a linear regression was used to predict the principal component scores of the contact force waveforms. Knee joint contact force waveforms were reconstructed using the predicted scores. We tested our method using a heterogenous population of asymptomatic controls and subjects with knee osteoarthritis. The reconstructed contact force waveforms had mean (SD) RMS differences of 0.17 (0.05) bodyweight compared to the contact forces predicted by a musculoskeletal model. Our method successfully predicted subject-specific shape features of contact force waveforms and is a potentially powerful tool in biofeedback and clinical gait analysis.

Bicruciate-retaining Total Knee Replacement Provides Satisfactory Function and Implant Survivorship at 23 Years.

PubMed

Pritchett, James W

2015-07-01

One of the goals of a TKA is to approximate the function of a normal knee. Preserving the natural ligaments might provide a method of restoring close to normal function. Sacrifice of the ACL is common and practical during a TKA. However, this ligament is functional in more than 60% of patients undergoing a TKA and kinematic studies support the concept of bicruciate-retaining (that is, ACL-preserving) TKA; however, relatively few studies have evaluated patients treated with bicruciate-retaining TKA implants. I asked: (1) what is the long-term (minimum 20-year) survivorship, (2) what are the functional results, and (3) what are the reasons for revision of bicruciate-retaining knee arthroplasty prostheses? From January 1989 to September 1992, I performed 639 total knee replacements in 537 patients. Of these, 489 were performed in 390 patients using a bicruciate-retaining, minimally constrained device. During the period in question, this knee prosthesis was used for all patients observed intraoperatively to have an intact, functional ACL with between 15° varus and 15° valgus joint deformity. There were 234 women and 156 men with a mean age at surgery of 65 years (range, 42-84 years) and a primary diagnosis of osteoarthritis in 89%. The patella was resurfaced in all knees. The mean followup was 23 years (range, 20-24 years). At the time of this review, 199 (51%) patients had died and 31 (8%) patients were lost to followup, leaving 160 (41%) patients (214 knees) available for review. Component survivorship was determined by competing-risks analysis and Kaplan Meier survivorship analysis with revision for any reason as the primary endpoint. Patients were evaluated every 2 years to assess ROM, joint laxity, knee stability, and to determine American Knee Society scores. The Kaplan-Meier survivorship was 89% (95% CI, 82%-93%) at 23 years with revision for any reason as the endpoint. Competing-risks survivorship was 94% (95% CI, 91%%-96 %) at 23 years. At followup, the mean age of the patients was 84 years (range, 63-101 years), the mean flexion was 117° (range, 90°-130°), the mean American Knee Society score improved from a preoperative mean of 42 (range, 26-49) to 91 (range, 61-100; p < .001). Twenty-two knees in 21 patients (5.6%) were revised, most commonly because of polyethylene wear. ACL sacrifice may be an unnecessary concession during TKA. This study found satisfactory survivorship and function after more than 20 years of use for patients receiving a bicruciate-retaining TKA implant. A TKA that preserves cruciate ligaments provides a stable, well-functioning knee with a low likelihood of revision at long-term followup. Retaining both cruciate ligaments during knee arthroplasty is an attractive concept that is worth considering. Level IV, therapeutic study.

Agonist-antagonist active knee prosthesis: a preliminary study in level-ground walking.

PubMed

Martinez-Villalpando, Ernesto C; Herr, Hugh

2009-01-01

We present a powered knee prosthesis with two series-elastic actuators positioned in parallel in an agonist-antagonist arrangement. To motivate the knee's design, we developed a prosthetic knee model that comprises a variable damper and two series-elastic clutch units that span the knee joint. Using human gait data to constrain the model's joint to move biologically, we varied model parameters using an optimization scheme that minimized the sum over time of the squared difference between the model's joint torque and biological knee values. We then used these optimized values to specify the mechanical and control design of the prosthesis for level-ground walking. We hypothesized that a variable-impedance control design could produce humanlike knee mechanics during steady-state level-ground walking. As a preliminary evaluation of this hypothesis, we compared the prosthetic knee mechanics of an amputee walking at a self-selected gait speed with those of a weight- and height-matched nonamputee. We found qualitative agreement between prosthetic and human knee mechanics. Because the knee's motors never perform positive work on the knee joint throughout the level-ground gait cycle, the knee's electrical power requirement is modest in walking (8 W), decreasing the size of the onboard battery required to power the prosthesis.

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

PubMed

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

2016-01-01

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. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. 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. 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 medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction. © 2015 The Author(s).

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 medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Conclusion Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction. PMID:26493337

Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis.

PubMed

Fantini Pagani, Cynthia H; Willwacher, Steffen; Benker, Rita; Brüggemann, Gert-Peter

2014-12-01

Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Controlled laboratory study, repeated measurements. In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle-foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2013.

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 cemented...

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 cemented...

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 cemented...

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 cemented...

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 cemented...

Three-dimensional reconstruction of rat knee joint using episcopic fluorescence image capture.

PubMed

Takaishi, R; Aoyama, T; Zhang, X; Higuchi, S; Yamada, S; Takakuwa, T

2014-10-01

Development of the knee joint was morphologically investigated, and the process of cavitation was analyzed by using episcopic fluorescence image capture (EFIC) to create spatial and temporal three-dimensional (3D) reconstructions. Knee joints of Wister rat embryos between embryonic day (E)14 and E20 were investigated. Samples were sectioned and visualized using an EFIC. Then, two-dimensional image stacks were reconstructed using OsiriX software, and 3D reconstructions were generated using Amira software. Cavitations of the knee joint were constructed from five divided portions. Cavity formation initiated at multiple sites at E17; among them, the femoropatellar cavity (FPC) was the first. Cavitations of the medial side preceded those of the lateral side. Each cavity connected at E20 when cavitations around the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were completed. Cavity formation initiated from six portions. In each portion, development proceeded asymmetrically. These results concerning anatomical development of the knee joint using EFIC contribute to a better understanding of the structural feature of the knee joint. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

[Joint dislocation after total knee arthroplasty as an ankle fracture complication. Case report].

PubMed

Hrubina, M; Skoták, M

2012-01-01

Joint dislocation after total knee arthroplasty is a rare complication. It is described as the result of ligamentous instability. Here we report the case of an 82-year-old women who underwent primary total knee arthroplasty (TKA) for advanced primary grade III gonarthrosis. At 3 post-operative months the joint was stable and painless, with radiographic evidence of good TKA alignment and integration. At 4 months the patient suffered injury to the ankle involving a bimalleolar fracture and damage to knee soft tissues. The fracture was surgically treated. Subsequently, dorsal tibial dislocation was manifested. This was managed by individual intramedullary nail arthrodesis. At 8 months following the operation, the knee condition was satisfactory, with rigid arthrodesis and leg shortening of 4 cm. The patient was satisfied because she was free of pain and able to walk. Arthrodesis of the knee joint with an individual nail is an option for a definitive treatment of TKA instability. When other joints, such as ankle or hip joints, are injured, it is recommended to pay attention also to any TKA implanted previously because of potential development of instability or infection.

Effects of tibial plateau angle and spacer thickness applied during in vitro canine total knee replacement on three-dimensional kinematics and collateral ligament strain.

PubMed

Baker, Katherine M; Foutz, Timothy L; Johnsen, Kyle J; Budsberg, Steven C

2014-09-01

To quantify the 3-D kinematics and collateral ligament strain of stifle joints in cadaveric canine limbs before and after cranial cruciate ligament transection followed by total knee replacement (TKR) involving various tibial plateau angles and spacer thicknesses. 6 hemi-pelvises collected from clinically normal nonchondrodystrophic dogs (weight range, 25 to 35 kg). Hemi-pelvises were mounted on a modified Oxford knee rig that allowed 6 degrees of freedom of the stifle joint but prevented mechanical movement of the hip and tarsal joints. Kinematics and collateral ligament strain were measured continuously while stifle joints were flexed. Data were again collected after cranial cruciate ligament transection and TKR with combinations of 3 plateau angles (0°, 4°, and 8°) and spacer thicknesses (5, 7, and 9 mm). Presurgical (ie, normal) stifle joint rotations were comparable to those previously documented for live dogs. After TKR, kinematics recorded for the 8°, 5-mm implant most closely resembled those of unaltered stifle joints. Decreasing the plateau angle and increasing spacer thickness altered stifle joint adduction, internal rotation, and medial translation. Medial collateral ligament strain was minimal in unaltered stifle joints and was unaffected by TKR. Lateral collateral ligament strain decreased with steeper plateau angles but returned to a presurgical level at the flattest plateau angle. Among the constructs tested, greatest normalization of canine stifle joint kinematics in vitro was achieved with the steepest plateau angle paired with the thinnest spacer. Furthermore, results indicated that strain to the collateral ligaments was not negatively affected by TKR.

Reliability and accuracy of a goniometer mobile device application for video measurement of the functional movement screen deep squat test.

PubMed

Krause, David A; Boyd, Michael S; Hager, Allison N; Smoyer, Eric C; Thompson, Anthony T; Hollman, John H

2015-02-01

The squat is a fundamental movement of many athletic and daily activities. Methods to clinically assess the squat maneuver range from simple observation to the use of sophisticated equipment. The purpose of this study was to examine the reliability of Coach's Eye (TechSmith Corp), a 2-dimensional (2D) motion analysis mobile device application (app), for assessing maximal sagittal plane hip, knee, and ankle motion during a functional movement screen deep squat, and to compare range of motion values generated by it to those from a Vicon (Vicon Motion Systems Ltd) 3-dimensional (3D) motion analysis system. Twenty-six healthy subjects performed three functional movement screen deep squats recorded simultaneously by both the app (on an iPad [Apple Inc]) and the 3D motion analysis system. Joint angle data were calculated with Vicon Nexus software (Vicon Motion Systems Ltd). The app video was analyzed frame by frame to determine, and freeze on the screen, the deepest position of the squat. With a capacitive stylus reference lines were then drawn on the iPad screen to determine joint angles. Procedures were repeated with approximately 48 hours between sessions. Test-retest intrarater reliability (ICC3,1) for the app at the hip, knee, and ankle was 0.98, 0.98, and 0.79, respectively. Minimum detectable change was hip 6°, knee 6°, and ankle 7°. Hip joint angles measured with the 2D app exceeded measurements obtained with the 3D motion analysis system by approximately 40°. Differences at the knee and ankle were of lower magnitude, with mean differences of 5° and 3°, respectively. Bland-Altman analysis demonstrated a systematic bias in the hip range-of-motion measurement. No such bias was demonstrated at the knee or ankle. The 2D app demonstrated excellent reliability and appeared to be a responsive means to assess for clinical change, with minimum detectable change values ranging from 6° to 7°. These results also suggest that the 2D app may be used as an alternative to a sophisticated 3D motion analysis system for assessing sagittal plane knee and ankle motion; however, it does not appear to be a comparable alternative for assessing hip motion. 3.

[Influence of patellofemoral joint degeneration on outcome of medial unicompartmental knee arthroplasty].

PubMed

Xu, B Y; Ji, B C; Guo, W T; Mu, W B; Cao, L

2017-06-01

Objective: To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). Methods: A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m(2) ranging from 19.7 to 31.5 kg/m(2). Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre- and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. T test and ANOVA were used to analyze the data. Results: The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 vs . 38.9±4.7, 19.3±4.2 vs . 39.6±4.6, 18.1±3.2 vs . 38.1±3.7)( t =5.64 to 7.08, all P <0.01) and WOMAC (10.9±2.3 vs .53.2±4.5, 10.4±2.1 vs .54.6±3.4, 11.7±1.8 vs .52.8±3.7)( t =14.50 to 19.16, all P <0.01) decreased, and the Lonner score (88.9±3.4 vs .38.6±2.8, 87.5±4.1 vs .38.2±2.3, 88.2±3.2 vs . 37.6±3.5)( t =-19.78 to -18.16, all P <0.01) increased significantly in anterior-medial pain group, anterior knee pain group and general knee pain group. According to Ahlback scoring system, compared to pre-operation, OKS (18.3±2.4 vs . 38.7±4.4, 19.6±1.8 vs . 38.4±3.1)( t =7.05, 9.08, both P <0.01) and WOMAC (10.6 ±2.6 vs .53.2±4.5, 12.1±1.4 vs .52.4±3.3)( t =14.21, 19.52, both P <0.01) decreased, the Lonner score (88.1±3.1 vs .38.3±3.3, 86.9±2.6 vs .39.1±2.4)( t =-18.90, -23.40, both P <0.01) increased significantly in patellofemoral joint degeneration group and normal group, the outcomes were the same according to Altman and Outerbridge scoring system. There was no significant difference between patellofemoral joint degeneration group and normal group based on Ahlback grading system. According to Altman classification, compared to normal group, there was no statistically differences in OKS, WOMAC and Lonner scoring system between patients with degeneration in the medial patellofemoral joint group, OKS and WOMAC increased (20.2±1.4 vs .18.2±2.7, 12.5±1.7 vs .10.5±2.5) ( t =-4.30, P =0.03; t =-4.80, P =0.02), the Lonner score decreased (84.3±2.8 vs .87.4±3.2) ( t =-6.20, P =0.01) in lateral patellofemoral degeneration group. According to Outerbridge scoring system, there were no statistically differences in patients in patellofemoral joint degeneration group and normal group. Conclusions: There is a good evidence that neither mild to moderate degree of patellofemoral joint degeneration nor pre-operative pain location will compromise the short-term outcome of medial Oxford UKA, and should not be considered as contraindications. The situation is less clear for lateral patellofemoral degeneration, and more cautious option is advised.

Knock knee and the gait of six-year-old children.

PubMed

Pretkiewicz-Abacjew, E

2003-06-01

Knock knee (genu valgum) interferes with the locomotive and supporting function of the lower limb. In static conditions the load-bearing axis of the valgus limb is displaced laterally in relation to the middle of the joint, causing the knee joint, the ankle joint, and the foot as a whole to be weighted in the wrong way. The purpose of this work is to examine the influence of knock knee on gait kinematics. The gait of twenty-two 6-year-old children of both sexes in whom knock knee had been medically diagnosed was compared with the gait of 33 children of the same age whose knee joints conformed to the norm in formation and position. Gait was recorded separately for the sagittal and the frontal planes, using a video-computer system. The results of the examination indicated statistically significant differences in the gait of the two groups of children. These differences related mainly to the time features of gait and to data on the angles in the knee and ankle joints. Although the results obtained for other features of gait did not reveal statistical differences, these did indicate that the children with knock knee walked more slowly and with a lower cadence. The results indicate that knock knee in 6-year-old children has an adverse impact on the mechanics of the lower limb joints in gait and causes a deterioration in gait quality. Thus knock knee in children should not be treated merely as a superficial defect but should be subject to therapy and, more importantly, taken into account when introducing children to early sports training.

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

PubMed

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

2014-10-01

Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4 ± 5.5 years, 175.3 ± 7.9 cm, 83.6 ± 12.8 kg, mean ± SD) and 21 healthy controls (18 men, 42.0 ± 6.7 years, 176.8 ± 5.7 cm, 77.8 ± 13.4 kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3 years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. Greater knee joint varus (-10.1 vs. -7.3°, p<0.001), valgus (7.1 vs. 5.6°, p=0.001) and total (17.2 vs. 12.9°, p<0.001) angular laxity together with reduced midrange passive stiffness (1.71 vs. 2.36 Nm/°, p<0.001) were observed in patients vs. healthy controls. No differences were observed in change in stiffness over time between patients and controls, however a tendency towards increased laxity in patients was seen. Meniscectomized patients showed increased knee joint angular laxity and reduced passive stiffness ~3 months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients. Copyright © 2014 Elsevier B.V. All rights reserved.

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: a randomized controlled trial.

PubMed

Sørensen, T J; Langberg, H; Hodges, P W; Bliddal, H; Henriksen, M

2012-01-01

Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals. Twenty-seven healthy untrained volunteers participated in a randomized controlled trial of quadriceps strengthening (3 times per week for 8 weeks). Participants were randomized to perform resistance training either during pain induced by injections of painful hypertonic saline (pain group, n = 13) or during a nonpainful control condition with injection of isotonic saline (control group, n = 14) into the infrapatellar fat pad. The primary outcome measure was change in maximal isokinetic muscle strength in knee extension/flexion (60, 120, and 180 degrees/second). The group who exercised with pain had a significantly larger improvement in isokinetic muscle strength at all angular velocities of knee extension compared to the control group. In knee flexion there were improvements in isokinetic muscle strength in both groups with no between-group differences. Experimental knee joint pain improved the training-induced gain in muscle strength following 8 weeks of quadriceps training. It remains to be studied whether knee joint pain has a positive effect on strength gain in patients with knee pathology. Copyright © 2012 by the American College of Rheumatology.

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation

PubMed Central

Tao, Xingguang; Chen, Nong; Pan, Fugen; Cheng, Biao

2017-01-01

Abstract The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation. Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups. The mean follow-up time was 18.6 months (range: 5–24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05). External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation. PMID:29019890

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

PubMed

Tao, Xingguang; Chen, Nong; Pan, Fugen; Cheng, Biao

2017-10-01

The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5-24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5-9 months) and 6.0 months (range: 5-8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°-150°) and 135° (range: 100°-160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases

PubMed Central

Senioris, Antoine; Rahali, Said; Malekpour, Louis; Dujardin, Franck; Courage, Olivier

2016-01-01

Background Anterior knee pain (AKP) is observed in total knee arthroplasty (TKA) both with and without patellar resurfacing, and neither patellar denervation nor secondary resurfacing are effective for treating the symptoms. The exact causes for pain remain unclear, though abnormal patellofemoral forces due to patellar malalignment or inadequate implant design can play an important role. The purpose of this study was to arthroscopically evaluate patellofemoral congruence after wound closure following TKA without patellar resurfacing and correlate it to patellar morphology and postoperative pain and function. Methods The authors prospectively studied 30 patients that received uncemented mobile-bearing TKA. Patellofemoral congruence was assessed arthroscopically after wound closure by estimating the contact area between the native patella and the prosthetic trochlea (> two-thirds, > one-third, < one-third). The findings were correlated to preoperative assessments of patellar geometry (Wiberg classification using X-rays) and clinical outcomes [Knee Society Score (KSS), AKP on Visual Analogic Scale (VAS), and patient satisfaction]. Results Knees of 22 women and 8 men aged 69.8 years (range, 61–84 years) were analyzed at 16 months (range, 12–23 months). Preoperative patellar geometry was Wiberg type A in 11, type B in 12 and type C in 7 knees. Postoperative KSS was 79.1 (range, 50.0–94) and the VAS for AKP was 1.6±1.3 (median, 1; range, 0–5). Patellar congruence was correlated with patellar morphology (P<0.001) but not correlated with any clinical outcomes (KSS, VAS or satisfaction). There were also no statistical correlations between patellar morphology or patellofemoral congruence and patient characteristics. Conclusions While patellar morphology and patellofemoral congruence are strongly related, they are not associated with clinical outcomes or patient demographics. Considering that numerous incongruent patellofemoral joints were pain-free, and conversely, many perfectly congruent patellofemoral joints had anterior pain, the authors suppose that pain is probably caused by mechanisms other than patellofemoral pressures. PMID:27570773

Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases.

