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Lateral ligament insufficiency of the ankle (LLIA)caused by inversion sprain is the most frequent injury in athletes. Kinetic analysis was conducted to determine the influence of LLIA on kinetics of the adjacent joint(knee) for thirty collegiate athletes with experience of ankle inversion sprain. The athletes were divided into three groups according to their instability: negative group, positive group, and severe group. The severe group showed increased knee varus moment and decreased subtalar valgus moment. The sum of the values of these two moments was similar between groups, and two moments negatively correlated with each other. It is suggested that LLIA results in increase of the knee varus moment, and management for the knee should be considered for those athletes with LLIA. [ABSTRACT FROM AUTHOR]

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Curved intertrochanteric varus osteotomy is osteotomized between the lesser trochanter and the greater trochanter which is curved so as to place the femoral head in a varus position by rotating it in the coronal plane. After mean follow-up of 5.4 years of 57 joints, approximately 98% of joints were preserved and 90% of joints were protected from the progression of disease. Curved intertrochanteric varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.

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In the present experiment an attempt was made to investigate dynamic mechanical properties of the knee in varus-valgus direction in vivo. Twelve adult cats with the knees which consist of medial collateral, lateral collateral, anterior cruciate and posterior cruciate ligaments were used. A measuring device, which was developed for this investigation, consisted of a fixation unit, a driving unit and strain and force transducers. Non-linearity of these transducers were 0.5% F.S. and 1% F.S. respectively. Both static and dynamic measurement could be performed with the measuring device. The femur of the cat was firmly clumped with the fixation unit. Care was taken to avoid crushing the skin and muscles by splitting small part of the skin and underlying muscles. Operation and measurement were carried out under general anesthesia and a muscle relaxant was given at regular intervals. Sinusoidal bending strain (bending oscillation) of 0.3, 1.0, 1.6, 3.3, 5.0, 8.6 and 10.0 Hz in varus-valgus direction was transmitted to the knee-leg complex under each pre-bending strain, which was given to varus or valgus direction prior to the initiation of the test, and bending moment was measured. Bending strain could be regarded as generated in the knee because bending strain in the femur and tibia may be ignored. Frequency, amplitude and phase of bending strain-bending moment response were analysed after passing through amplifiers and low-pass filters, and dynamic mechanical properties of the knee-leg complex was given as a complex bending elastic coefficient. Overall error of the present investigation was within 5%. Dynamic mechanical properties of the knee-leg complex resembled those of the Kelvin model on condition that pre-bending strain and amplitude of bending oscillation were constant. Corner frequency was approximately 5 Hz. It suggested that bending elastic and bending dumping coefficients of the knee were calculated by the least square method. Bending elastic and bending dumping coefficients of the knee were under the influence of pre-bending strain and amplitude of bending oscillation. As the pre-bending strain, which was loaded in the step-loading method, increased on condition of constant amplitude, bending elastic coefficient increased linearly, while bending dumping coefficient increased although the rate of increase decreased gradually. As amplitude increased sequentially from small to large on condition of constant pre-bending strain, both bending elastic and bending dumping coefficients decreased monotonously. However, dumping-elastic ratio (D/K) of the knee was approximately constant in spite of variation of those parameters.(ABSTRACT TRUNCATED AT 400 WORDS)

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[Purpose] The purpose of this study was to investigate the characteristics of gait in patients with hallux valgus and the effects on the joints of the lower extremities (hip, knee and ankle). [Subjects] The patient was a 69-year-old female diagnosed with rheumatoid arthritis (RA) including hallux valgus. The patient had a chief complaint of pain on the medial side of the right hallux in gait. [Methods] Gait analyses, using the VICON-MX systems were performed preoperatively and postoperatively at 6 months. [Results] The postoperative valgus of knee moments decreased, and valgus of ankle moments had increased on the operated side. The varus of knee moments on the non-operated side was higher than on the operated side. [Conclusion] The results revealed instability in the lateral direction of the lower extremity with deformity of the foot. Hallux valgus associated with valgus knee deformity on the operated and varus on the non-operated side is a potential cause of osteoarthritis of the knee. We should be careful not only to prevent the recurrence of hallux valgus on the operated side but also osteoarthritis of the knee on the opposite side. These results are useful indicators for rehabilitation management of hallux valgus. [ABSTRACT FROM AUTHOR]

[Purpose] We investigated the relationship between locus of the center of foot pressure (COP) and the position of the rear part of the foot, and considered the functions of the foot parts in the movement of bringing the feet together. [Subjects] The subjects were 13 healthy adults: 8 males, 5 females, average age 21.6±2.5 years. [Method] We measured the locus of COP during movement of one leg in bringing the feet together from standing with the legs apart. In addition, we divided the subjects into those who ended the movement with the stepping leg in varus or valgus and compared the two groups. [Results] We found a significant correlation between the left-right value of COP in the step-off period and the left-right and anterior-posterior values of COP just after the movement to the stance foot was completed in the transfer phase. We also found significant differences between the varus and valgus groups in the left-right component in the step-off phase and the anterior-posterior and left-right components in the transfer phase. [Conclusion] The results suggest that the landing position of the foot influences the locus of the center of foot pressure in the movement of bringing the feet together. [ABSTRACT FROM AUTHOR]

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OBJECTIVES This study was to examine the effect of the 12-week video-based non-contact corrective exercise continuum (CEC) program on the forward head posture, central asymmetry, varus and valgus knees for men and women with postural imbalance. METHODS Subjects were recruited openly by the Internet community and measured their posture with a 3D whole body scanner (Medicube WS-210, Korea), and then classified into exercise group (n=32, EG) and control group (n=32, CG). Total subjects were classified into forward head posture exercise group (n=8), central asymmetry exercise group (n=8), varus exercise group (n=8), valgus exercise group and each control group (n=8). For the non-contact home training, 12 weeks of 30 minutes/day, 3 times/week, corrective exercise continuum were conducted. The CEC program is an effective treatment to correct the anatomical alignment of the extremities as suggested by the National Academy of Sports Medicine. RESULTS As a result, the distance between the centers according to the forward head posture CEC program in EG, the angle of spinal inclination of the cervical and thoracic vertebrae, and central asymmetry were lowered (p

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Copyright of Japanese Journal of Clinical Sports Medicine / Nihon Rinsho Supotsu is the property of Japanese Society of Clinical Sports Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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There are concepts of medial and lateral bandaging to fixing joints of limbs. Medial bandaging means bandaging toward the midline of the trunk, and lateral bandaging means bandaging away from the midline of the trunk. In inversion sprain of the ankle, medial bandaging is usually applied to induce a valgus position. In this study, difference in the varus control effect between medial and lateral bandaging of the cotton bandage was evaluated according to the talar tilt angle (TTA). The subjects were 8 male college soccer players (12 feet) with chronic mechanical instability of the ankle. Spica bandage was applied by medial and lateral bandaging in a random order using 7.5 cm wide and 6 m long cotton bandage to the ankle at neutral plantar/dorsal flexion. Plain varus stress radiography was performed with a load of 15 kg under 3 conditions, i.e., before bandaging, with medial bandaging, and with lateral bandaging. The TTA was measured in the images obtained. The images were classified into 2 groups according to the TTA before bandaging, and the difference in the TTA before and after bandaging as an index of the varus control effect was compared between medial and lateral bandaging. The varus control effect was 4.8±3.0° by medial bandaging and 3.8±2.4° by lateral bandaging with a significant difference (p<0.05) when the TTA before bandaging was 9.1° or greater. When the TTA before bandaging was less than 9.1° however, the varus control effect was 3.1±1.3° and 3.1±1.2° , respectively, with no significant difference. The results of this study suggest that both medial and lateral bandaging provides a sufficient varus control effect in mild inversion sprain of the ankle, but that the effect of lateral bandaging is insufficient when the instability is greater. The ability to apply cotton bandage is considered to vary widely among individuals depending on experience, but medial bandaging should be selected for markedly unstable ankles. [ABSTRACT FROM AUTHOR]

We encountered two cases of ankle dislocation without fracture. Case 1 was a 27 year old woman, who was injured when playing volleyball. There was no contributory past history, but her BMI was 29 (≥25). Her ankle joint showed varus deformity, and dislocation without fracture on a roentgenogram. We reduced the dislocated ankle immediately and examined the laxity with inversion stress roentgenography under anesthesia. The talar tilt angle of her ankle showed 40-degree instability. We repaired the disrupted lateral ligaments. Thereafter, her ankle was immobilized with no weight bearing for 4 weeks. Japanese orthopaedic association score(JOA score) was 95 points 30 months post operatively. Currently, works full time. Case 2 was a 36-year-old man, who was injured playing softball. He had been healthy, but had an ankle sprain injury 3 month earlier. His ankle joint showed severe varus and inversion deformity, and dislocation without accompanying fracture on a roentgenogram. We also recognized an open 8cm wound on the ankle exposing the lateral malleolus. We performed emergency surgery to repair both the anterior talo-fibular ligament and calcaneo-fibular ligament after debridement. A below-knee cast was applied for 4 weeks before starting weight bearing. JOA score was 92 points 6 months post operatively. He enjoys playing softball at present. Dislocation of the ankle without accompanying malleolar fracture is a rare lesion. A dislocated ankle remains very unstable even after reduction. We considered it necessary to repair the ligaments of the dislocated ankle anatomically, and operated on both of these of cases. The results were satisfactory. [ABSTRACT FROM AUTHOR]