PubMed

Senioris, Antoine; Saffarini, Mo; Rahali, Said; Malekpour, Louis; Dujardin, Franck; Courage, Olivier

2016-08-01

Anterior knee pain (AKP) is observed in total knee arthroplasty (TKA) both with and without patellar resurfacing, and neither patellar denervation nor secondary resurfacing are effective for treating the symptoms. The exact causes for pain remain unclear, though abnormal patellofemoral forces due to patellar malalignment or inadequate implant design can play an important role. The purpose of this study was to arthroscopically evaluate patellofemoral congruence after wound closure following TKA without patellar resurfacing and correlate it to patellar morphology and postoperative pain and function. The authors prospectively studied 30 patients that received uncemented mobile-bearing TKA. Patellofemoral congruence was assessed arthroscopically after wound closure by estimating the contact area between the native patella and the prosthetic trochlea (> two-thirds, > one-third, < one-third). The findings were correlated to preoperative assessments of patellar geometry (Wiberg classification using X-rays) and clinical outcomes [Knee Society Score (KSS), AKP on Visual Analogic Scale (VAS), and patient satisfaction]. Knees of 22 women and 8 men aged 69.8 years (range, 61-84 years) were analyzed at 16 months (range, 12-23 months). Preoperative patellar geometry was Wiberg type A in 11, type B in 12 and type C in 7 knees. Postoperative KSS was 79.1 (range, 50.0-94) and the VAS for AKP was 1.6±1.3 (median, 1; range, 0-5). Patellar congruence was correlated with patellar morphology (P<0.001) but not correlated with any clinical outcomes (KSS, VAS or satisfaction). There were also no statistical correlations between patellar morphology or patellofemoral congruence and patient characteristics. While patellar morphology and patellofemoral congruence are strongly related, they are not associated with clinical outcomes or patient demographics. Considering that numerous incongruent patellofemoral joints were pain-free, and conversely, many perfectly congruent patellofemoral joints had anterior pain, the authors suppose that pain is probably caused by mechanisms other than patellofemoral pressures.

Deconstructing the power resistance relationship for squats: A joint-level analysis.

PubMed

Farris, D J; Lichtwark, G A; Brown, N A T; Cresswell, A G

2016-07-01

Generating high leg power outputs is important for executing rapid movements. Squats are commonly used to increase leg strength and power. Therefore, it is useful to understand factors affecting power output in squatting. We aimed to deconstruct the mechanisms behind why power is maximized at certain resistances in squatting. Ten male rowers (age = 20 ± 2.2 years; height = 1.82 ± 0.03 m; mass = 86 ± 11 kg) performed maximal power squats with resistances ranging from body weight to 80% of their one repetition maximum (1RM). Three-dimensional kinematics was combined with ground reaction force (GRF) data in an inverse dynamics analysis to calculate leg joint moments and powers. System center of mass (COM) velocity and power were computed from GRF data. COM power was maximized across a range of resistances from 40% to 60% 1RM. This range was identified because a trade-off in hip and knee joint powers existed across this range, with maximal knee joint power occurring at 40% 1RM and maximal hip joint power at 60% 1RM. A non-linear system force-velocity relationship was observed that dictated large reductions in COM power below 20% 1RM and above 60% 1RM. These reductions were due to constraints on the control of the movement. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Dynamic knee joint mechanics after anterior cruciate ligament reconstruction.

PubMed

Clarke, Sarah B; Kenny, Ian C; Harrison, Andrew J

2015-01-01

There is scarcity of information on the long-term adaptations in lower limb biomechanics during game-specific movements after anterior cruciate ligament (ACL) reconstruction. Particularly, variables such as knee abduction moments and transverse plane knee motion have not been studied during a game-specific landing and cutting task after ACL reconstruction. The purpose of this study was to compare the hip and knee mechanics between the ACL-reconstructed (ACLr) group and a healthy control group. Thirty-eight reconstructed athletes (18 ACLr, 18 control) participated in the study. Three-dimensional hip, knee, and ankle angles were calculated during a maximal drop jump land from a 0.30-m box and unanticipated cutting task at 45°. During the landing phase, ACLr participants had increased hip flexion (P < 0.003) and transverse plane knee range of motion (P = 0.027). During the cutting phase, the ACLr participant's previously injured limb had increased internal knee abduction moment compared with that of the control group (P = 0.032). No significant differences were reported between the previously injured and contralateral uninjured limb. Previously injured participants demonstrated higher knee abduction moment and transverse plane range of motion when compared with those of control participants during a game-specific landing and cutting task.

Standardising the clinical assessment of coronal knee laxity.

PubMed

Clarke, Jon V; Wilson, William T; Wearing, Scott C; Picard, Frederic; Riches, Philip E; Deakin, Angela H

2012-09-01

Clinical laxity tests are used for assessing knee ligament injuries and for soft tissue balancing in total knee arthroplasty. This study reports the development and validation of a quantitative technique of assessing collateral knee laxity through accurate measurement of potential variables during routine clinical examination. The hypothesis was that standardisation of a clinical stress test would result in a repeatable range of laxity measurements. Non-invasive infrared tracking technology with kinematic registration of joint centres gave real-time measurement of both coronal and sagittal mechanical tibiofemoral alignment Knee flexion, moment arm and magnitude of the applied force were all measured and standardised. Three clinicians then performed six knee laxity examinations on a single volunteer using a target moment of 18 Nm. Standardised laxity measurements had small standard deviations (within 1. 1 degree) for each clinician and similar mean values between clinicians, with the valgus laxity assessment (mean of 3 degrees) being slightly more consistent than varus (means of 4 degrees or 5 degrees). The manual technique of coronal knee laxity assessment was successfully quantified and standardised, leading to a narrow range of measurements (within the accuracy of the measurement system). Minimising the subjective variables of clinical examination could improve current knowledge of soft tissue knee behaviour.

Gene-expression changes in knee-joint tissues with aging and menopause: implications for the joint as an organ

PubMed Central

Rollick, Natalie C; Lemmex, Devin B; Ono, Yohei; Reno, Carol R; Hart, David A; Lo, Ian KY; Thornton, Gail M

2018-01-01

Background When considering the “joint as an organ”, the tissues in a joint act as complementary components of an organ, and the “set point” is the cellular activity for homeostasis of the joint tissues. Even in the absence of injury, joint tissues have adaptive responses to processes, like aging and menopause, which result in changes to the set point. Purpose The purpose of this study in a preclinical model was to investigate age-related and menopause-related changes in knee-joint tissues with the hypothesis that tissues will change in unique ways that reflect their differing contributions to maintaining joint function (as measured by joint laxity) and the differing processes of aging and menopause. Methods Rabbit knee-joint tissues from three groups were evaluated: young adult (gene expression, n=8; joint laxity, n=7; water content, n=8), aging adult (gene expression, n=6; joint laxity, n=7; water content, n=5), and menopausal adult (gene expression, n=8; joint laxity, n=7; water content, n=8). Surgical menopause was induced with ovariohysterectomy surgery and gene expression was assessed using reverse-transcription quantitative polymerase chain reaction. Results Aging resulted in changes to 37 of the 150 gene–tissue combinations evaluated, and menopause resulted in changes to 39 of the 150. Despite the similar number of changes, only eleven changes were the same in both aging and menopause. No differences in joint laxity were detected comparing young adult rabbits with aging adult rabbits or with menopausal adult rabbits. Conclusion Aging and menopause affected the gene-expression patterns of the tissues of the knee joint differently, suggesting unique changes to the set point of the knee. Interestingly, aging and menopause did not affect knee-joint laxity, suggesting that joint function was maintained, despite changes in gene expression. Taken together, these findings support the theory of the joint as an organ where the tissues of the joint adapt to maintain joint function. PMID:29535510

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study

PubMed Central

Jaspers, Richard T.; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A.; Witbreuk, Melinda M.; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G.

2018-01-01

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening. PMID:29408925

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study.

PubMed

Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G; Maas, Huub; Buizer, Annemieke I

2018-01-01

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.

The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty.

PubMed

Shi, Xiaojun; Shen, Bin; Kang, Pengde; Yang, Jing; Zhou, Zongke; Pei, Fuxing

2013-12-01

To evaluate and quantify the effect of the tibial slope on the postoperative maximal knee flexion and stability in the posterior-stabilized total knee arthroplasty (TKA). Fifty-six patients (65 knees) who had undergone TKA with the posterior-stabilized prostheses were divided into the following 3 groups according to the measured tibial slopes: Group 1: ≤4°, Group 2: 4°-7° and Group 3: >7°. The preoperative range of the motion, the change in the posterior condylar offset, the elevation of the joint line, the postoperative tibiofemoral angle and the preoperative and postoperative Hospital for Special Surgery (HSS) scores were recorded. The tibial anteroposterior translation was measured using the Kneelax 3 Arthrometer at both the 30° and the 90° flexion angles. The mean values of the postoperative maximal knee flexion were 101° (SD 5), 106° (SD 5) and 113° (SD 9) in Groups 1, 2 and 3, respectively. A significant difference was found in the postoperative maximal flexion between the 3 groups (P < 0.001). However, no significant differences were found between the 3 groups in the postoperative HSS scores, the changes in the posterior condylar offset, the elevation of the joint line or the tibial anteroposterior translation at either the 30° or the 90° flexion angles. A 1° increase in the tibial slope resulted in a 1.8° flexion increment (r = 1.8, R (2) = 0.463, P < 0.001). An increase in the posterior tibial slope can significantly increase the postoperative maximal knee flexion. The tibial slope with an appropriate flexion and extension gap balance during the operation does not affect the joint stability.

Arthroscopic-assisted Arthrodesis of the Knee Joint With the Ilizarov Technique

PubMed Central

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

2016-01-01

Abstract 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. PMID:26817899

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.

A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.

PubMed

Wakitani, S; Imoto, K; Saito, M; Yamamoto, T; Kawabata, H

2002-05-01

Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

Arthroscopic Treatment of Discoid Lateral Meniscus Tears in Children With Achondroplasia.

PubMed

Atanda, Alfred; Wallace, Maegen; Bober, Michael B; Mackenzie, William

2016-01-01

Achondroplasia is the most common form of skeletal dysplasia that presents to the pediatric orthopaedist. More than half of achondroplasia patients are affected with knee pain. It is thought that the majority of this pain may be due to spinal stenosis, hip pathology, or knee malalignment. Discoid menisci can be a source of lateral knee joint pain in skeletally immature patients in general. We present the first case series of patients with achondroplasia who had symptomatic discoid lateral menisci treated with arthroscopic knee surgery. The charts of 6 patients (8 knees) with achondroplasia who underwent arthroscopic knee surgery for symptomatic discoid lateral menisci were collected. History and physical examination data, magnetic resonance imaging findings, and operative reports were reviewed. Meniscal tear configuration and treatment type (meniscectomy vs. repair) were noted. Each patient was found to have a tear of the discoid meniscus. All menisci were treated with saucerization. In addition, meniscal repair was performed in 2 cases, partial meniscectomy in 3 cases, and subtotal meniscectomy in 3 cases. Two patients had bilateral discoid meniscal tears which were treated. Average follow-up was 2.4 years (range, 1 to 4.5 y) and the average pediatric International Knee Documentation Committee (pedi-IKDC) score was 85.3% (range, 75% to 95.4%). At final follow-up, all patients were pain free and able to return to full activities. Discoid meniscus tears may be a source of lateral joint line pain in patients with achondroplasia. These injuries can be successfully treated with arthroscopic surgery in this patient population. Future studies need to be done to determine the exact incidence of discoid menisci in achondroplasia patients and also to determine whether there is a genetic relationship between the 2 conditions. Level IV-case series.

Biomechanics of Hyperflexion and Kneeling before and after Total Knee Arthroplasty

PubMed Central

2014-01-01

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90°, 105°, 120°, and 135°. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135°). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120° of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis. PMID:24900891

Biomechanics of hyperflexion and kneeling before and after total knee arthroplasty.

PubMed

Lee, Thay Q

2014-06-01

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90°, 105°, 120°, and 135°. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135°). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120° of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.

Collateral ligament strains during knee joint laxity evaluation before and after TKA.

PubMed

Delport, Hendrik; Labey, Luc; De Corte, Ronny; Innocenti, Bernardo; Vander Sloten, Jos; Bellemans, Johan

2013-08-01

Passive knee stability is provided by the soft tissue envelope. There is consensus among orthopedic surgeons that good outcome in Total Knee Arthroplasty requires equal tension in the medial/lateral compartment of the knee joint, as well as equal tension in the flexion/extension gap. The purpose of this study was to quantify the ligament laxity in the normal non-arthritic knee before and after Posterior-Stabilized Total Knee Arthroplasty. We hypothesized that the Medial/Lateral Collateral Ligament shows minimal changes in length when measured directly by extensometers in the native human knee during varus/valgus laxity testing. We also hypothesized that due to differences in material properties and surface geometry, native laxity is difficult to reconstruct using a Posterior-Stabilized Total Knee. Six specimens were used to perform this in vitro cadaver test using extensometers to provide numerical values for laxity and varus-valgus tilting in the frontal plane. This study enabled a precise measurement of varus-valgus laxity as compared with the clinical assessment. The strains in both ligaments in the replaced knee were different from those in the native knee. Both ligaments were stretched in extension, in flexion the Medial Collateral Ligament tends to relax and the Lateral Collateral Ligament remains tight. As material properties and surface geometry of the replaced knee add stiffness to the joint, we recommend to avoid overstuffing the joint, when using this type of Posterior-Stabilized Total Knee Arthroplasty, in order to obtain varus/valgus laxity close to the native joint. Copyright © 2013 Elsevier Ltd. All rights reserved.

Modelling knee flexion effects on joint power absorption and adduction moment.

PubMed

Nagano, Hanatsu; Tatsumi, Ichiroh; Sarashina, Eri; Sparrow, W A; Begg, Rezaul K

2015-12-01

Knee osteoarthritis is commonly associated with ageing and long-term walking. In this study the effects of flexing motions on knee kinetics during stance were simulated. Extended knees do not facilitate efficient loading. It was therefore, hypothesised that knee flexion would promote power absorption and negative work, while possibly reducing knee adduction moment. Three-dimensional (3D) position and ground reaction forces were collected from the right lower limb stance phase of one healthy young male subject. 3D position was sampled at 100 Hz using three Optotrak Certus (Northern Digital Inc.) motion analysis camera units, set up around an eight metre walkway. Force plates (AMTI) recorded ground reaction forces for inverse dynamics calculations. The Visual 3D (C-motion) 'Landmark' function was used to change knee joint positions to simulate three knee flexion angles during static standing. Effects of the flexion angles on joint kinetics during the stance phase were then modelled. The static modelling showed that each 2.7° increment in knee flexion angle produced 2.74°-2.76° increments in knee flexion during stance. Increased peak extension moment was 6.61 Nm per 2.7° of increased knee flexion. Knee flexion enhanced peak power absorption and negative work, while decreasing adduction moment. Excessive knee extension impairs quadriceps' power absorption and reduces eccentric muscle activity, potentially leading to knee osteoarthritis. A more flexed knee is accompanied by reduced adduction moment. Research is required to determine the optimum knee flexion to prevent further damage to knee-joint structures affected by osteoarthritis. Copyright © 2015 Elsevier B.V. All rights reserved.

ISHKS joint registry: A preliminary report.

PubMed

Pachore, Jawahir A; Vaidya, Shrinand V; Thakkar, Chandrasekhar J; Bhalodia, Haresh Kumar P; Wakankar, Hemant M

2013-09-01

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are the most widely practiced surgical options for arthritis all over the world and its application is rising in India. Indian Society of Hip and Knee Surgeons (ISHKS) has established a joints registry and has been collecting data for last 6 years. All members of ISHKS are encouraged to actively participate in the registry. A simple two page knee and hip form can be downloaded from the website www.ishks.com. The information collected includes patient demographics, indication for surgery, implant details and in case of revision arthroplasty: the details of implants removed and the cause of failure of primary arthroplasty. These forms are mailed to the central registry office and the data is fed in computerized registry. Data collection started in October 2006. Joint registry is a very important initiative of ISHKS and till date, have data of 34,478 TKAs and 3604 THAs, contributed by 42 surgeons across India. Some important observations have emerged. Data of 34,478 TKAs was assessed: These included 8612 males (25%) and 25,866 females (75%). Average age was 64.4 years (Osteoarthritis range: 45 to 88 years; Rheumatoid arthritis range: 22 to 74 years). Average body mass index was 29.1 (Range: 18.1 to 42.9). The indication for TKA was osteoarthritis in 33,444 (97%) and rheumatoid arthritis in 759 (2.2%). Total of 3604 THA procedures were recorded. These included 2162 (60%) male patients and 1442 (40%) female patients. Average age was 52 years (Range 17 to 85 years) and average BMI was 25.8 (Range: 17.3 to 38.5). The indications for THA was AVN in 49%. The registry will become more meaningful in years to come. Active participation of all arthroplasty surgeons across India is vital for the success of the joints registry.

Ready to Use Tissue Construct for Military Bone & Cartilage Trauma

DTIC Science & Technology

2014-10-01

during nail introduction and reaming. In the present study, we examined the load - bearing capacity and optimal internal fixation of a bone/poly-ε...segmental defect, (a) axial loading via ball bearing , (b) torsional loading via square clamp allowing axial displacement, (c) three-point bending of tibia...knee joints by simulating loads seen during ambulation and knee range of motion. Our central hypothesis is that an anatomically and

[Application of tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty].

PubMed

Li, Guoliang; Han, Guangpu; Zhang, Jinxiu; Ma, Shiqiang; Guo, Donghui; Yuan, Fulu; Qi, Bingbing; Shen, Runbin

2013-07-01

To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line. Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.' All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed < 2 degrees knee deviation angle in the others except 1 case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00). The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.