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[Purpose] The purpose of this study was to clarify the effects of a heel-arch pad on anterior pelvis and knee joint acceleration and timing of the "foot flat" (FF) phase during walking. [Subjects] The subjects were 43 legs of 28 healthy adults, 22 male legs and 21 female legs. [Method] Subjects were allocated to the Early group or Delayed group according to the timing of the incidence of FF, early or delayed. Using an accelerometer, we investigated the differences in acceleration rates between the two groups and the changes in acceleration rates after fixation of the heel-arch pad. [Results] In the Early group, anterior acceleration of the knee joint increased just before FF, and just after FF anterior acceleration of the knee joint decreased. In the Delayed group, anterior acceleration of the knee and pelvis just before FF were significantly decreased by fixation of the heel-arch pad, and just after FF, anterior acceleration of the pelvis was significantly decreased by fixation of the heel-arch pad, revealing the mutual interaction of pad height and the timing of FF. [Conclusion] The results suggest the timing of FF and heel-arch pad influence anterior acceleration of the pelvis and knee. [ABSTRACT FROM AUTHOR]

There are several traditional methods to fix sprained ankles that involve wrapping the joint with nonelastic cotton bandages, such as BAKUSUI (spica) and KIKKO (fan shaped), and splinting. On the basis of the talar tilt angle (TTA), we evaluated the fixed effects of a combination of BAKUSUI, SANSETSU (heel lock), and KIKKO wrapping (hereafter referred to as the study method) and those of the Judo therapy clinic (JTC) method, which is a rightward KIKKO wrapping method. The subjects were 8 male collegiate soccer players (12 feet) with chronic mechanical ankle instability. They were randomly treated with the study and JTC methods; in both methods, a 7.5-cm-wide and 6-m-long cotton bandage was wrapped around the ankle, with the joint in neutral plantar/dorsal flexion. Plain varus stress radiography was performed with a load of 150 N under 3 conditions, namely, before wrapping, after wrapping according to the study method, and after wrapping according to the JTC method. The TTAs were measured using the obtained images, and the fixed effects were compared between the right and left feet, and before and after wrapping. As a result of non-elastic cotton bandage fixation, the TTA without wrapping, after treatment with the study method, and after treatment with the JTC method were 8.6° ± 3.4° ±, 7.3° ± 3.8°, and 6.5° ± 3.8°, respectively. A significant difference was noted between the TTAs without wrapping and after treatment with the JTC method (p < 0.05). The TTAs of the right feet were 7.8° ± 3.5° before wrapping, 6.5° ± 3.3° after treatment with the study method, and 6.0° ± 3.9° after treatment with the JTC method. The corresponding values for the left feet were 9.1° ± 3.3°, 8.2° ± 3.8°, and 7.0° ± 3.2° The TTAs without wrapping and after treatment with the JTC method significantly differed for both the right and left feet (p < 0.05). The study method, which is a combination of BAKUSUI, SANSETSU, and KIKKO wrapping, does not provide adequate fixed effects. In contrast, the JTC method, which is the method only involving rightward KIKKO wrapping, provided sufficient fixed effects for both the right and left foot. These results suggest that when using the same length of a cotton bandage, increase repetition of single KIKKO wrapping has superior fixed effect than combination of BAKUSUI, SANSETSU, and KIKKO methods. [ABSTRACT FROM AUTHOR]

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Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bone morphological abnormalities, such as acetabular dysplasia, femoroacetabular impingement (FAI) , and knee varus deformity, are causes of osteoarthritis (OA) . These deformities have complex three-dimensional characteristics, and an accurate image assessment is not always easy. In recent years, statistical shape models (SSM) have been applied to analyzing variations of bone morphology in OA. Bone microstructural changes in OA include bone sclerosis, subchondral cysts, and osteophytes. Recent studies show that various pathological changes in subchondral bone affect the onset and development of OA, becoming targets for new drugs. Quantitative methods to analyze the subchondral trabecular bone of OA patients using MDCT and 3TMRI are currently under development.