Position controlled Knee Rehabilitation Orthotic Device for Patients after Total Knee Replacement Arthroplasty

NASA Astrophysics Data System (ADS)

Wannaphan, Patsiri; Chanthasopeephan, Teeranoot

2016-11-01

Knee rehabilitation after total knee replacement arthroplasty is essential for patients during their post-surgery recovery period. This study is about designing one degree of freedom knee rehabilitation equipment to assist patients for their post-surgery exercise. The equipment is designed to be used in sitting position with flexion/extension of knee in sagittal plane. The range of knee joint motion is starting from 0 to 90 degrees angle for knee rehabilitation motion. The feature includes adjustable link for different human proportions and the torque feedback control at knee joint during rehabilitation and the control of flexion/extension speed. The motion of the rehabilitation equipment was set to move at low speed (18 degrees/sec) for knee rehabilitation. The rehabilitation link without additional load took one second to move from vertical hanging up to 90° while the corresponding torque increased from 0 Nm to 2 Nm at 90°. When extra load is added, the link took 1.5 seconds to move to 90° The torque is then increased from 0 Nm to 4 Nm. After a period of time, the speed of the motion can be varied. User can adjust the motion to 40 degrees/sec during recovery activity of the knee and users can increase the level of exercise or motion up to 60 degrees/sec to strengthen the muscles during throughout their rehabilitation program depends on each patient. Torque control is included to prevent injury. Patients can use the equipment for home exercise to help reduce the number of hospital visit while the patients can receive an appropriate therapy for their knee recovery program.

Joint Angular Velocity in Spastic Gait and the Influence of Muscle-Tendon Lengthening*

PubMed Central

GRANATA, KEVIN P.; ABEL, MARK F.; DAMIANO, DIANE L.

2006-01-01

Background Joint angular velocity (the rate of flexion and extension of a joint) is related to the dynamics of muscle activation and force generation during walking. Therefore, the goal of this research was to examine the joint angular velocity in normal and spastic gait and changes resulting from muscle-tendon lengthening (recession and tenotomy) in patients who have spastic cerebral palsy. Methods The gait patterns of forty patients who had been diagnosed with spastic cerebral palsy (mean age, 8.3 years; range, 3.7 to 14.8 years) and of seventy-three age-matched, normally developing subjects were evaluated with three-dimensional motion analysis and electromyography. The patients who had cerebral palsy were evaluated before muscle-tendon lengthening and nine months after treatment. Results The gait patterns of the patients who had cerebral palsy were characterized by increased flexion of the knee in the stance phase, premature plantar flexion of the ankle, and reduced joint angular velocities compared with the patterns of the normally developing subjects. Even though muscle-tendon lengthening altered sagittal joint angles in gait, the joint angular velocities were generally unchanged at the hip and knee. Only the ankle demonstrated modified angular velocities, including reduced dorsiflexion velocity at foot-strike and improved dorsiflexion velocity through midstance, after treatment. Electromyographic changes included reduced amplitude of the gastrocnemius-soleus during the loading phase and decreased knee coactivity (the ratio of quadriceps and hamstring activation) at toe-off. Principal component analyses showed that, compared with joint-angle data, joint angular velocity was better able to discriminate between the gait patterns of the normal and cerebral palsy groups. Conclusions This study showed that muscle-tendon lengthening corrects biomechanical alignment as reflected by changes in sagittal joint angles. However, joint angular velocity and electromyographic data suggest that the underlying neural input remains largely unchanged at the hip and knee. Conversely, electromyographic changes and changes in velocity in the ankle indicate that the activation pattern of the gastrocnemius-soleus complex in response to stretch was altered by recession of the complex. PMID:10682726

Walking velocity and step length adjustments affect knee joint contact forces in healthy weight and obese adults.

PubMed

Milner, Clare E; Meardon, Stacey A; Hawkins, Jillian L; Willson, John D

2018-04-28

Knee osteoarthritis is a major public health problem and adults with obesity are particularly at risk. One approach to alleviating this problem is to reduce the mechanical load at the joint during daily activity. Adjusting temporospatial parameters of walking could mitigate cumulative knee joint mechanical loads. The purpose of this study was to determine how adjustments to velocity and step length affects knee joint loading in healthy weight adults and adults with obesity. We collected three-dimensional gait analysis data on 10 adults with a normal body mass index and 10 adults with obesity during over ground walking in nine different conditions. In addition to preferred velocity and step length, we also conducted combinations of 15% increased and decreased velocity and step length. Peak tibiofemoral joint impulse and knee adduction angular impulse were reduced in the decreased step length conditions in both healthy weight adults (main effect) and those with obesity (interaction effect). Peak knee joint adduction moment was also reduced with decreased step length, and with decreased velocity in both groups. We conclude from these results that adopting shorter step lengths during daily activity and when walking for exercise can reduce mechanical stimuli associated with articular cartilage degenerative processes in adults with and without obesity. Thus, walking with reduced step length may benefit adults at risk for disability due to knee osteoarthritis. Adopting a shorter step length during daily walking activity may reduce knee joint loading and thus benefit those at risk for knee cartilage degeneration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Standing stability enhancement with an intelligent powered transfemoral prosthesis.

PubMed

Lawson, Brian Edward; Varol, Huseyin Atakan; Goldfarb, Michael

2011-09-01

The authors have developed a ground-adaptive standing controller for a powered knee and ankle prosthesis which is intended to enhance the standing stability of transfemoral amputees. The finite-state-based controller includes a ground-searching phase, a slope estimation phase, and a joint impedance modulation phase, which together enable the prosthesis to quickly conform to the ground and provide stabilizing assistance to the user. In order to assess the efficacy of the ground-adaptive standing controller, the control approach was implemented on a powered knee and ankle prosthesis, and experimental data were collected on an amputee subject for a variety of standing conditions. Results indicate that the controller can estimate the ground slope within ±1° over a range of ±15°, and that it can provide appropriate joint impedances for standing on slopes within this range.

Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space

PubMed Central

Wikstrom, Erik A.; Guderian, Sophie; Turner, Michael J.

2017-01-01

Context:  Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known. Objective:  To measure knee-joint space after a single surgically induced ankle sprain in mice. Design:  Randomized controlled trial. Setting:  University research laboratory. Patients or Other Participants:  Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice. Main Outcome Measure(s):  Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs. Results:  Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups. Conclusions:  Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function. PMID:28437129

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. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Sonomyography Analysis on Thickness of Skeletal Muscle During Dynamic Contraction Induced by Neuromuscular Electrical Stimulation: A Pilot Study.

PubMed

Qiu, Shuang; Feng, Jing; Xu, Jiapeng; Xu, Rui; Zhao, Xin; Zhou, Peng; Qi, Hongzhi; Zhang, Lixin; Ming, Dong

2017-01-01

Neuromuscular electrical stimulation (NMES) that stimulates skeletal muscles to induce contractions has been widely applied to restore functions of paralyzed muscles. However, the architectural changes of stimulated muscles induced by NMES are still not well understood. The present study applies sonomyography (SMG) to evaluate muscle architecture under NMES-induced and voluntary movements. The quadriceps muscles of seven healthy subjects were tested for eight cycles during an extension exercise of the knee joint with/without NMES, and SMG and the knee joint angle were recorded during the process of knee extension. A least squares support vector machine (LS-SVM) LS-SVM model was developed and trained using the data sets of six cycles collected under NMES, while the remaining data was used to test. Muscle thickness changes were extracted from ultrasound images and compared between NMES-induced and voluntary contractions, and LS-SVM was used to model a relationship between dynamical knee joint angles and SMG signals. Muscle thickness showed to be significantly correlated with joint angle in NMES-induced contractions, and a significant negative correlation was observed between Vastus intermedius (VI) thickness and rectus femoris (RF) thickness. In addition, there was a significant difference between voluntary and NMES-induced contractions . The LS-SVM model based on RF thickness and knee joint angle provided superior performance compared with the model based on VI thickness and knee joint angle or total thickness and knee joint angle. This suggests that a strong relation exists between the RF thickness and knee joint angle. These results provided direct evidence for the potential application of RF thickness in optimizing NMES system as well as measuring muscle state under NMES.

Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space.

PubMed

Hubbard-Turner, Tricia; Wikstrom, Erik A; Guderian, Sophie; Turner, Michael J

2017-06-02

  Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known.   To measure knee-joint space after a single surgically induced ankle sprain in mice.   Randomized controlled trial.   University research laboratory.   Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice.   Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs.   Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups.   Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function.

Knee Biomechanics During Jogging After Arthroscopic Partial Meniscectomy: A Longitudinal Study.

PubMed

Hall, Michelle; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Cicuttini, Flavia M; Dempsey, Alasdair R; Lloyd, David G; Bennell, Kim L

2017-07-01

Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population. To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up. Controlled laboratory study. Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg. At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P > .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P < .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P > .05). Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic differences were small (~1.4°) and therefore of questionable clinical relevance. These results may facilitate future clinical research regarding the implications of jogging on knee joint health in middle-aged, overweight patients after APM.

Development of a Wearable Assist Robot for Walk Rehabilitation After Knee Arthroplasty Surgery

NASA Astrophysics Data System (ADS)

Terada, H.; Zhu, Y.; Horiguchi, K.; Nakamura, M.; Takahashi, R.

In Japan, it is popular that the disease knee joints will be replaced to artificial joints by surgery. And we have to assist so many patients for walk rehabilitation. So, the wearable assist robot has been developed. This robot includes the knee motion assist mechanism and the hip joint support mechanism. Especially, the knee motion assist mechanism consists of a non-circular gear and grooved cams. This mechanism rotates and slides simultaneously, which has two degree-of-freedom. Also, the hip joint support mechanism consists of a hip brace and a ball-joint. This mechanism can avoid motion constraints which are the internal or external rotation and the adduction or abduction. Then, the control algorithm, which considers an assisting timing for the walk rehabilitation, has been proposed. A sensing system of a walk state for this control system uses a heel contacts sensor and knee and hip joint rotation angle sensors. Also, the prototype robot has been tested. And it is confirmed that the assisting system is useful.

Study of Wearable Knee Assistive Instruments for Walk Rehabilitation

NASA Astrophysics Data System (ADS)

Zhu, Yong; Nakamura, Masahiro; Ito, Noritaka; Fujimoto, Hiroshi; Horikuchi, Kenichi; Wakabayashi, Shojiro; Takahashi, Rei; Terada, Hidetsugu; Haro, Hirotaka

A wearable Knee Assistive Instrument for the walk rehabilitation was newly developed. Especially, this system aimed at supporting the rehabilitation for the post-TKA (Total Knee Arthroplasty) which is a popular surgery for aging people. This system consisted of an assisting mechanism for the knee joint, a hip joint support system and a foot pressure sensor system. The driving system of this robot consisted of a CPU board which generated the walking pattern, a Li-ion battery, DC motors with motor drivers, contact sensors to detect the state of foot and potentiometers to detect the hip joint angle. The control method was proposed to reproduce complex motion of knee joint as much as possible, and to increase hip or knee flexion angle. Especially, this method used the timing that heel left from the floor. This method included that the lower limb was raised to prevent a subject's fall. Also, the prototype of knee assisting system was tested. It was confirmed that the assisting system is useful.

Selective arterial embolization with gelatin particles for refractory knee hemarthrosis.

PubMed

Yamagami, Takuji; Yoshimatsu, Rika; Miura, Hiroshi; Arai, Yuji; Terauchi, Ryu; Nakagawa, Shuji; Yamada, Kei

2013-01-01

We aimed to evaluate the feasibility and safety of selective arterial embolization for refractory knee hemarthrosis. Transcatheter arterial embolization for refractory knee hemarthrosis was performed on five female patients (median age, 77 years; range, 71-80 years) between May 2009 and September 2012. Selective arterial embolization of the feeding artery was performed using a 2.5 F microcatheter coaxially advanced from a 5 F catheter with its tip positioned in the superficial femoral artery. One- or two-millimeter gelatin particles were used as embolic agents. In all patients, transarterial embolization performed successfully after arteriography showed nontumorous staining around the knee joint. The feeding arteries were the lateral superior genicular artery in all five patients, the lateral inferior genicular artery in four patients, the medial superior genicular artery in one patient, the medial inferior genicular artery in one patient, the middle genicular artery in one patient, and the descending genicular artery in one patient. In all five patients, staining was remarkably diminished around the knee joint after the embolization procedure. No complication was observed. The hemarthrosis improved after the embolization, and the postoperative course has been uneventful with no recurrence in any patient. These results suggest that selective arterial embolization for refractory hemarthrosis of the knee is safe and useful.

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 uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590...

21 CFR 888.3590 - Knee joint tibial (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 tibial (hemi-knee) metallic resurfacing uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590...

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 uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590...

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 uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590...

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

How joint torques affect hamstring injury risk in sprinting swing-stance transition.

PubMed

Sun, Yuliang; Wei, Shutao; Zhong, Yunjian; Fu, Weijie; Li, Li; Liu, Yu

2015-02-01

The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases.

How Joint Torques Affect Hamstring Injury Risk in Sprinting Swing–Stance Transition

PubMed Central

SUN, YULIANG; WEI, SHUTAO; ZHONG, YUNJIAN; FU, WEIJIE; LI, LI; LIU, YU

2015-01-01

ABSTRACT Purpose The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Methods Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. Results During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. Conclusions During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases. PMID:24911288

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Atypical location of an osteoid osteoma with atypical anterior knee pain

PubMed Central

Harun, Mutlu; Hayrettin, Yaldız; Serhat, Mutlu; Engin, Cetinkaya; Kamil, Cepni; Armagan, Arslan; Sancar, Parmaksızoglu Atilla

2014-01-01

INTRODUCTION An osteoid osteoma is a painful tumor that most commonly affects the extra-articular parts of the long bones. An intra-articular location of an osteoid osteoma is rare. Various differential diagnoses may arise in connection with such an unusual location because it causes atypical clinical signs. PRESENTATION OF CASE A 24-year-old male developed pain in the central region of the right knee. Magnetic resonance imaging (MRI) showed no clear pathology in the knee joint. A technetium bone scan and computed tomography (CT) were then ordered and confirmed the presence of an osteoid osteoma in the knee joint. The patient was treated through an anteromedial approach to the knee, and the lesion was removed by excisional biopsy under fluoroscopy. DISCUSSION The diagnosis of intra-articular osteoid osteoma is challenging because the clinical presentation can be misleading. MRI is often requested as the first imaging method when dealing with knee symptoms, and radiologists are often unaware of the clinical presentation. Edema seen on MRI can be misleading with respect to the location of the nidus. CT is considered to be the best imaging method because it usually allows for clear visualization of the nidus. Different treatments have been proposed, ranging from open excision to arthroscopic resection. CONCLUSION Osteoid osteoma should be considered in young adult patients with chronic knee pain and no history of trauma. PMID:25462055

Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5 Years.

PubMed

Cameron, James I; McCauley, Julie C; Kermanshahi, Arash Y; Bugbee, William D

2015-06-01

Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. (1) Does lateral opening-wedge osteotomy lead to accurate correction? (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Between 2000 and 2010, we performed 40 distal femoral osteotomies. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]). Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Time to radiographic union, complications, and reoperations were recorded. Twenty-one of 31 knees had postoperative radiographic data available for review. Of these, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of ± 3° from neutral mechanical alignment. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. One nonunion occurred in the arthritis group. No postoperative complications were experienced. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than expected, but the procedure was associated with improved knee pain and function scores. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Achieving our desired correction of ± 3° from neutral alignment was clinically difficult. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Future studies with more patients and longer followup will provide clarity on this topic. Level IV, therapeutic study.

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.

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

Coupling motion between rearfoot and hip and knee joints during walking and single-leg landing.

PubMed

Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Okunuki, Takumi; Ishida, Tomoya; Samukawa, Mina; Tohyama, Harukazu

2017-12-01

The objective of the current study was to investigate the kinematic relationships between the rearfoot and hip/knee joint during walking and single-leg landing. Kinematics of the rearfoot relative to the shank, knee and hip joints during walking and single-leg landing were analyzed in 22 healthy university students. Kinematic relationships between two types of angular data were assessed by zero-lag cross-correlation coefficients and coupling angles, and were compared between joints and between tasks. During walking, rearfoot eversion/inversion and external/internal rotation were strongly correlated with hip adduction/abduction (R=0.69 and R=0.84), whereas correlations with knee kinematics were not strong (R≤0.51) and varied between subjects. The correlations with hip adduction/abduction were stronger than those with knee kinematics (P<0.001). Most coefficients during single-leg landing were strong (R≥0.70), and greater than those during walking (P<0.001). Coupling angles indicated that hip motion relative to rearfoot motion was greater than knee motion relative to rearfoot motion during both tasks (P<0.001). Interventions to control rearfoot kinematics may affect hip kinematics during dynamic tasks. The coupling motion between the rearfoot and hip/knee joints, especially in the knee, should be considered individually. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cumulative loads increase at the knee joint with slow-speed running compared to faster running: a biomechanical study.

PubMed

Petersen, Jesper; Sørensen, Henrik; Nielsen, Rasmus Østergaard

2015-04-01

Biomechanical cross-sectional study. To investigate the hypothesis that the cumulative load at the knee during running increases as running speed decreases. The knee joint load per stride decreases as running speed decreases. However, by decreasing running speed, the number of strides per given distance is increased. Running a given distance at a slower speed may increase the cumulative load at the knee joint compared with running the same distance at a higher speed, hence increasing the risk of running-related injuries in the knee. Kinematic and ground reaction force data were collected from 16 recreational runners, during steady-state running with a rearfoot strike pattern at 3 different speeds (mean ± SD): 8.02 ± 0.17 km/h, 11.79 ± 0.21 km/h, and 15.78 ± 0.22 km/h. The cumulative load (cumulative impulse) over a 1000-m distance was calculated at the knee joint on the basis of a standard 3-D inverse-dynamics approach. Based on a 1000-m running distance, the cumulative load at the knee was significantly higher at a slow running speed than at a high running speed (relative difference, 80%). The mean load per stride at the knee increased significantly across all biomechanical parameters, except impulse, following an increase in running speed. Slow-speed running decreases knee joint loads per stride and increases the cumulative load at the knee joint for a given running distance compared to faster running. The primary reason for the increase in cumulative load at slower speeds is an increase in number of strides needed to cover the same distance.

Lower Limb Kinematics and Metabolic Cost During Elliptical Exercises and Treadmill Running.

PubMed

Chester, Stephanie; Zucker-Levin, Audrey; Melcher, Daniel A; Peel, Shelby A; Bloomer, Richard J; Paquette, Max R

2016-04-01

The purpose of this study was to compare knee and hip joint kinematics previously associated with anterior knee pain and metabolic cost among conditions including treadmill running (TR), standard elliptical (SE), and lateral elliptical (LE) in healthy runners. Joint kinematics and metabolic parameters of 16 runners were collected during all 3 modalities using motion capture and a metabolic system, respectively. Sagittal knee range of motion (ROM) was greater in LE (P < .001) and SE (P < .001) compared with TR. Frontal and transverse plane hip ROM were greater in LE compared with SE (P < .001) and TR (P < .001). Contralateral pelvic drop ROM was smaller in SE compared with TR (P = .002) and LE (P = .005). Similar oxygen consumption was found during LE and TR (P = .39), but LE (P < .001) and TR (P < .001) required greater oxygen consumption than SE. Although LE yields similar metabolic cost to TR and produces hip kinematics that may help strengthen hip abductors, greater knee flexion and abduction during LE may increase symptoms in runners with anterior knee pain. The findings suggest that research on the implications of elliptical exercise for injured runners is needed.

Physiotherapy in the management of total knee arthroplasty: a review.

PubMed

Akodu, A K; Giwa, S O; Akinbo, S R A; Ahmed, U A

2011-01-01

Although total knee arthroplasty (TKA) is considered the treatment of choice for patients with intractable pain and substantial functional disabilities who have not had acceptable relief and functional improvement after conservative treatment. It was found out that patients with total knee arthroplasty need physiotherapy intervention for pre-operative and post-operative management. To take a critical look at the importance of TKA following destruction of the knee joint, its indications and contraindications and to ascertain the current trend involved in the physiotherapy management of TKA. The current literature materials on physiotherapy management of TKA was reviewed. The aim of treatment is to maximize functionality and independence and to minimize complication such as deep vein thrombosis and pulmonary embolism by relieving pain using cryotherapy, improving range of motion with mobilization techniques, muscle strengthening, therapeutic exercise, transfer training, gait training and training of activities of daily living. These are administered as home programme or in organized groups led by a physiotherapist and has been shown to improve outcome related to physical activity after knee joint arthroplasty. It was concluded that interventions, including physiotherapy and functional exercises after discharge, is still beneficial after TKA.

Knee contact forces and lower extremity support moments during running in young individuals post-partial meniscectomy.

PubMed

Willy, R W; Bigelow, M A; Kolesar, A; Willson, J D; Thomas, J S

2017-01-01

While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments and reduced tibiofemoral joint contact forces. 3-D Treadmill running mechanics were evaluated in 23 athletic individuals post-partial meniscectomy (37.5 ± 19.0 months post-partial meniscectomy) and 23 matched controls. Bilateral hip, knee and ankle contributions to the total support moment and the peak knee extension moment were calculated. A musculoskeletal model estimated peak and impulse tibiofemoral joint contact forces. Knee function was quantified with the Knee injury and Osteoarthritis Outcome Score (KOOS). During running, the partial meniscectomy group had a greater hip support moment (p = 0.002) and a reduced knee support moment (p < 0.001) relative to the total support moment. This movement pattern was associated with a 14.5 % reduction (p = 0.019) in the peak knee extension moment. Despite these differences, there were no significant group differences in peak or impulse tibiofemoral joint contact forces. Lower KOOS Quality of Life scores were associated with greater hip support moment (p = 0.004, r = -0.58), reduced knee support moment (p = 0.006, r = 0.55) and reduced peak knee extension moment (p = 0.01, r = 0.52). Disordered running mechanics are present long term post-partial meniscectomy. A coordination strategy that shifts a proportion of the total support moment away from the knee to the hip reduces the peak knee extension moment, but does not equate to reduced tibiofemoral joint contact forces during running in individuals post-partial meniscectomy. III.

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. Copyright © 2014 Elsevier B.V. All rights reserved.

Do changes in neuromuscular activation contribute to the knee extensor angle-torque relationship?

PubMed

Lanza, Marcel B; Balshaw, Thomas G; Folland, Jonathan P

2017-08-01

What is the central question of the study? Do changes in neuromuscular activation contribute to the knee extensor angle-torque relationship? What is the main finding and its importance? Both agonist (quadriceps) and antagonist coactivation (hamstrings) differed with knee joint angle during maximal isometric knee extensions and thus both are likely to contribute to the angle-torque relationship. Specifically, two independent measurement techniques showed quadriceps activation to be lower at more extended positions. These effects might influence the capacity for neural changes in response to training and rehabilitation at different knee joint angles. The influence of joint angle on knee extensor neuromuscular activation is unclear, owing in part to the diversity of surface electromyography (sEMG) and/or interpolated twitch technique (ITT) methods used. The aim of the study was to compare neuromuscular activation, using rigorous contemporary sEMG and ITT procedures, during isometric maximal voluntary contractions (iMVCs) of the quadriceps femoris at different knee joint angles and examine whether activation contributes to the angle-torque relationship. Sixteen healthy active men completed two familiarization sessions and two experimental sessions of isometric knee extension and knee flexion contractions. The experimental sessions included the following at each of four joint angles (25, 50, 80 and 106 deg): iMVCs (with and without superimposed evoked doublets); submaximal contractions with superimposed doublets; and evoked twitch and doublet contractions whilst voluntarily passive, and knee flexion iMVC at the same knee joint positions. The absolute quadriceps femoris EMG was normalized to the peak-to-peak amplitude of an evoked maximal M-wave, and the doublet-voluntary torque relationship was used to calculate activation with the ITT. Agonist activation, assessed with both normalized EMG and the ITT, was reduced at the more extended compared with the more flexed positions (25 and 50 versus 80 and 106 deg; P ≤ 0.016), whereas antagonist coactivation was greatest in the most flexed compared with the extended positions (106 versus 25 and 50 deg; P ≤ 0.02). In conclusion, both agonist and antagonist activation differed with knee joint angle during knee extension iMVCs, and thus both are likely to contribute to the knee extensor angle-torque relationship. © 2017 The Authors. Experimental Physiology © 2017 The Physiological Society.

Design and control of a prosthetic leg for above-knee amputees operated in semi-active and active modes

NASA Astrophysics Data System (ADS)

Park, Jinhyuk; Yoon, Gun-Ha; Kang, Je-Won; Choi, Seung-Bok

2016-08-01

This paper proposes a new prosthesis operated in two different modes; the semi-active and active modes. The semi-active mode is achieved from a flow mode magneto-rheological (MR) damper, while the active mode is obtained from an electronically commutated (EC) motor. The knee joint part of the above knee prosthesis is equipped with the MR damper and EC motor. The MR damper generates reaction force by controlling the field-dependent yield stress of the MR fluid, while the EC motor actively controls the knee joint angle during gait cycle. In this work, the MR damper is designed as a two-end type flow mode mechanism without air chamber for compact size. On other hand, in order to predict desired knee joint angle to be controlled by EC motor, a polynomial prediction function using a statistical method is used. A nonlinear proportional-derivative controller integrated with the computed torque method is then designed and applied to both MR damper and EC motor to control the knee joint angle. It is demonstrated that the desired knee joint angle is well achieved in different walking velocities on the ground ground.

Proximal fibular osteotomy: a new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis.

PubMed

Wang, Xiaohu; Wei, Lei; Lv, Zhi; Zhao, Bin; Duan, Zhiqing; Wu, Wenjin; Zhang, Bin; Wei, Xiaochun

2017-02-01

Objective To explore the effects of proximal fibular osteotomy as a new surgery for pain relief and improvement of medial joint space and function in patients with knee osteoarthritis. Methods From January 2015 to May 2015, 47 patients who underwent proximal fibular osteotomy for medial compartment osteoarthritis were retrospectively followed up. Preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained to analyse the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment). Knee pain was assessed using a visual analogue scale, and knee ambulation activities were evaluated using the American Knee Society score preoperatively and postoperatively. Results Medial pain relief was observed in almost all patients after proximal fibular osteotomy. Most patients exhibited improved walking postoperatively. Weight-bearing lower extremity radiographs showed an average increase in the postoperative medial knee joint space. Additionally, obvious correction of alignment was observed in the whole lower extremity radiographs in 8 of 47 patients. Conclusions The present study demonstrates that proximal fibular osteotomy effectively relieves pain and improves joint function in patients with medial compartment osteoarthritis at a mean of 13.38 months postoperatively.

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.

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

PubMed

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.

[The effects of hand acupuncture therapy on pain, ROM, ADL and depression among elders with low back pain and knee joint pain].

PubMed

Yang, Jin-Hyang

2009-02-01

The purpose of this study was to identify the effects of hand acupuncture therapy on pain, ROM, ADL, and depression among older people with low back pain and knee joint pain. The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 40 patients, 18 in the experimental group and 22 in the control group. A pretest and 2 posttest were conducted to measure the main variables. For the experimental group, hand acupuncture therapy, consisting of hand acupuncture and press-pellets based on corresponding points, was given. There were statistically significant differences in pain, ROM in knee joint, and ADL in the experimental group but not in depression compared to the control group over two different times. The hand acupuncture therapy was effective for low back pain, knee joint pain, ROM in knee joint and ADL among the elders in this study. Therefore, the hand acupuncture therapy can be utilized in the field of geriatric nursing as a nursing intervention for older people with low back pain and knee joint pain.

Rapidly growing non-tuberculous mycobacteria infection of prosthetic knee joints: A report of two cases.

PubMed

Kim, Manyoung; Ha, Chul-Won; Jang, Jae Won; Park, Yong-Beom

2017-08-01

Non-tuberculous mycobacteria (NTM) cause prosthetic knee joint infections in rare cases. Infections with rapidly growing non-tuberculous mycobacteria (RGNTM) are difficult to treat due to their aggressive clinical behavior and resistance to antibiotics. Infections of a prosthetic knee joint by RGNTM have rarely been reported. A standard of treatment has not yet been established because of the rarity of the condition. In previous reports, diagnoses of RGNTM infections in prosthetic knee joints took a long time to reach because the condition was not suspected, due to its rarity. In addition, it is difficult to identify RGNTM in the lab because special identification tests are needed. In previous reports, after treatment for RGNTM prosthetic infections, knee prostheses could not be re-implanted in all cases but one, resulting in arthrodesis or resection arthroplasty; this was most likely due to the aggressiveness of these organisms. In the present report, two cases of prosthetic knee joint infection caused by RGNTM (Mycobacterium abscessus) are described that were successfully treated, and in which prosthetic joints were finally reimplanted in two-stage revision surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

Does proprioceptive acuity during active knee rotation in the transverse plane vary at different ranges?

PubMed

Muaidi, Qassim I

2016-11-21

Knee proprioception in the sagittal plane has been widely investigated in prospective studies, however limited information is known about proprioceptive acuity during active knee rotation and the way most commonly injured. To investigate whether proprioceptive acuity during active internal and external knee rotation varies at different ranges in the transverse plane. Healthy volunteers (N: 26) without previous injury or surgery of the knee joint participated in the study.Knee rotation proprioceptive acuity was measured using a custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable-difference (JND). Participants actively rotated the knee at different intervals(initial, mid, and terminal internal or external rotation range) to one of four movement blocks and the magnitude of the permitted motion was judged. The means of the JND for proprioceptive acuity at initial internal rotation (0.80° ± 0.06) were significantly (p< 0.002) lower than for mid (1.62° ± 0.18), and terminal (2.08° ± 0.35) internal rotation. The means of the JND for proprioceptive acuity at initial external rotation (1.16° ± 0.10) were significantly (p< 0.04) lower than for mid (1.95° ± 0.30), and terminal (1.97° ± 0.24) internal rotation. Participants perceived smaller differences between active internal and external rotation movements at initial rotation range than at the mid and terminal rotation range of movement. This suggests better proprioceptive acuity at the initial rotation range of movement in the transverse plane.

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

Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee.

PubMed

Eid, Ahmed Salem; Nassar, Wael Ahmed Mohamed; Fayyad, Tamer Abdelmeguid Mohamed

2016-11-01

Total knee arthroplasty (TKA) is a well-proven modality that can provide pain relief and restore mobility for rheumatoid arthritis (RA) patients with advanced joint destruction. Patellar ligament avulsion, especially in presence of poor bone quality and knee stiffness, is one of the special considerations that must be addressed in this unique population of patients. This study aimed to determine the functional results in a series of rheumatoid patients with stiff knee and end-stage joint destruction who underwent tibial tubercle osteotomy during TKA. Twenty-three knees in 20 patients (16 women; four men) at a mean age of 54 years with end-stage arthritis and knee stiffness due to RA were operated upon for TKA using tibial tubercle osteotomy as a step during the operation. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Hospital for Special Surgery (HSS) score was recorded pre-operatively and at six and 12 months postoperatively. Union occurred at the osteotomy site in 21 of 23 cases. One case had deep venous thrombosis (DVT). There was no infection or periprosthetic fracture, and at last follow-up, no patient required revision. HSS score improved from 46 (15-60) pre-operatively to 85 (71-96) post-operatively. Tibial tubercle osteotomy during TKA in patients with RA and stiff knee is technically demanding yet proved to be effective in improving post-operative range of movement and minimising the complication of patellar ligament avulsion.

[Evaluation of early physiotherapy in patients after surgical treatment of cruciate ligament injury by bone-tendon-bone method].

PubMed

Klupiński, Kamil; Krekora, Katarzyna; Woldańska-Okońska, Marta

2014-01-01

Anterior cruciate ligament (ACL) is one of the most important structures of the knee joint. It has a stabilizing function and causes sliding movement between the articular surfaces. Most frequently there comes to the anterior cruciate ligament injury during practicing sports such as skiing, football, sports which require sudden turns and those which are associated with jumps for height like basketball and volleyball. The aim of study was to evaluate of the outcomes of complex physiotherapy after reconstruction of anterior cruciate ligament by bone -tendon-bone (BTB) method. The study involved 41 patients, 8 women and 33 men, aged 20 to 45 years, body height 1.60-1.90 cm and body weight 50-100 kg. The patients were divided into two groups. Group I included 26 patients (3 women and 23 men) after arthroscopic ACL reconstruction. Group II--control-group included 15 patients (5 women and 10 men) after ACL injury but not subjected to the ligament reconstruction. The patients from both groups underwent rehabilitation according to the same rehabilitation program suggested by the Medical Magnus Clinic in Lodz, which consisted in performing daily exercises in open and closed kinetic chains. All group I and II patients were examined three times: after surgery (before the start of the rehabilitation), in the sixth week of rehabilitation and 12 weeks afterwards. The clinical examination included: measurement of the range of movement in the knee joint, the measurement of musculoskeletal strength with Lovett scale, knee pain assessment using Visual Analog Scale (VAS), transpatellar anthropometric measurement of the knee joint, linear measurements of the thigh and shin (at two points: 5 and 10 cm above the patellar apex and at two points: 5 and 10 cm below the patellar base). Introduction of early highly specialized physiotherapy has been demonstrated to contribute to the improvement of the rehabilitation outcomes and to the shortening of the therapy. A statistically significant improvement has been obtained in all examined patients after anterior cruciate ligament reconstruction by bone - tendon - bone method at every stage of rehabilitation in relation to the initial values. Early motor physiotherapy has a significant impact on the condition of patients treated both surgically and conservatively. The differences observed between the groups in the range of the measurement of movement in the knee joint, the measurement of musculoskeletal strength, severity of pain in the knee joint, transpatellar anthropometric measurement of the knee joint and linear measurements of the thigh and shin were caused by necessary surgery which leads to the conclusion that the therapeutic rehabilitation should be longer in the investigated group. In this group introduction of physical therapy with analgesic effects is also of importance. Taking into account good results observed in patients from the control group, who were treated conservatively, the possible indications for surgery should be carefully considered.

The short-term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee.

PubMed

Boocock, M; McNair, P; Cicuttini, F; Stuart, A; Sinclair, T

2009-07-01

To investigate the short-term effects of recreational running on the deformation of knee articular cartilage and to examine the relationship between changes in knee cartilage volume and biomechanical modulators of knee joint load. Twenty healthy volunteers participated in a two phase cross-sectional study. Session 1 involved Magnetic Resonance Imaging (MRI) of femoral and tibial cartilage volumes prior to and following a 30 min period of relaxed sitting, which was directly followed by a recreational run of 5000 steps. Subsequently, all participants undertook a laboratory study of their running gait to compare biomechanical derived measures of knee joint loading with changes in cartilage volume. Estimates of knee joint load were determined using a rigid-link segment, dynamic biomechanical model of the lower limbs and a simplified muscle model. Running resulted in significant deformation of the medial (5.3%, P<0.01) and lateral femoral cartilage (4.0%, P<0.05) and lateral aspect of the tibial cartilage (5.7%, P<0.01), with no significant differences between genders. Maximum compression stress was significantly correlated with percentage changes in lateral femoral cartilage volume (r(2)=0.456, P<0.05). No other biomechanical variables correlated with volume changes. Limited evidence was found linking biomechanical measures of knee joint loading and observed short-term deformation of knee articular cartilage volume following running. Further enhancement of knee muscle modelling and analysis of stress distribution across cartilage are needed if we are to fully understand the contribution of biomechanical factors to knee joint loading and the pathogenesis of knee osteoarthritis (OA).

Does frontal knee kinematics predict treatment outcomes? Exploratory analyses from the Intensive Diet and Exercise for Arthritis (IDEA) trial.

PubMed

Hall, Michelle; Bennell, Kim L; Beavers, Daniel P; Wrigley, Tim V; DeVita, Paul; Messier, Stephen P

2018-04-27

Pain is a cardinal symptom of knee osteoarthritis (OA) and although conservative treatments such as exercise and diet related interventions can reduce pain, effects are modest and can be improved. Frontal plane knee joint motion has been associated with knee pain, and is suggested as a patient-specific characteristic on which to tailor interventions. Does the association between baseline frontal plane knee joint kinematics and pain-relief differ among overweight and obese people with knee OA who underwent an intervention from the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial: diet-only, exercise-only, and combined diet and exercise intervention? 323 participants with knee OA were included in the analysis (77% females; 66 ± 6 years; 33.5 ± 3.7 kg/m 2 ). At baseline, frontal plane knee joint kinematics during walking were measured using 3-dimensional gait analysis and characterised as peak varus-valgus knee angle, peak varus-valgus excursion, and peak varus angular velocity. Pain was assessed at baseline and 18-month follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. Linear regressions were performed unadjusted and adjusted for covariates to determine if the associations between baseline frontal plane knee joint kinematics and 18-month change in pain differed according to intervention. The interaction terms between the intervention and measures of frontal plane knee joint kinematics were not statistically significant (all P ≥ 0.05). We found no evidence to suggest that 18-months of either exercise, diet, or a combination of diet and exercise could be more effective than the other to improve pain based on frontal plane measures of knee kinematics. Copyright © 2018. Published by Elsevier B.V.