Osteoarthritis (OA) is a disease caused by the degeneration and destruction of joint cartilage followed by peri-articular or subchondral bone formation and concomitant degeneration of other components of joints including synovium. Several animal OA models that adopt surgically induced joint instability have been developed. Analysis of those OA models indicates that increased mechanical stress exacerbates OA. In contrast, the effectiveness of physical therapy to alleviate OA symptoms suggests that optimal mechanical stimulation can impede the progression of OA. We propose that there are two facets of mechanical stress in light of the influence on OA ; one is detrimental, whilst the other is beneficial for articular cartilage and other joint compositions. From the malalignment and incongruity that underlie hip OA succeeding to congenital hip dislocation (acetabular hypoplasia) and the varus (or valgus) deformity observed in knee OA, shear force appears to prone to be a villain mechanical stress. On the other hand, compressive force may facilitate the maintenance or turnover of the articular cartilage unless it becomes excessive. Although essential differences between detrimental and beneficial mechanical stresses remain elusive, we speculate that the degree or magnitude of the deformation of mechano-sensor(s) may be crucial. Uncovering the mechano-sensing machinery in joints may demarcate the beneficial mechanical stress, and bring about a paradigm shift in the therapeutic strategy for OA.

The etiology and pathogenesis of non-traumatic osteonecrosis of the femoral head is still unknown although many studied has been performed. Using Magnetic resonance imaging, decision of the extent and location of the necrotic lesion, exist of bone marrow oedema has been developed. The revised criteria for diagnosis, classification, and staging of the disease from specific disease investigation committee of Japanese ministry of health, labor and welfare was established. As joint preservation operation, transtrochanteric rotational osteotomy, curved varus osteotomy were proved to be effective. Hip arthroplasty for maintaining bone stock has been developed for the treatment of young patients.

Idiopathic osteonecrosis of the femoral head commonly develops during adolescence and in the prime of adulthood. In Japan, joint-preserving procedures such as transtrochanteric rotational osteotomy, femoral varus osteotomy and vascularized bone grafting are often the surgical treatments of choice. However, the results of these procedures are not necessarily satisfactory. These procedures force patients to endure longer waits for their entire treatment. In addition, it is often difficult for surgeons to choose the appropriate treatment, especially in patients who have bilateral extensive osteonecrosis. We reported transplantation of bone marrow mononuclear cells for osteonecrosis of the femoral head and short-term results.

Transtrochanteric rotational osteotomy (TRO) is one of the joint-preserving surgical treatments for osteonecrosis of the femoral head (ONFH). It can prevent collapse of the femoral head as necrotic lesions in the weight-bearing portion can be moved sufficiently to less weight-bearing portion by anterior rotation, posterior rotation or varus angulation. Patient selection and preoperative planning are important to determine indications for TRO. It has been reported that successful TRO requires at least 34% of the weight-bearing area supported by the intact part of the femoral head. However, this ratio is difficult to preoperatively quantify according to the rotation angle using conventional two-dimensional MR images or X-rays. Therefore, we developed a method of simulating TRO using three-dimensional (3-D) models reconstructed from 3-D MR images and applied it to serial patients with types C1 and C2 osteonecrosis at stage 1 or 2. The simulation visualized positional changes of the necrotic lesion in the weight-bearing area and enabled quantitation of the postoperative intact ratio. Our surgical simulation is useful for evaluating the postoperative intact ratio and for determining indications for TRO as well as the optimal angle of femoral head rotation and varus angulation.

We report two difficult cases in total knee arthroplasty (TKA). One is an arthritis mutilans knee with large tibial bone deficiency that required TKA using tibial metal wedge augmentation. Another is a post-traumatic OA knee with varus deformity and rotational malalignment that had TKA by the ROBODOC system.

Objective: The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR)., Methods: From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems., Results: Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot., Discussion: Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.

Majority of osteoarthritic knee (OA knee) shows varus deformity which causes to the wear of medial joint cartilage and the complaint of knee pain. High tibial osteotomy (HTO) is often performed; wedge osteotomy above tibial tubercle provides the shift toward the lateral articulation of mechanical axis passing through medial articulation preoperatively, regeneration of medial joint cartilage and improvement of the knee complaints. Indication of HTO is as follows; (1) knee pain, (2) less than 500 m of continuous walking distance, (3) lateral thrust of the knee at walking, (4) narrowing (less than 3mm) of medial joint space in knee A-P radiograph at standing, (5) more than 180 degrees of standing femoro-tibial angle. This is thought to be almost equal to less than 60 points of JOA OA knee assessment score. Long term follow-up results have been reported to be good and satisfactory.