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

Knee joint motion and muscle activation patterns are altered during gait in individuals with moderate hip osteoarthritis compared to asymptomatic cohort.

PubMed

Rutherford, Derek; Moreside, Janice; Wong, Ivan

2015-07-01

Knee replacements are common after hip replacement for end stage osteoarthritis. Whether abnormal knee mechanics exist in moderate hip osteoarthritis remains undetermined and has implications for understanding early osteoarthritis joint mechanics. The purpose of this study was to determine whether three-dimensional (3D) knee motion and muscle activation patterns in individuals with moderate hip osteoarthritis differ from an asymptomatic cohort and whether these features differ between contra- and ipsilateral knees. 3D motions and medial and lateral quadriceps and hamstring surface electromyography were recorded on 20 asymptomatic individuals and 20 individuals with moderate hip osteoarthritis during treadmill walking, using standardized collection and processing procedures. Principal component analysis was used to derive electromyographic amplitude and temporal waveform features. 3D stance-phase range of motion was calculated. A 2-factor repeated analysis of variance determined significant within-group leg and muscle differences. Student's t-tests identified between group differences, with Bonferroni corrections where applicable (α=0.05). Lower sagittal plane motion between early and mid/late stance (5°, P=0.004, effect size: 0.96) and greater mid-stance quadriceps activity was found in the osteoarthritis group (P=0.01). Compared to the ipsilateral knee, a borderline significant increase in mid-stance hamstring activity was found in the contra-lateral knee of the hip osteoarthritis group (P=0.018). Bilateral knee mechanics were altered, suggesting potentially increased loads and knee muscle fatigue. There was no indication that one knee is more susceptible to osteoarthritis than the other, thus clinicians should include bilateral knee analysis when treating patients with hip osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of Progressive Resistance Strength Training on Knee Biomechanics During Single Leg Step-up in Persons with Mild Knee Osteoarthritis

PubMed Central

McQuade, Kevin James; de Oliveira, Anamaria Siriani

2011-01-01

Background The goal of this study was to determine if increasing strength in primary knee extensors and flexors would directly affect net knee joint moments during a common functional task in persons with knee osteoarthritis. Methods An exploratory single sample clinical trial with pre-post treatment measures was used to study volunteers with clinical diagnosis of mild knee OA in one knee. Subjects participated in an individually supervised training program 3 times a week for eight weeks consisting of progressive resistive exercises for knee extensors and knee flexors. Pre and post training outcome assessments included: 1. Net internal knee joint moments, 2. Electromyography of primary knee extensors and flexors, and 3. Self-report measures of knee pain and function. The distribution of lower extremity joint moments as a percent of the total support moment was also investigated. Findings Pain, symptoms, activities of daily life, quality of life, stiffness, and function scores showed significant improvement following strength training. Knee internal valgus and hip internal rotation moments showed increasing but non-statistically significant changes post-training. There were no significant differences in muscle co-contraction activation of the Quadriceps and Hamstrings. Interpretations While exercise continues to be an important element of OA management, the results of this study suggest improvements in function, pain, and other symptoms, as a result of strength training may not be causally related to specific biomechanical changes in net joint moments. PMID:21514018

An automatic 2D–3D image matching method for reproducing spatial knee joint positions using single or dual fluoroscopic images

PubMed Central

Zhu, Zhonglin; Li, Guoan

2013-01-01

Fluoroscopic image technique, using either a single image or dual images, has been widely applied to measure in vivo human knee joint kinematics. However, few studies have compared the advantages of using single and dual fluoroscopic images. Furthermore, due to the size limitation of the image intensifiers, it is possible that only a portion of the knee joint could be captured by the fluoroscopy during dynamic knee joint motion. In this paper, we presented a systematic evaluation of an automatic 2D–3D image matching method in reproducing spatial knee joint positions using either single or dual fluoroscopic image techniques. The data indicated that for the femur and tibia, their spatial positions could be determined with an accuracy and precision less than 0.2 mm in translation and less than 0.4° in orientation when dual fluoroscopic images were used. Using single fluoroscopic images, the method could produce satisfactory accuracy in joint positions in the imaging plane (average up to 0.5 mm in translation and 1.3° in rotation), but large variations along the out-plane direction (in average up to 4.0 mm in translation and 2.28 in rotation). The precision of using single fluoroscopic images to determine the actual knee positions was worse than its accuracy obtained. The data also indicated that when using dual fluoroscopic image technique, if the knee joint outlines in one image were incomplete by 80%, the algorithm could still reproduce the joint positions with high precisions. PMID:21806411

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

PubMed

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

2015-12-01

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. 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. 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. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Supracondylar femoral osteotomy and knee joint replacement during the same surgical procedure in a type A haemophiliac patient with knee flexion deformity and ankylosis.

PubMed

Osma Rueda, Jose Luis; Oliveros Vargas, Alejandra; Sosa, Cristian David

2017-03-01

Haemophilia A is the cause of diverse musculoskeletal disorders such as ankylosis, arthritis and associated angular deformity. There are few reported cases in patients with haemophilia A in which simultaneous supracondylar femoral osteotomy and knee joint replacement has been performed to treat knee angular deformity and ankylosis. Here we present the case of an 18year old male patient, with an evolution of two years, who was unable to walk due to the presence of an untreated supracondylar fracture in the left femur and ipsilateral haemophilic arthropathy which led him to develop an ankylosis in flexion close to 70°. Supracondylar osteotomy of the femur and of the left knee joint was performed in the same surgical procedure. Bleeding control was achieved with a protocol of factor VIII supply. The patient was followed up for eight years, and recovered a 0 to 90° range of motion and regained his gait pattern. This case potentially provides a new alternative approach for haemophilia patients presenting with angular deformities and complex ankylosis. We suggest that mixed lesions of intra- and extra-articular deformity in haemophiliac patients can be corrected during the same surgical intervention. In addition, interdisciplinary management including haematology for operative and immediately postoperative control of intra-bleeding using factor VIII supply and control, combined with a controlled rehabilitation plan, can yield good functional outcomes in patients with haemophilic arthropathy. Copyright © 2016 Elsevier B.V. All rights reserved.

The initial effects of knee joint mobilization on osteoarthritic hyperalgesia.

PubMed

Moss, Penny; Sluka, Kathleen; Wright, Anthony

2007-05-01

Physiotherapists often employ lower limb joint mobilization to reduce pain and increase function. However, there is little experimental data confirming its efficacy. The purpose of this study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. The study employed a double-blind, controlled, within-subjects repeated-measures design. Thirty-eight subjects with mild to moderate knee pain participated. The effects of a 9-min, non-noxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions. Pressure pain threshold (PPT) and 3-m 'up and go' time were measured immediately before and after each intervention. Results demonstrated a significantly greater mean (95% CI) percentage increase in PPT following knee joint mobilization (27.3% (20.9-33.7)) than after manual contact (6.4% (0.4-12.4)) or no-contact (-9.6% (-20.7 to 1.6)) interventions. Knee joint mobilization also increased PPT at a distal, non-painful site and reduced 'up and go' time significantly more (-5% (-9.3 to 0.8)) than manual contact (-0.4% (-4.2 to 3.5)) or no-contact control (+7.9% (2.6-13.2)) interventions. This study therefore provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population.

Correlation between radiographic findings of osteoarthritis and arthroscopic findings of articular cartilage degeneration within the patellofemoral joint.

PubMed

Kijowski, Richard; Blankenbaker, Donna; Stanton, Paul; Fine, Jason; De Smet, Arthur

2006-12-01

To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain. The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined. The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively. Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation.

Intra-Articular Blockade of P2X7 Receptor Reduces the Articular Hyperalgesia and Inflammation in the Knee Joint Synovitis Especially in Female Rats.

PubMed

Teixeira, Juliana Maia; Dias, Elayne Vieira; Parada, Carlos Amílcar; Tambeli, Cláudia Herrera

2017-02-01

Synovitis is a key factor in joint disease pathophysiology, which affects a greater proportion of women than men. P2X7 receptor activation contributes to arthritis, but whether it plays a role in articular inflammatory pain in a sex-dependent manner is unknown. We investigated whether the P2X7 receptor blockade in the knee joint of male and female rats reduces the articular hyperalgesia and inflammation induced by a carrageenan knee joint synovitis model. Articular hyperalgesia was quantified using the rat knee joint incapacitation test and the knee joint inflammation, characterized by the concentration of cytokines tumor necrosis factor-α, interleukin-1β, interleukin-6, and cytokine-induced neutrophil chemoattractant-1, and by neutrophil migration, was quantified using enzyme-linked immunosorbent assay and by myeloperoxidase enzyme activity measurement, respectively. P2X7 receptor blockade by the articular coadministration of selective P2X7 receptor antagonist A740003 with carrageenan significantly reduced articular hyperalgesia, pro-inflammatory cytokine concentrations, and myeloperoxidase activity induced by carrageenan injection into the knee joint of male and estrus female rats. However, a lower dose of P2X7 receptor antagonist was sufficient to significantly induce the antihyperalgesic and anti-inflammatory effects in estrus female but not in male rats. These results suggest that P2X7 receptor activation by endogenous adenosine 5'-triphosphate is essential to articular hyperalgesia and inflammation development in the knee joint of male and female rats. However, female rats are more responsive than male rats to the antihyperalgesic and anti-inflammatory effects induced by P2X7 receptor blockade. P2X7 receptors could be promising therapeutic targets in the treatment of knee joint disease symptoms, especially in women, who are more affected than men by these conditions. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

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. Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

Fully automated system for the quantification of human osteoarthritic knee joint effusion volume using magnetic resonance imaging.

PubMed

Li, Wei; Abram, François; Pelletier, Jean-Pierre; Raynauld, Jean-Pierre; Dorais, Marc; d'Anjou, Marc-André; Martel-Pelletier, Johanne

2010-01-01

Joint effusion is frequently associated with osteoarthritis (OA) flare-up and is an important marker of therapeutic response. This study aimed at developing and validating a fully automated system based on magnetic resonance imaging (MRI) for the quantification of joint effusion volume in knee OA patients. MRI examinations consisted of two axial sequences: a T2-weighted true fast imaging with steady-state precession and a T1-weighted gradient echo. An automated joint effusion volume quantification system using MRI was developed and validated (a) with calibrated phantoms (cylinder and sphere) and effusion from knee OA patients; (b) with assessment by manual quantification; and (c) by direct aspiration. Twenty-five knee OA patients with joint effusion were included in the study. The automated joint effusion volume quantification was developed as a four stage sequencing process: bone segmentation, filtering of unrelated structures, segmentation of joint effusion, and subvoxel volume calculation. Validation experiments revealed excellent coefficients of variation with the calibrated cylinder (1.4%) and sphere (0.8%) phantoms. Comparison of the OA knee joint effusion volume assessed by the developed automated system and by manual quantification was also excellent (r = 0.98; P < 0.0001), as was the comparison with direct aspiration (r = 0.88; P = 0.0008). The newly developed fully automated MRI-based system provided precise quantification of OA knee joint effusion volume with excellent correlation with data from phantoms, a manual system, and joint aspiration. Such an automated system will be instrumental in improving the reproducibility/reliability of the evaluation of this marker in clinical application.

Ballistic movements of jumping legs implemented as variable components of cricket behaviour.

PubMed

Hustert, R; Baldus, M

2010-12-01

Ballistic accelerations of a limb or the whole body require special joint mechanisms in many animals. Specialized joints can be moved by stereotypic or variable motor control during motor patterns with and without ballistic components. As a model of variable motor control, the specialized femur-tibia (knee) joints of cricket (Acheta domesticus) hindlegs were studied during ballistic kicking, jumping and swimming and in non-ballistic walking. In this joint the tendons of the antagonistic flexor and the extensor muscles attach at different distances from the pivot and the opposed lever arms form an angle of 120 deg. A 10:1 ratio of their effective lever arms at full knee flexion helps to prepare for most ballistic extensions: the tension of the extensor can reach its peak while it is restrained by flexor co-contraction. In kicks, preparatory flexion is rapid and the co-contraction terminates just before knee extensions. Therefore, mainly the stored tension of the extensor muscle accelerates the small mass of the tibia. Jumps are prepared with slower extensor-flexor co-contractions that flex both knees simultaneously and then halt to rotate both legs outward to a near horizontal level. From there, catapult extension of both knees accelerates the body, supported by continued high frequency motor activity to their tibia extensor muscles during the ongoing push-off from the substrate. Premature extension of one knee instantly takes load from the lagging leg that extends and catches up, which finally results in a straight jump. In swimming, synchronous ballistic power strokes of both hindlegs drive the tibiae on a ventral-to-posterior trajectory through the water, well coordinated with the swimming patterns of all legs. In walking, running and climbing the steps of the hindlegs range between 45 deg flexion and 125 deg extension and use non-ballistic, alternating activity of knee flexor and extensor muscles. Steep climbing requires longer bursts from the extensor tibiae muscles when they support the extended hindlegs against gravity forces when the body hangs over. All ballistic movements of cricket knees are elicited by a basic but variable motor pattern: knee flexions by co-contraction of the antagonists prepare catapult extensions with speeds and forces as required in the different behaviours.

Variability of Plyometric and Ballistic Exercise Technique Maintains Jump Performance.

PubMed

Chandler, Phillip T; Greig, Matthew; Comfort, Paul; McMahon, John J

2018-06-01

Chandler, PT, Greig, M, Comfort, P, and McMahon, JJ. Variability of plyometric and ballistic exercise technique maintains jump performance. J Strength Cond Res 32(6): 1571-1582, 2018-The aim of this study was to investigate changes in vertical jump technique over the course of a training session. Twelve plyometric and ballistic exercise-trained male athletes (age = 23.4 ± 4.6 years, body mass = 78.7 ± 18.8 kg, height = 177.1 ± 9.0 cm) performed 3 sets of 10 repetitions of drop jump (DJ), rebound jump (RJ) and squat jump (SJ). Each exercise was analyzed from touchdown to peak joint flexion and peak joint flexion to take-off. Squat jump was analyzed from peak joint flexion to take-off only. Jump height, flexion and extension time and range of motion, and instantaneous angles of the ankle, knee, and hip joints were measured. Separate 1-way repeated analyses of variance compared vertical jump technique across exercise sets and repetitions. Exercise set analysis found that SJ had lower results than DJ and RJ for the angle at peak joint flexion for the hip, knee, and ankle joints and take-off angle of the hip joint. Exercise repetition analysis found that the ankle joint had variable differences for the angle at take-off, flexion, and extension time for RJ. The knee joint had variable differences for flexion time for DJ and angle at take-off and touchdown for RJ. There was no difference in jump height. Variation in measured parameters across repetitions highlights variable technique across plyometric and ballistic exercises. This did not affect jump performance, but likely maintained jump performance by overcoming constraints (e.g., level of rate coding).

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.

[Clinical evaluation of the ceramic femoral component used for reconstruction of total knee replacement].

PubMed

Vavrík, P; Landor, I; Denk, F

2008-12-01

The study evaluates mid-term results of total knee replacement with a zirconia ceramic (ZrO2) femoral component. The evaluated group comprised 20 knees in 19 patients (4 men and 15 women). In one patient the replacement was performed bilaterally. Two patients had in the contralateral knee the same type of prosthesis with a femoral chrome-cobalt component.The mean age at the time of operation was 65.2 years (range, 38-81 years).The primary indication was 14 times osteoarthritis and 5 times rheumatoid arthritis. The average follow-up period was 6.5 years (range, 2.1-8.5 years). Patients included in the study regardless of age, body mass and the basic diagnosis, agreed with the use of the ceramic femoral component. The evaluation covered a range of motion, mechanical axis, joint stability, pain, swelling, ability to walk on level ground and on stairs, subjective satisfaction (EULAR Knee Chart). Radiograph were assessed at one year intervals in two projections to identify the incidence of radiolucency around the implant. The Kaplan-Meier survival curve was used and compared with the survival curve in identical chrome-cobalt implants. At he final follow-up, 14 knees were evaluated, because 3 patients died without any connection with the implant, in one case the tibial component migrated due to necrosis of the tibial condyle in a patient with RA and two implants had to be revised and replaced due to polyethylene wear. No infection or negative tissue reaction was recorded in the evaluated group. The average flexion range was 109 degrees. All knees were stable and without swelling, in two cases there occurred slight femoropatellar pain. Twelve patients were fully satisfied, 2 patients were satisfied with a certain reservation. The differences in the course of the survival curves of chrome-cobalt and ceramic implants were statistically insignificant. Although the use of zirconia ceramics in vitro reduces the amount of polyethylene wear, the clinical outcomes of total knee replacements as compared to the hip are not convincing. One of the causes may be the substantially different and more complex biomechanics of the knee. Tribology improvement of the femoral ceramic component cannot compensate the deficiencies in the joint balancing in flexion and extension. The economically and technologically demanding production of these implants may be justified in patients with allergies caused by chrome-cobalt components. The results of mid-term follow-up of the use of zirconia ceramic femoral components proved no impact on the improvement of the period of survival of the knee implant. No adverse response to the material or mechanical failure of the ceramic components was encountered. Key words: total knee replacement, zirconia ceramic femoral component, TKR mid-term results, ceramic knee survival curve.

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

Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial.

PubMed

Knoop, J; Dekker, J; van der Leeden, M; van der Esch, M; Thorstensson, C A; Gerritsen, M; Voorneman, R E; Peter, W F; de Rooij, M; Romviel, S; Lems, W F; Roorda, L D; Steultjens, M P M

2013-08-01

To investigate whether an exercise program, initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only, in reducing activity limitations in patients with knee osteoarthritis (OA) and instability of the knee joint. A single-blind, randomized, controlled trial involving 159 knee OA patients with self-reported and/or biomechanically assessed knee instability, randomly assigned to two treatment groups. Both groups received a supervised exercise program for 12 weeks, consisting of muscle strengthening exercises and training of daily activities, but only in the experimental group specific knee joint stabilization training was provided. Outcome measures included activity limitations (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function, primary outcome), pain, global perceived effect and knee stability. Both treatment groups demonstrated large (∼20-40%) and clinically relevant reductions in activity limitations, pain and knee instability, which were sustained 6 months post-treatment. No differences in effectiveness between experimental and control treatment were found on WOMAC physical function (B (95% confidence interval - CI) = -0.01 (-2.58 to 2.57)) or secondary outcome measures, except for a higher global perceived effect in the experimental group (P = 0.04). Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee. In knee OA patients suffering from knee instability, specific knee joint stabilization training, in addition to muscle strengthening and functional exercises, does not seem to have any additional value. Dutch Trial Register (NTR) registration number: NTR1475. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Knee joint loading in knee osteoarthritis: influence of abdominal and thigh fat.

PubMed

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

2014-09-01

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). Fat depots were quantified using computed tomography, and total lean and fat mass were determined with dual energy x-ray absorptiometry in 176 adults (age, 66.3 yr; body mass index, 33.5 kg·m) with radiographic knee OA. Knee moments and joint bone-on-bone forces were calculated using gait analysis and musculoskeletal modeling. 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 that both were significantly associated with knee compressive and shear forces (P ≤ 0.04). Thigh fat was associated with knee abduction (P = 0.03) and knee extension moment (P = 0.02). 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.

Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department.

PubMed

Wang, Joon Ho; Lee, Jin Hyuck; Cho, Youngsuk; Shin, Jung Min; Lee, Byung Hoon

2016-08-01

To evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED). This retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7-14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up. The group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (p<0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p<0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p<0.001) higher than that (31.0%) in G2. Knee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department. Retrospective cohort study III. Copyright © 2016 Elsevier Ltd. All rights reserved.

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. © 2011 John Wiley & Sons A/S.

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

PubMed

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.

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

Tibiofemoral and patellofemoral joint 3D-kinematics in patients with posterior cruciate ligament deficiency compared to healthy volunteers.

PubMed

von Eisenhart-Rothe, Ruediger; Lenze, Ulrich; Hinterwimmer, Stefan; Pohlig, Florian; Graichen, Heiko; Stein, Thomas; Welsch, Frederic; Burgkart, Rainer

2012-11-26

The posterior cruciate ligament (PCL) plays an important role in maintaining physiological kinematics and function of the knee joint. To date mainly in-vitro models or combined magnetic resonance and fluoroscopic systems have been used for quantifying the importance of the PCL. We hypothesized, that both tibiofemoral and patellofemoral kinematic patterns are changed in PCL-deficient knees, which is increased by isometric muscle flexion. Therefore the aim of this study was to simultaneously investigate tibiofemoral and patellofemoral 3D kinematics in patients suffering from PCL deficiency during different knee flexion angles and under neuromuscular activation. We enrolled 12 patients with isolated PCL-insufficiency as well as 20 healthy volunteers. Sagittal MR-images of the knee joint were acquired in different positions of the knee joint (0°, 30°, 90° flexion, with and without flexing isometric muscle activity) on a 0.2 Tesla open MR-scanner. After segmentation of the patella, femur and tibia local coordinate systems were established to define the spatial position of these structures in relation to each other. At full extension and 30° flexion no significant difference was observed in PCL-deficient knee joints neither for tibiofemoral nor for patellofemoral kinematics. At 90° flexion the femur of PCL-deficient patients was positioned significantly more anteriorly in relation to the tibia and both, the patellar tilt and the patellar shift to the lateral side, significantly increased compared to healthy knee joints. While no significant effect of isometric flexing muscle activity was observed in healthy individuals, in PCL-deficient knee joints an increased paradoxical anterior translation of the femur was observed at 90° flexion compared to the status of muscle relaxation. Significant changes in tibiofemoral and patellofemoral joint kinematics occur in patients with isolated PCL-insufficiency above 30 degrees of flexion compared to healthy volunteers. Since this could be one reasonable mechanism in the development of osteoarthritis (OA) our results might help to understand the long-term development of tibiofemoral and/or patellofemoral OA in PCL-insufficient knee joints.

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.

Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

PubMed Central

López-Liria, Remedios; Padilla-Góngora, David; Catalan-Matamoros, Daniel; Rocamora-Pérez, Patricia; Pérez-de la Cruz, Sagrario; Fernández-Sánchez, Manuel

2015-01-01

Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. PMID:25961017

Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open and arthroscopic surgery: a case report.

PubMed

Jha, Subash Chandra; Nishisho, Toshihiko; Matsuura, Tetsuya; Takeuchi, Makoto; Miyagi, Ryo; Takao, Shoichiro; Suzue, Naoto; Toki, Shunichi; Nagamachi, Akihiro; Sairyo, Koichi

2016-11-01

Pigmented villonodular synovitis is an extremely rare disease in skeletally immature patients. Erosive destruction of the involved joint leads to early arthritis, and its high recurrence rate makes treatment challenging. Multiple surgical approaches exist, but it is unclear as to which among them achieves the lowest possible recurrence rate and morbidity. We report the case of a 5-year-old girl with left knee pain and swelling who was diagnosed with diffuse pigmented villonodular synovitis of the left knee based on MRI findings. Combined open and arthroscopic surgery was performed to completely remove the tumor. Postoperative histopathological examination confirmed the diagnosis of diffuse pigmented villonodular synovitis. The postoperative course was uneventful, with a gradual improvement in symptoms. There were no signs of recurrence on postoperative MRI performed at the 8-month follow-up, with neither knee pain nor limitation of range of motion. The favorable outcome in this case suggests that combined open and arthroscopic surgery may be an effective method for treating pigmented villonodular synovitis in skeletally immature patients.

Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

PubMed Central

Sim, Jae Ang; Gadikota, Hemanth R.; Li, Jing-Sheng; Li, Guoan; Gill, Thomas J.

2013-01-01

Background Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design Controlled laboratory study. Hypothesis Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation (P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations (P <.05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation (P > .05) at 0° of flexion but could not do so at 30° of flexion (P <.05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques (P <.05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique. PMID:21908717

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

PubMed Central

2012-01-01

Background Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis. Methods We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion. Results During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design. Conclusions Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding. PMID:22704638

Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique.

PubMed

Schliemann, Benedikt; Lenschow, Simon; Domnick, Christoph; Herbort, Mirco; Häberli, Janosch; Schulze, Martin; Wähnert, Dirk; Raschke, Michael J; Kösters, Clemens

2017-04-01

Dynamic intraligamentary stabilization (DIS) has been introduced for the repair of acute anterior cruciate ligament (ACL) tears as an alternative to delayed reconstruction. The aim of the present study was to compare knee joint kinematics after DIS to those of the ACL-intact and ACL-deficient knee under simulated Lachman/KT-1000 and pivot-shift tests. We hypothesized that DIS provides knee joint kinematics equivalent to an intact ACL. With the use of a robotic knee simulator, knee kinematics were determined in simulated Lachman/KT-1000 and pivot-shift tests at 0°, 15°, 30°, 60°, and 90° of flexion in eight cadaveric knees under the following conditions: (1) intact ACL, (2) ACL deficiency, (3) DIS with a preload of 60 N, and (4) DIS with a preload of 80 N. Statistical analyses were performed using two-factor repeated-measures analysis of variance. The significance level was set at a p value of <0.05. After DIS with a preload of either 60 N or 80 N, the anterior translation was significantly reduced in the simulated Lachman/KT-1000 and pivot-shift tests when compared to the ACL-deficient knee (p < 0.05). No significant differences were observed between the DIS reconstruction with a preload of 80 N and the intact ACL with regard to anterior laxity in either test. However, DIS with a preload of only 60 N was not able to restore knee joint kinematics to that of an intact knee in all degrees of flexion. DIS with a preload of 80 N restores knee joint kinematics comparable to that of an ACL-intact knee and is therefore capable of providing knee joint stability during ACL healing. DIS therefore provides a new technique for primary ACL repair with superior biomechanical properties in comparison with other techniques that have been described previously, although further clinical studies are required to determine its usefulness in clinical settings.

Assistive Walking Device Use and Knee Osteoarthritis: the Health, Aging, and Body Composition Study (Health ABC Study)

PubMed Central

Carbone, Laura D.; Satterfield, Suzanne; Liu, Caiqin; Kwoh, Kent C.; Neogi, Tuhina; Tolley, Elizabeth; Nevitt, Michael

2012-01-01

Objectives To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee. Design Prospective cohort study. Setting 2,639 elderly men and women in the Health ABC (Health, Aging and Body Composition). Study followed for incident use of AWDs, including a subset of 874 with prevalent knee pain. Participants NA Interventions NA Main Outcome Measures Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores and frequency of joint space narrowing on knee radiographs over a three year time period. Results AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 [entire cohort: OR 2.07 (95% CI 1.43, 3.01); knee pain subset: OR 1.87 (95% CI 1.16, 3.03)], black race [entire cohort: OR 2.95 (95% CI 2.09, 4.16); knee pain subset: OR 3.21 (95% CI 2.01, 5.11)] and lower balance ratios [entire cohort: OR 3.18 (95% CI 2.21, 4.59); knee pain subset: OR 3.77 (95% CI 2.34, 6.07)]. Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. 20% of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least one knee. 14% of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least one knee. Conclusions Assistive walking devices are frequently used by elderly men and women. Knee pain and balance problems are significant reasons why elderly individuals initiate use of an assistive walking device. In an exploratory analysis, there was no consistent relationship between use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relationship of use of AWDs to changes in knee osteoarthritis are needed. PMID:23041146

Effect of Knee Joint Angle and Contraction Intensity on Hamstrings Coactivation.

PubMed

Wu, Rui; Delahunt, Eamonn; Ditroilo, Massimiliano; Lowery, Madeleine M; DE Vito, Giuseppe

2017-08-01

This study investigated the effect of knee joint angle and contraction intensity on the coactivation of the hamstring muscles (when acting as antagonists to the quadriceps) in young and older individuals of both sexes. A total of 25 young (24 ± 2.6 yr) and 26 older (70 ± 2.5 yr) healthy men and women participated. Maximal voluntary isometric contraction of the knee extensors and flexors was assessed at two knee joint angles (90° and 60°, 0° = full extension). At each angle, participants performed submaximal contractions of the knee extensors (20%, 50%, and 80% maximal voluntary isometric contraction), whereas surface EMG was simultaneously acquired from the vastus lateralis and biceps femoris muscles to assess the level (EMG root-mean-square) of agonist activation and antagonist coactivation. Subcutaneous adipose tissue in the areas corresponding to surface EMG electrode placements was measured via ultrasonography. The contractions performed at 90° knee flexion demonstrated higher levels of antagonist coactivation (all P < 0.01) and agonist activation (all P < 0.01) as a function of contraction intensity compared with the 60° knee flexion. Furthermore, after controlling for subcutaneous adipose tissue, older participants exhibited a higher level of antagonist coactivation at 60° knee flexion compared with young participants (P < 0.05). The results of the present study suggest that 1) the antagonist coactivation is dependent on knee joint angle and contraction intensity and 2) subcutaneous adipose tissue may affect the measured coactivation level likely because of a cross-talk effect. Antagonist coactivation may play a protective role in stabilizing the knee joint and maintaining constant motor output.

Gait changes after using a temporomandibular joint exerciser in patients who underwent lower limb joint surgery

PubMed Central

Chung, Gu-Young; Choi, Geun-Seok; Shin, Ki-Young; Park, Joon-Soo

2016-01-01

[Purpose] The improvements in gait of the patients with lower limb disease who used a temporomandibular joint (TMJ) exerciser were verified. [Subjects and Methods] Eleven subjects were included. Their mean age was 53.2 years. The lower limb joint angles before and after using the TMJ exerciser were measured using a gait analyzer. Before the gait experiment, the TMJ exerciser setting process and one-leg stance balance test (OLST) were repeated until the balance maintenance time improved. [Results] Because of the OLST, the mean change in the body center point after the subjects used the exerciser improved from 5.76 mm to 4.20 mm. When the TMJ exerciser was used, the joint angle range of the subjects approached that of the normal individuals. [Conclusion] According to the gait experiments, the angles of the subjects’ hips, knees, and ankle joints approached to those of the normal individuals after the subjects used the TMJ exerciser; however, the results did not completely match. The changes in the hip, knee, and ankle joint angles were statistically significant, which confirm the usefulness of the TMJ exerciser. PMID:27313377

Control of speed during the double poling technique performed by elite cross-country skiers.

PubMed

Lindinger, Stefan Josef; Stöggl, Thomas; Müller, Erich; Holmberg, Hans-Christer

2009-01-01

Double poling (DP) as a main technique in cross-country skiing has developed substantially over the last 15 yr. The purpose of the present study was to analyze the question, "How do modern elite skiers control DP speed?" Twelve male elite cross-country skiers roller skied using DP at 9, 15, 21, and 27 km.h(-1) and maximum velocity (V(max)). Cycle characteristics, pole and plantar forces, and elbow, hip, and knee joint angles were analyzed. Both poling frequency and cycle length increased up to 27 km.h (-1)(P < 0.05), with a further increase in poling frequency at V(max) (P < 0.05). Peak pole force, rate of force development, and rearfoot plantar force increased with submaximal velocities (V(sm)), whereas poling time and time-to-peak pole force gradually shortened (P < 0.05). Changes in elbow joint kinematics during the poling phase were characterized by a decreased angle minimum and an increased flexion and extension ranges of motion as well as angular velocities across V(sm) (P < 0.05), with no further changes at V(max). Hip and knee joint kinematics adapted across V(sm) by 1) decreasing angles at pole plant and angle minima during the poling phase, 2) increasing the ranges of motion and angular velocities during the flexion phases occurring around pole plant, and 3) increasing extension ranges of motion and angular velocities during the recovery phase (all P values <0.05), with no further changes at V(max). Elite skiers control DP speed by increasing both poling frequency and cycle length; the latter is achieved by increased pole force despite reduced poling time. Adaptation to higher speeds was assisted by an increased range of motion, smaller angle minima, and higher angular velocities in the elbow, the hip, and the knee joints.

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. Copyright © 2016 Elsevier B.V. All rights reserved.

A practical solution to reduce soft tissue artifact error at the knee using adaptive kinematic constraints.

PubMed

Potvin, Brigitte M; Shourijeh, Mohammad S; Smale, Kenneth B; Benoit, Daniel L

2017-09-06

Musculoskeletal modeling and simulations have vast potential in clinical and research fields, but face various challenges in representing the complexities of the human body. Soft tissue artifact from skin-mounted markers may lead to non-physiological representation of joint motions being used as inputs to models in simulations. To address this, we have developed adaptive joint constraints on five of the six degree of freedom of the knee joint based on in vivo tibiofemoral joint motions recorded during walking, hopping and cutting motions from subjects instrumented with intra-cortical pins inserted into their tibia and femur. The constraint boundaries vary as a function of knee flexion angle and were tested on four whole-body models including four to six knee degrees of freedom. A musculoskeletal model developed in OpenSim simulation software was constrained to these in vivo boundaries during level gait and inverse kinematics and dynamics were then resolved. Statistical parametric mapping indicated significant differences (p<0.05) in kinematics between bone pin constrained and unconstrained model conditions, notably in knee translations, while hip and ankle flexion/extension angles were also affected, indicating the error at the knee propagates to surrounding joints. These changes to hip, knee, and ankle kinematics led to measurable changes in hip and knee transverse plane moments, and knee frontal plane moments and forces. Since knee flexion angle can be validly represented using skin mounted markers, our tool uses this reliable measure to guide the five other degrees of freedom at the knee and provide a more valid representation of the kinematics for these degrees of freedom. Copyright © 2017 Elsevier Ltd. All rights reserved.

Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1).

PubMed

Muraki, S; Akune, T; En-Yo, Y; Yoshida, M; Suzuki, T; Yoshida, H; Ishibashi, H; Tokimura, F; Yamamoto, S; Tanaka, S; Nakamura, K; Kawaguchi, H; Oka, H; Yoshimura, N

2015-06-01

The objective of the present study was to clarify the association of joint space narrowing with knee pain in Japanese men and women using a large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. This study examined the association between minimum joint space width (mJSW) in the medial compartment and pain at the knee. mJSW was measured in the medial and lateral compartments of the knee using a knee osteoarthritis (OA) computer-aided diagnosis system. From the 3040 participants in the ROAD study, the present study analyzed 2733 participants who completed the radiographic examinations and questionnaires regarding knee pain (975 men and 1758 women; mean age, 69.9 ± 11.2 years). Subjects with lateral knee OA were excluded. After adjustment for age and Body mass index (BMI), medial mJSW, as well as medial mJSW/lateral mJSW, was significantly associated with knee pain. Sex and BMI affected the association of medial mJSW with knee pain. The threshold of medial mJSW was approximately 3 mm in men and 2 mm in women, while that of medial mJSW/lateral mJSW was approximately 60% in both men and women. BMI was found to have a distinct effect on the association of mJSW with pain. The present cross-sectional study using a large-scale population from the ROAD study showed that joint space narrowing had a significant association with knee pain. The thresholds of joint space narrowing for knee pain were also established. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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

Interposition of the Posterior Cruciate Ligament into the Medial Compartment of the Knee Joint on Coronal Magnetic Resonance Imaging.

PubMed

Kim, Hyun Su; Yoon, Young Cheol; Park, Ki Jeong; Wang, Joon Ho; Choe, Bong-Keun

2016-01-01

The purpose of our study was to evaluate the overall prevalence and clinical significance of interposition of the posterior cruciate ligament (PCL) into the medial compartment of the knee joint in coronal magnetic resonance imaging (MRI). We retrospectively reviewed 317 consecutive patients referred for knee MRI at our institution between October 2009 and December 2009. Interposition of the PCL into the medial compartment of the knee joint on proton coronal MRI was evaluated dichotomously (i.e., present or absent). We analyzed the interposition according to its prevalence as well as its relationship with right-left sidedness, gender, age, and disease categories (osteoarthritis, anterior cruciate ligament tear, and medial meniscus tear). Prevalence of interposition of PCL into the medial compartment of the knee joint was 47.0% (149/317). There was no right (50.0%, 83/166) to left (43.7%, 66/151) or male (50.3%, 87/173) to female (43.1%, 62/144) differences in the prevalence. There was no significant association between the prevalence and age, or the disease categories. Interposition of the PCL into the medial compartment of the knee joint is observed in almost half of patients on proton coronal MRI of the knee. Its presence is not associated with any particular factors including knee pathology and may be regarded as a normal MR finding.

Knee joint laxity does not moderate the relationship between quadriceps strength and physical function in knee osteoarthritis patients: A cross-sectional study.

PubMed

Altubasi, Ibrahim M

2018-06-07

Knee osteoarthritis is a common and a disabling musculoskeletal disorder. Patients with knee osteoarthritis have activity limitations which are linked to the strength of the quadriceps muscle. Previous research reported that the relationship between quadriceps muscle strength and physical function is moderated by the level of knee joint frontal plane laxity. The purpose of the current study is to reexamine the moderation effect of the knee joint laxity as measured by stress radiographs on the relationship between quadriceps muscle strength and physical function. One-hundred and sixty osteoarthritis patients participated in this cross-sectional study. Isometric quadriceps muscle strength was measured using an isokinetic dynamometer. Self-rated and performance-based physical function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale and Get Up and Go test, respectively. Stress radiographs which were taken while applying varus and valgus loads to knee using the TELOS device. Knee joint laxity was determined by measuring the distance between joint surfaces on the medial and lateral sides. Hierarchical multiple regression models were constructed to study the moderation effect of laxity on the strength function relationship. Two regression models were constructed for self-rated and performance-based function. After controlling for demographics, strength contributed significantly in the models. The addition of laxity and laxity-strength interaction did not add significant contributions in the regression models. Frontal plane knee joint laxity measured by stress radiographs does not moderate the relationship between quadriceps muscle strength and physical function in patients with osteoarthritis. Copyright © 2018 Elsevier B.V. All rights reserved.

Chemical synovectomy with sodium morrhuate in the treatment of symptomatic recurrent knee joint effusion.

PubMed

Schaumburger, Jens; Trum, Stefanie; Anders, Sven; Beckmann, Johannes; Winkler, Sebastian; Springorum, Hans-Robert; Grifka, Joachim; Lechler, Philipp

2012-10-01

The aim of this study was to assess the efficacy and safety of intra-articular sodium morrhuate injections in the treatment of recurrent knee joint effusions. Ninety-eight knees of 92 patients (f = 59, m = 33) with knee arthritis of heterogeneous etiology were treated with chemical synovectomy (CSO). Of those, 39 patients suffered from rheumatoid arthritis (RA). The mean follow-up was 29.8 months. Clinical outcome was evaluated by analyzing subjective patient satisfaction, activity level, pain severity on the basis of the Visual Analogue Pain Scale (VAS), Lysholm and Gillquist score, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven percent of all patients and 67% of patients diagnosed with RA were satisfied with CSO. No significant effects on patient satisfaction by CSO were noted in patients older than 40 years. Overall, VAS, Lysholm and Gillquist score, and KOOS improved significantly at final review. The intra-articular application of sodium morrhuate is an effective and safe measure in the treatment of recurrent symptomatic knee joint effusions in young patients suffering from recurrent knee joint effusions.

A validated method for modeling anthropoid hip abduction in silico.

PubMed

Hammond, Ashley S; Plavcan, J Michael; Ward, Carol V

2016-07-01

The ability to reconstruct hip joint mobility from femora and pelves could provide insight into the locomotion and paleobiology of fossil primates. This study presents a method for modeling hip abduction in anthropoids validated with in vivo data. Hip abduction simulations were performed on a large sample of anthropoids. The modeling approach integrates three-dimensional (3D) polygonal models created from laser surface scans of bones, 3D landmark data, and shape analysis software to digitally articulate and manipulate the hip joint. Range of femoral abduction (degrees) and the abducted knee position (distance spanned at the knee during abduction) were compared with published live animal data. The models accurately estimate knee position and (to a lesser extent) angular abduction across broad locomotor groups. They tend to underestimate abduction for acrobatic or suspensory taxa, but overestimate it in more stereotyped taxa. Correspondence between in vivo and in silico data varies at the specific and generic level. Our models broadly correspond to in vivo data on hip abduction, although the relationship between the models and live animal data is less straightforward than hypothesized. The models can predict acrobatic or stereotyped locomotor adaptation for taxa with values near the extremes of the range of abduction ability. Our findings underscore the difficulties associated with modeling complex systems and the importance of validating in silico models. They suggest that models of joint mobility can offer additional insight into the functional abilities of extinct primates when done in consideration of how joints move and function in vivo. Am J Phys Anthropol 160:529-548, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Musculoskeletal multibody dynamics simulation of the contact mechanics and kinematics of a natural knee joint during a walking cycle.

PubMed

Hu, Jiayu; Chen, Zhenxian; Xin, Hua; Zhang, Qida; Jin, Zhongmin

2018-05-01

Detailed knowledge of the in vivo loading and kinematics in the knee joint is essential to understand its normal functions and the aetiology of osteoarthritis. Computer models provide a viable non-invasive solution for estimating joint loading and kinematics during different physiological activities. However, the joint loading and kinematics of the tibiofemoral and patellofemoral joints during a gait cycle were not typically investigated concurrently in previous computational simulations. In this study, a natural knee architecture was incorporated into a lower extremity musculoskeletal multibody dynamics model based on a force-dependent kinematics approach to investigate the contact mechanics and kinematics of a natural knee joint during a walking cycle. Specifically, the contact forces between the femoral/tibial articular cartilages and menisci and between the femoral and tibial/patellar articular cartilages were quantified. The contact forces and kinematics of the tibiofemoral and patellofemoral joints and the muscle activations and ligament forces were predicted simultaneously with a reasonable level of accuracy. The developed musculoskeletal multibody dynamics model with a natural knee architecture can serve as a potential platform for assisting clinical decision-making and postoperative rehabilitation planning.

Joint Coordination and Muscle Activities of Ballet Dancers During Tiptoe Standing.

PubMed

Tanabe, Hiroko; Fujii, Keisuke; Kouzaki, Motoki

2017-01-01

We aimed to investigate joint coordination of lower limbs in dancers during tiptoe standing and the relationship between joint coordination and muscle coactivation. Seven female ballet dancers performed tiptoe standing with six leg positions (fi e classical dance positions and one modern dance position) for 10 s. The kinematic data of the metatarsophalangeal (MP), ankle, knee, and hip joints was collected, and surface electromyography (EMG) of over 13 lower limb muscles was conducted. Principal component analysis was performed to determine joint coordination. MP-ankle and ankle-knee had in-phase coordination, whereas knee-hip showed anti-phase coordination in the sagittal plane. In addition, most EMG-EMG coherence around the MP and ankle joints was significant up to 50 Hz when these two joints swayed with in-phase. This suggests that different joint coordination patterns are associated with neural processing related to different muscle coactivation patterns. In conclusion, ballet dancers showed in-phase coordination from the MP to knee joints, which was associated with muscle coactivation to a higher frequency domain (up to 50 Hz) in comparison with anti-phase coordination.

The KineSpring® Knee Implant System: an implantable joint-unloading prosthesis for treatment of medial knee osteoarthritis

PubMed Central

Clifford, Anton G; Gabriel, Stefan M; O’Connell, Mary; Lowe, David; Miller, Larry E; Block, Jon E

2013-01-01

Symptomatic medial compartment knee osteoarthritis (OA) is the leading cause of musculoskeletal pain and disability in adults. Therapies intended to unload the medial knee compartment have yielded unsatisfactory results due to low patient compliance with conservative treatments and high complication rates with surgical options. There is no widely available joint-unloading treatment for medial knee OA that offers clinically important symptom alleviation, low complication risk, and high patient acceptance. The KineSpring® Knee Implant System (Moximed, Inc, Hayward, CA, USA) is a first-of-its-kind, implantable, extra-articular, extra-capsular prosthesis intended to alleviate knee OA-related symptoms by reducing medial knee compartment loading while overcoming the limitations of traditional joint-unloading therapies. Preclinical and clinical studies have demonstrated excellent prosthesis durability, substantial reductions in medial compartment and total joint loads, and clinically important improvements in OA-related pain and function. The purpose of this report is to describe the KineSpring System, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The KineSpring System has potential to bridge the gap between ineffective conservative treatments and irreversible surgical interventions for medial compartment knee OA. PMID:23717052

The Preferred Movement Path Paradigm: Influence of Running Shoes on Joint Movement.

PubMed

Nigg, Benno M; Vienneau, Jordyn; Smith, Aimée C; Trudeau, Matthieu B; Mohr, Maurice; Nigg, Sandro R

2017-08-01

(A) To quantify differences in lower extremity joint kinematics for groups of runners subjected to different running footwear conditions, and (B) to quantify differences in lower extremity joint kinematics on an individual basis for runners subjected to different running footwear conditions. Three-dimensional ankle and knee joint kinematics were collected for 35 heel-toe runners when wearing three different running shoes and when running barefoot. Absolute mean differences in ankle and knee joint kinematics were computed between running shoe conditions. The percentage of individual runners who displayed differences below a 2°, 3°, and 5° threshold were also calculated. The results indicate that the mean kinematics of the ankle and knee joints were similar between running shoe conditions. Aside from ankle dorsiflexion and knee flexion, the percentage of runners maintaining their movement path between running shoes (i.e., less than 3°) was in the order of magnitude of about 80% to 100%. Many runners showed ankle and knee joint kinematics that differed between a conventional running shoe and barefoot by more than 3°, especially for ankle dorsiflexion and knee flexion. Many runners stay in the same movement path (the preferred movement path) when running in various different footwear conditions. The percentage of runners maintaining their preferred movement path depends on the magnitude of the change introduced by the footwear condition.

Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial.

PubMed

Scuderi, Giles R; Hedden, David R; Maltry, John A; Traina, Steven M; Sheinkop, Mitchell B; Hartzband, Mark A

2012-03-01

Between May 2001 and June 2004, 388 total knee arthroplasty cases were enrolled in a prospective, randomized, multicenter investigational device exemption trial. Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control. At 2 to 4 years of follow-up, results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. The mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores, maximum flexion, and range of motion. One mobile-bearing arthroplasty required revision. Radiographic results were unremarkable, and implant-related complications were rare in both groups. At this early follow-up, the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable, effective performance. Copyright © 2012 Elsevier Inc. All rights reserved.

MRI of the knees in asymptomatic adolescent soccer players: A case-control study.

PubMed

Matiotti, Simone B; Soder, Ricardo B; Becker, Rafaela G; Santos, Francisco S; Baldisserotto, Matteo

2017-01-01

To determine the range of asymptomatic abnormal findings in adolescent soccer players at 3.0T MRI of the knee. In all, 87 knees of asymptomatic 14-17-year-old male adolescents were evaluated at 3T, using a standardized examination protocol comprising four sequences: two fat-suppressed T 2 -weighted fast spin-echo sequences (T 2 FSE), in the sagittal (repetition time / echo time [TR/TE], 5.300/71, echo train length [ETL] 17) and coronal planes (TR/TE, 4234/70, ETL 17), one fat-suppressed proton density (PD) sequence in the axial plane (TR/TE, 2.467/40, ETL 9), and one T 1 -weighted spin-echo (T 1 SE) sequence in the sagittal plane (TR/TE, 684/12.5). Soccer players (46 knees) were paired with controls (41 knees) by age and weight. Bone marrow, articular cartilage, meniscus, tendons, ligaments, fat pad abnormalities, and joint fluid were assessed. One or more abnormalities were detected in 31 knees (67.4%) in the soccer player group, compared to 20 knees (48.8%) in the control group. The prevalence of bone marrow edema was higher in the soccer group (19 knees, 41.3%) than in the control group (3 knees, 7.3%), P = 0.001. Other abnormalities found in this sample (joint effusion, cartilage lesions, tendinopathy, ganglion cysts, and infrapatellar fat pat edema) were not significantly different between the two study groups. Asymptomatic adolescents had a high prevalence of abnormal findings on knee imaging, especially bone marrow edema. This prevalence was higher among soccer players. 4 J. Magn. Reson. Imaging 2017;45:59-65. © 2016 International Society for Magnetic Resonance in Medicine.

The effects of Navy ship ladder descent on the knee internal joint reaction forces

NASA Astrophysics Data System (ADS)

Coulter, Jonathan D.; Weinhandl, Joshua T.; Bawab, Sebastian Y.; Ringleb, Stacie I.

2017-02-01

Military populations may be at risk for developing knee osteoarthritis and other knee problems when descending a Navy ship ladder, which differs from traditional stairs due to non-overlapping treads, a larger rise and a steeper inclination angle. The purpose of this study was to develop a forward dynamic model of the descent of a Navy ship ladder to determine how this motion affects the internal knee reaction forces and how altering the hamstring/quadriceps ratio affects the internal joint reaction forces in the knee. Kinematic and kinetic data were collected from three male sailors descending a replica of a Navy ship ladder and were used as input into a model constructed in OpenSim. The peak resultant joint reaction force was 6.6 × BW, which was greater than values reported in the literature in traditional stairs. Peak compressive and anterior joint reaction forces, 4.05 × BW and 5.46 × BW, respectively, were greater than reported values for a squat, a motion similar to descending a ship ladder. The average peak vertical and anterior internal joint reaction force at the knee were 4.05 × BW and 5.46 × BW, respectively. The resultant joint reaction forces calculated from the ladder descent were greater than stair descent and squatting. Little effects were found in the joint reaction forces after adjusting the quadriceps to hamstring muscle strength ratios, possibly because these ratios might change the distribution of the contact forces across the joint, not the resultant forces.

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.

Effect of intraarticular tramadol administration in the rat model of knee joint inflammation.

PubMed

Garlicki, Jarosław; Dorazil-Dudzik, Magdalena; Wordliczek, Jerzy; Przewłocka, Barbara

2006-01-01

Local administration of exogenous opioids may cause effective analgesia without adverse symptoms from the central nervous system. Experiments show that peripheral antinociceptive effect of opioids is observed especially in inflammatory pain. The aim of the research was to estimate the effect of tramadol on nociceptive process at the level of peripheral nervous system, after its local administration in the model of knee joint inflammation. Tramadol was administered intraarticulary into the rat knee joint, before the inflammation as a preemptive analgesia and, for comparison, after the intraarticular injection of carrageenan. The research determined the influence of tramadol injection on pain threshold for thermal stimuli, development of inflammatory processes using the measurement of joint edema and motor function following the induction of knee joint inflammation in the rat. Functional assessment of knee joint with inflammation, in terms of rats' mobility and body position as well as joint loading and mobility were studied. The results of the experiments show that local administration of tramadol induces antinociceptive effect. The effect of tramadol, which elicits also a decrease in inflammatory edema, appears not only after its administration after carrageenan when inflammation was already present, but also in the case of its injection prior to carrageenan in the scheme of preemptive analgesia. The results of the described research show that not only morphine but also another opioid, tramadol, widely used in clinical practice, inhibits nociception, edema and functional impairment of the paw after its local application directly to the inflamed knee joint.

The interaction between the vastus medialis and vastus intermedius and its influence on the extensor apparatus of the knee joint.

PubMed

Grob, Karl; Manestar, Mirjana; Filgueira, Luis; Kuster, Markus S; Gilbey, Helen; Ackland, Timothy

2018-03-01

Although the vastus medialis (VM) is closely associated with the vastus intermedius (VI), there is a lack of data regarding their functional relationship. The purpose of this study was to investigate the anatomical interaction between the VM and VI with regard to their origins, insertions, innervation and function within the extensor apparatus of the knee joint. Eighteen human cadaveric lower limbs were investigated using macro-dissection techniques. Six limbs were cut transversely in the middle third of the thigh. The mode of origin, insertion and nerve supply of the extensor apparatus of the knee joint were studied. The architecture of the VM and VI was examined in detail, as was their anatomical interaction and connective tissue linkage to the adjacent anatomical structures. The VM originated medially from a broad hammock-like structure. The attachment site of the VM always spanned over a long distance between: (1) patella, (2) rectus femoris tendon and (3) aponeurosis of the VI, with the insertion into the VI being the largest. VM units were inserted twice-once on the anterior and once on the posterior side of the VI. The VI consists of a complex multi-layered structure. The layers of the medial VI aponeurosis fused with the aponeuroses of the tensor vastus intermedius and vastus lateralis. Together, they form the two-layered intermediate layer of the quadriceps tendon. The VM and medial parts of the VI were innervated by the same medial division of the femoral nerve. The VM consists of multiple muscle units inserting into the entire VI. Together, they build a potential functional muscular complex. Therefore, the VM acts as an indirect extensor of the knee joint regulating and adjusting the length of the extensor apparatus throughout the entire range of motion. It is of clinical importance that, besides the VM, substantial parts of the VI directly contribute to the medial pull on the patella and help to maintain medial tracking of the patella during knee extension. The interaction between the VM and VI, with responsibility for the extension of the knee joint and influence on the patellofemoral function, leads readily to an understanding of common clinical problems found at the knee joint as it attempts to meet contradictory demands for both mobility and stability. Surgery or trauma in the anteromedial aspect of the quadriceps muscle group might alter a delicate interplay between the VM and VI. This would affect the extensor apparatus as a whole.

Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees.

PubMed

Yuuki, Arata; Muneta, Takeshi; Ohara, Toshiyuki; Sekiya, Ichiro; Koga, Hideyuki

2017-03-01

Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees. One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated. All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant. Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee instability on ACL-related instability was less than that of lateral knee instability. Level IV, case series with no comparison group. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Clinical features of symptomatic patellofemoral joint osteoarthritis

PubMed Central

2012-01-01

Introduction Patellofemoral joint osteoarthritis (OA) is common and leads to pain and disability. However, current classification criteria do not distinguish between patellofemoral and tibiofemoral joint OA. The objective of this study was to provide empirical evidence of the clinical features of patellofemoral joint OA (PFJOA) and to explore the potential for making a confident clinical diagnosis in the community setting. Methods This was a population-based cross-sectional study of 745 adults aged ≥50 years with knee pain. Information on risk factors and clinical signs and symptoms was gathered by a self-complete questionnaire, and standardised clinical interview and examination. Three radiographic views of the knee were obtained (weight-bearing semi-flexed posteroanterior, supine skyline and lateral) and individuals were classified into four subsets (no radiographic OA, isolated PFJOA, isolated tibiofemoral joint OA, combined patellofemoral/tibiofemoral joint OA) according to two different cut-offs: 'any OA' and 'moderate to severe OA'. A series of binary logistic and multinomial regression functions were performed to compare the clinical features of each subset and their ability in combination to discriminate PFJOA from other subsets. Results Distinctive clinical features of moderate to severe isolated PFJOA included a history of dramatic swelling, valgus deformity, markedly reduced quadriceps strength, and pain on patellofemoral joint compression. Mild isolated PFJOA was barely distinguished from no radiographic OA (AUC 0.71, 95% CI 0.66, 0.76) with only difficulty descending stairs and coarse crepitus marginally informative over age, sex and body mass index. Other cardinal signs of knee OA - the presence of effusion, bony enlargement, reduced flexion range of movement, mediolateral instability and varus deformity - were indicators of tibiofemoral joint OA. Conclusions Early isolated PFJOA is clinically manifest in symptoms and self-reported functional limitation but has fewer clear clinical signs. More advanced disease is indicated by a small number of simple-to-assess signs and the relative absence of classic signs of knee OA, which are predominantly manifestations of tibiofemoral joint OA. Confident diagnosis of even more advanced PFJOA may be limited in the community setting. PMID:22417687

Haemophilia Joint Health Score in healthy adults playing sports.

PubMed

Sluiter, D; Foppen, W; de Kleijn, P; Fischer, K

2014-03-01

To evaluate outcome of prophylactic clotting factor replacement in children with haemophilia, the Haemophilia Joint Health Score (HJHS) was developed aiming at scoring early joint changes in children aged 4-18. The HJHS has been used for adults on long-term prophylaxis but interpretation of small changes remains difficult. Some changes in these patients may be due to sports-related injuries. Evaluation of HJHS score in healthy adults playing sports could improve the interpretation of this score in haemophilic patients. The aim of this study was to evaluate the HJHS scores in a cohort of young, healthy men participating in sports. Concomitant with a project collecting MRI images of ankles and knees in normal young adults, HJHS scores were assessed in 30 healthy men aged 18-26, participating in sports one to three times per week. One physiotherapist assessed their clinical function using the HJHS 2.1. History of joint injuries was documented. MRI images were scored by a single radiologist, using the International Prophylaxis Study Group additive MRI score. Median age of the study group was 24.3 years (range 19.0-26.4) and median frequency of sports activities was three times per week (range 1-4). Six joints (five knees, one ankle) had a history of sports-related injury. The median overall HJHS score was 0 out of 124 (range 0-3), with 60% of subjects showing no abnormalities on HJHS. All joints were normal on MRI. These results suggest that frequent sports participation and related injuries are not related with abnormalities in HJHS scores. © 2013 John Wiley & Sons Ltd.

Medial knee loading is altered in subjects with early osteoarthritis during gait but not during step-up-and-over task

PubMed Central

Wesseling, Mariska; Smith, Colin R.; Thelen, Darryl G.; Verschueren, Sabine; Jonkers, Ilse

2017-01-01

This study evaluates knee joint loading during gait and step-up-and-over tasks in control subjects, subjects with early knee OA and those with established knee OA. Thirty-seven subjects with varying degrees of medial compartment knee OA severity (eighteen with early OA and sixteen with established OA), and nineteen healthy controls performed gait and step-up-and-over tasks. Knee joint moments, contact forces (KCF), the magnitude of contact pressures and center of pressure (CoP) location were analyzed for the three groups for both activities using a multi-body knee model with articular cartilage contact, 14 ligaments, and six degrees of freedom tibiofemoral and patellofemoral joints. During gait, the first peak of the medial KCF was significantly higher for patients with early knee OA (p = 0.048) and established knee OA (p = 0.001) compared to control subjects. Furthermore, the medial contact pressure magnitudes and CoP location were significantly different in both groups of patients compared to controls. Knee rotation moments (KRMs) and external rotation angles were significantly higher during early stance in both patient groups (p < 0.0001) compared to controls. During step-up-and-over, there was a high variability between the participants and no significant differences in KCF were observed between the groups. Knee joint loading and kinematics were found to be altered in patients with early knee OA only during gait. This is an indication that an excessive medial KCF and altered loading location, observed in these patients, is a contributor to early progression of knee OA. PMID:29117248

[Posttraumatic deformities of the knee joint : Intra-articular osteotomy after malreduction of tibial head fractures].

PubMed

Frosch, K-H; Krause, M; Frings, J; Drenck, T; Akoto, R; Müller, G; Madert, J

2016-10-01

Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.

Open Knee: Open Source Modeling & Simulation to Enable Scientific Discovery and Clinical Care in Knee Biomechanics

PubMed Central

Erdemir, Ahmet

2016-01-01

Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical function of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor intensive reproduction of model development steps can be avoided. The interested parties can immediately utilize readily available models for scientific discovery and for clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes detailed anatomical representation of the joint's major tissue structures, their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next generation knee models are noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age groups and pathological states. PMID:26444849

Open Knee: Open Source Modeling and Simulation in Knee Biomechanics.

PubMed

Erdemir, Ahmet

2016-02-01

Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical functions of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor-intensive reproduction of model development steps can be avoided. Interested parties can immediately utilize readily available models for scientific discovery and clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes the detailed anatomical representation of the joint's major tissue structures and their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next-generation knee models is noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age groups and pathological states. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

P2X3 and P2X2/3 Receptors Play a Crucial Role in Articular Hyperalgesia Development Through Inflammatory Mechanisms in the Knee Joint Experimental Synovitis.

PubMed

Teixeira, Juliana Maia; Bobinski, Franciane; Parada, Carlos Amílcar; Sluka, Kathleen A; Tambeli, Cláudia Herrera

2017-10-01

Osteoarthritis (OA) is a degenerative and progressive disease characterized by cartilage breakdown and by synovial membrane inflammation, which results in disability, joint swelling, and pain. The purinergic P2X3 and P2X2/3 receptors contribute to development of inflammatory hyperalgesia, participate in arthritis processes in the knee joint, and are expressed in chondrocytes and nociceptive afferent fibers innervating the knee joint. In this study, we hypothesized that P2X3 and P2X2/3 receptors activation by endogenous ATP (adenosine 5'-triphosphate) induces articular hyperalgesia in the knee joint of male and female rats through an indirect sensitization of primary afferent nociceptors dependent on the previous release of pro-inflammatory cytokines and/or on neutrophil migration. We found that the blockade of articular P2X3 and P2X2/3 receptors significantly attenuated carrageenan-induced hyperalgesia in the knee joint of male and estrus female rats in a similar manner. The carrageenan-induced knee joint inflammation increased the expression of P2X3 receptors in chondrocytes of articular cartilage. Further, the blockade of articular P2X3 and P2X2/3 receptors significantly reduced the increased concentration of TNF-α, IL-6, and CINC-1 and the neutrophil migration induced by carrageenan. These findings indicate that P2X3 and P2X2/3 receptors activation by endogenous ATP is essential to hyperalgesia development in the knee joint through an indirect sensitization of primary afferent nociceptors dependent on the previous release of pro-inflammatory cytokines and/or on neutrophil migration.

Wearable Inertial Sensors Allow for Quantitative Assessment of Shoulder and Elbow Kinematics in a Cadaveric Knee Arthroscopy Model.

PubMed

Rose, Michael; Curtze, Carolin; O'Sullivan, Joseph; El-Gohary, Mahmoud; Crawford, Dennis; Friess, Darin; Brady, Jacqueline M

2017-12-01

To develop a model using wearable inertial sensors to assess the performance of orthopaedic residents while performing a diagnostic knee arthroscopy. Fourteen subjects performed a diagnostic arthroscopy on a cadaveric right knee. Participants were divided into novices (5 postgraduate year 3 residents), intermediates (5 postgraduate year 4 residents), and experts (4 faculty) based on experience. Arm movement data were collected by inertial measurement units (Opal sensors) by securing 2 sensors to each upper extremity (dorsal forearm and lateral arm) and 2 sensors to the trunk (sternum and lumbar spine). Kinematics of the elbow and shoulder joints were calculated from the inertial data by biomechanical modeling based on a sequence of links connected by joints. Range of motion required to complete the procedure was calculated for each group. Histograms were used to compare the distribution of joint positions for an expert, intermediate, and novice. For both the right and left upper extremities, skill level corresponded well with shoulder abduction-adduction and elbow prono-supination. Novices required on average 17.2° more motion in the right shoulder abduction-adduction plane than experts to complete the diagnostic arthroscopy (P = .03). For right elbow prono-supination (probe hand), novices required on average 23.7° more motion than experts to complete the procedure (P = .03). Histogram data showed novices had markedly more variability in shoulder abduction-adduction and elbow prono-supination compared with the other groups. Our data show wearable inertial sensors can measure joint kinematics during diagnostic knee arthroscopy. Range-of-motion data in the shoulder and elbow correlated inversely with arthroscopic experience. Motion pattern-based analysis shows promise as a metric of resident skill acquisition and development in arthroscopy. Wearable inertial sensors show promise as metrics of arthroscopic skill acquisition among residents. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Antero-medial incision of knee joint for the treatment of intercondylar fracture of femur].

PubMed

Yin, Zi-Fei; Sun, Bin-Feng; Yang, Xiao-Hai; Wang, Qing; Qian, Ping-Kang; Wu, Xiao-Feng; Xu, Feng

2017-12-25

To explore the clinical effect of antero-medial incision of knee joint in treating intercondylar fracture of femur. From September 2012 to March 2015, 24 patients with intercondylar fracture of femur were selected, including 17 males and 7 females, aged from 20 to 65 years old with an average of(38.3±9.5) years old. Among them, 12 cases were caused by traffic accident, 8 cases were caused by falling injury and 4 cases were caused by falling down. All patients were closed fractures. The time from injury to hospital was from 30 min to 8 h with an average of(2.2±0.3) h. According to AO classification, 4 cases were type B1, 3 type B2, 2 type B3, 5 type C1, 6 type C2 and 4 type C3. All patients were treated with antero-medial incision of knee joint. Operative time, blood loss and postoperative complications were observed and recovery of keen function was evaluated by Kolmert scoring. All patients were followed-up from 6 to 12 months with average of (9.0±1.7) months. Operative time ranged from 50 to 90 min with an average of (70.0±8.2) min; blood loss ranged from 90 to 400 ml with an average of (180±36) ml; negative pressure flow was from 30 to 90 ml, with an average of (50.0±7.1) ml. All fracture were healed at stage I without loosening of internal fixator, fracture nonunion, and deep vein thrombosis. According to Kolmert scoring, 16 patients got excellent result, 5 patients good and 3 fair. Antero-medial incision of knee joint in treating intercondylar fracture of femur, which has advantages of good fracture reduction, less injury of soft tissue and simple operation, could obtain good clinical results.

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.

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.

Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters.

PubMed

Furtado, Rita Nely Vilar; Machado, Flávia Soares; Luz, Karine Rodrigues da; Santos, Marla Francisca Dos; Konai, Monique Sayuri; Lopes, Roberta Vilela; Natour, Jamil

To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0-10cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG). 289 patients (635 joints) were studied. VASSw (p<0.001) and VASR (0.001

A study on muscle activity and ratio of the knee extensor depending on the types of squat exercise

PubMed Central

Kang, Jeong-Il; Park, Joon-Su; Choi, Hyun; Jeong, Dae-Keun; Kwon, Hye-Min; Moon, Young-Jun

2017-01-01

[Purpose] For preventing the patellofemoral pain syndrome, this study aims to suggest a proper squat method, which presents selective muscle activity of Vastus Medialis Oblique and muscle activity ratios of Vastus Medialis Oblique/Vastus Lateralis by applying squat that is a representative weight bearing exercise method in various ways depending on the surface conditions and knee bending angles. [Subjects and Methods] An isometric squat that was accompanied by hip adduction, depending on the surface condition and the knee joint flexion angle, was performed by 24 healthy students. The muscle activity and the ratio of muscle activity were measured. [Results] In a comparison of muscle activity depending on the knee joint flexion angle on a weight-bearing surface, the vastus medialis oblique showed a significant difference at 15° and 60°. Meanwhile, in a comparison of the muscle activity ratio between the vastus medialis oblique and the vastus lateralis depending on the knee joint flexion angle on a weight-bearing surface, significant differences were observed at 15° and 60°. [Conclusion] An efficient squat exercise posture for preventing the patellofemoral pain syndrome is to increase the knee joint bending angle on a stable surface. But it would be efficient for patients with difficulties in bending the knee joint to keep a knee joint bending angle of 15 degrees or less on an unstable surface. It is considered that in future, diverse studies on selective Vastus Medialis Oblique strengthening exercise methods would be needed after applying them to patients with the patellofemoral pain syndrome. PMID:28210036

Dual-joint modeling for estimation of total knee replacement contact forces during locomotion.

PubMed

Hast, Michael W; Piazza, Stephen J

2013-02-01

Model-based estimation of in vivo contact forces arising between components of a total knee replacement is challenging because such forces depend upon accurate modeling of muscles, tendons, ligaments, contact, and multibody dynamics. Here we describe an approach to solving this problem with results that are tested by comparison to knee loads measured in vivo for a single subject and made available through the Grand Challenge Competition to Predict in vivo Tibiofemoral Loads. The approach makes use of a "dual-joint" paradigm in which the knee joint is alternately represented by (1) a ball-joint knee for inverse dynamic computation of required muscle controls and (2) a 12 degree-of-freedom (DOF) knee with elastic foundation contact at the tibiofemoral and patellofemoral articulations for forward dynamic integration. Measured external forces and kinematics were applied as a feedback controller and static optimization attempted to track measured knee flexion angles and electromyographic (EMG) activity. The resulting simulations showed excellent tracking of knee flexion (average RMS error of 2.53 deg) and EMG (muscle activations within ±10% envelopes of normalized measured EMG signals). Simulated tibiofemoral contact forces agreed qualitatively with measured contact forces, but their RMS errors were approximately 25% of the peak measured values. These results demonstrate the potential of a dual-joint modeling approach to predict joint contact forces from kinesiological data measured in the motion laboratory. It is anticipated that errors in the estimation of contact force will be reduced as more accurate subject-specific models of muscles and other soft tissues are developed.

Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.

PubMed

Snyder, Kelli R; Earl, Jennifer E; O'Connor, Kristian M; Ebersole, Kyle T

2009-01-01

Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P

Parameters Estimation For A Patellofemoral Joint Of A Human Knee Using A Vector Method

NASA Astrophysics Data System (ADS)

Ciszkiewicz, A.; Knapczyk, J.

2015-08-01

Position and displacement analysis of a spherical model of a human knee joint using the vector method was presented. Sensitivity analysis and parameter estimation were performed using the evolutionary algorithm method. Computer simulations for the mechanism with estimated parameters proved the effectiveness of the prepared software. The method itself can be useful when solving problems concerning the displacement and loads analysis in the knee joint.

Knee Brace Would Lock And Unlock Automatically

NASA Technical Reports Server (NTRS)

Myers, Neill; Forbes, John; Shadoan, Mike; Baker, Kevin

1995-01-01

Proposed knee brace designed to aid rehabilitation of person who suffered some muscle damage in leg. Not limited to locking in straight-leg position and, instead, locks at any bend angle. Does not prevent knee from bearing weight. Instead, knee brace allows knee to bear weight and locks only when foot and lower leg bear weight. Thus, brace prevents flexion that wearer desired to prevent but could not prevent because of weakened muscles. Knee bends freely to exercise knee-related muscles. Knee brace strapped at upper end to leg above knee, and anchored at lower end by stirrup under foot. Joint mechanism (identical mechanisms used in left and right assemblies) allows knee joint to flex freely except when weight applied to heel.

Gastrocnemius tightness on joint angle and work of lower extremity during gait.

PubMed

You, Jia-Yuan; Lee, Hsin-Min; Luo, Hong-Ji; Leu, Chwan-Chin; Cheng, Pen-Gang; Wu, Shyi-Kuen

2009-11-01

Muscular tightness is a common clinical musculoskeletal disorder and is regarded as a predisposing factor for muscle injuries. In this study, a two-way mixed design ANOVA was applied to investigate the effects of the gastrocnemius tightness on the joint angle and joint work during walking. Twenty-two patients with muscular tightness of gastrocnemius muscle (<12 degrees of ankle dorsiflexion with knee extended) and 22 age- and gender-matched subjects with normal gastrocnemius flexibility (>15 degrees of ankle dorsiflexion with knee extended) participated in this study. The joint angle and work at hip, knee, and ankle joints during the stance phase were analyzed at two preset cadences of 100 steps/min and 140 steps/min. Significantly greater flexion angles at hip (P=0.025) and knee (P=0.001) were found in the tightness group at the time of maximal ankle dorsiflexion. Significantly less work generation at knee (P=0.034) and greater work absorption at ankle (P=0.024) were detected in the tightness group. The subjects with gastrocnemius tightness revealed a compensatory gait pattern, which included the changes in the joint angles and associated work productions. The potential disturbance of the knee control and strain injuries of plantar flexors might be crucial in the clinical considerations for subjects with gastrocnemius tightness.

Estimating the Mechanical Behavior of the Knee Joint during Crouch Gait: Implications for Real-Time Motor Control of Robotic Knee Orthoses

PubMed Central

Damiano, Diane L.; Bulea, Thomas C.

2016-01-01

Individuals with cerebral palsy frequently exhibit crouch gait, a pathological walking pattern characterized by excessive knee flexion. Knowledge of the knee joint moment during crouch gait is necessary for the design and control of assistive devices used for treatment. Our goal was to 1) develop statistical models to estimate knee joint moment extrema and dynamic stiffness during crouch gait, and 2) use the models to estimate the instantaneous joint moment during weight-acceptance. We retrospectively computed knee moments from 10 children with crouch gait and used stepwise linear regression to develop statistical models describing the knee moment features. The models explained at least 90% of the response value variability: peak moment in early (99%) and late (90%) stance, and dynamic stiffness of weight-acceptance flexion (94%) and extension (98%). We estimated knee extensor moment profiles from the predicted dynamic stiffness and instantaneous knee angle. This approach captured the timing and shape of the computed moment (root-mean-squared error: 2.64 Nm); including the predicted early-stance peak moment as a correction factor improved model performance (root-mean-squared error: 1.37 Nm). Our strategy provides a practical, accurate method to estimate the knee moment during crouch gait, and could be used for real-time, adaptive control of robotic orthoses. PMID:27101612

Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: a prospective analysis of 410 consecutive cases.

PubMed

Bauer, T; Biau, D; Colmar, M; Poux, X; Hardy, P; Lortat-Jacob, A

2010-12-01

The range of motion of the knee joint after Total Knee Replacement (TKR) is a factor of great importance that determines the postoperative function of patients. Much enthusiasm has been recently directed towards the posterior condylar offset with some authors reporting increasing postoperative knee flexion with increasing posterior condylar offset and others who did not report any significant association. Patients undergoing primary total knee replacement were included in a prospective multicentre study and the effect of the posterior condylar offset on the postoperative knee flexion was assessed after adjusting for known influential factors. All knees were implanted by three senior orthopedist surgeons with the same cemented cruciate-sacrificing mobile-bearing implant and with identical surgical technique. Clinical data, active knee flexion and posterior condylar offset were recorded preoperatively and postoperatively at a minimal one year follow-up for all patients. Univariate and multivariate linear models were fitted to select independent predictors of the postoperative knee flexion. Four hundred and ten consecutive total knee replacements (379 patients) were included in the study. The mean preoperative knee flexion was 112°. The mean condylar offset was 28.3mm preoperatively and 29.4mm postoperatively. The mean postoperative knee flexion was 108°. No correlation was found between the posterior condylar offset or the tibial slope and the postoperative knee flexion. The most significant predictive factor for postoperative flexion after posterior-stabilized TKR without PCL retention was the preoperative range of flexion, with a linear effect. Copyright © 2009 Elsevier B.V. All rights reserved.