Osteoarthritis of knee joint is the disease that can be easily found at the ordinary examination. The aging and the continuous long-term stress are the most important ones among the many kind of causing factors. Most of osteoarthritis is appeared in medial femorotibial joint. The second largest number of osteoarthritis is appeared in patellofemoral joint. The first appearance of the disease is over forty and the number of the patients increases as patients grow older. Patients are almost female. Complication of osteoarthritis is obesity and varix of the lower limbs. 85% of the Japanese patients have varus deformity but few have valgus deformity. Main symptom is is pain that can be treated conservatively by medication and physical therapy. Medical care and the following effect are differ from the existence of injury of meniscus and ligament, and the level of the disease.

The patient of this case was a 64 year-old woman who visited our hospital with a complaint of arthralgia in the left knee lasting from nearly seven months ago. The radiogram taken at the first visit revealed no abnormalities in the knee, but she had persistent arthralgia, and so prednisolone was intraarticularly injected at a dose of 25 mg twice with an one-week interval. One month later, varus deformity rapidly progressed, resulting to cause gait disturbance. Since comminution and depression of the tibial plateau were revealed by radiography, steroid arthropathy was suspected. Histological examination showed normal articular cartilage and osteonecrosis in the subchondral bone. In addition, new bone formation was observed in the region around the tibial intercondylar eminence apart from the necrotic area, indicating extensive bone remodeling. On these findings, the patient was diagnosed as the spontaneous osteonecrosis. At that time unicompartmental knee arthroplasty (UKA) was done. Thereafter five years have passed and a revision TKA with bone graft was made because of the loosening of the prosthesis. Though the postoperative course is satisfactory, osteonecrosis developed in the contralateral medial femoral condyle, so that she is receiving a conservative treatment.

Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the femoral neck fractures, the bipolar prosthesis reduces acetabular erosion or central migration, and press-fit stem or cemented stem lowers the incedence of the stem sinking. In thorocanteric fractures, compression hip screws are most commonly used, however, in the cases of unstable fractures with severe osteoporosis, it is difficult to start weight-bearing within a few weeks of surgery because varus deformites or translations at the fracture site sometimes occur. To avoid this disadvantage, the gamma nail has been found to be more effective. In paralysis due to burst fractures of the osteoporotic spine, surgical decompression and spinal instrumentation is the established response. A special orthosis named 'rucksack type orthosis' has been devised and is used for patients who have back pain due to anterior bending posture of the trunk. In distal radius fractures, external fixators are now more frequently used.

An evaluation of the muscular functions of the vastus medialis, vastus lateralis, rectus femoris, medial hamstring, and of the lateral hamstring was performed using electromyography in 33 knees of 26 female patients with osteoarthritis (OA group) and in 25 knees of 19 healthy female volunteers (control group). During standing on both feet, all muscles in the OA group showed higher IEMG (integrated electromyography) and higher LMR (IEMG of vastus lateralis/IEMG of vastus medialis ratio in the quadriceps; and lateral hamstring/medial hamstring ratio in the hamstrings) than the control group. These augmentary muscular activities ameliorated the varus deformity caused by the osteoarthritis. During maximum isometric voluntary contraction, the OA group showed lower extension and flexion torque of the knees and also lower IEMG than to the control group, while the IEMG of vastus lateralis was not lower. These findings indicated decreased muscular activities in the osteoarthritic knee, and that the activity of the quadriceps was maintained mainly by the vastus lateralis under such conditions. Frequency analysis of the myoelectric signal during maximum isometric voluntary contraction revealed a single peak of low frequency in the power spectrum density function of the quadriceps and double peaks of low and of high frequency in the hamstring. In the OA group, the peak height of the low frequency component was increased in the quadriceps and decreased in the hamstring. We concluded that the duration of the motor unit action potentials was affected in the osteoarthritic knee.

To clarify the natural history of osteoarthritis of the knee joint, a field study of the knee joint was performed on the inhabitants of Matsudai Town, Niigata Prefecture in 1979 and 1986. The study included the same 979 individuals, involving 820 women and 159 men, aged between 40 and 65 years in 1986 as in 1979. Narrowing of the femoro-tibial joint space was found in 17.7% and 26.1% of the women, and in 5.3% and 12.0% of the men, in 1979 and 1986, respectively. The individuals without osteoarthritic change and those with subchondral sclerosis or osteophytes in the femoro-tibial joint space exhibited less progressive changes in symptoms and radiographic findings. On the other hand, many of those in whom the joint space was more than 50% narrowed compared with the contralateral joint space had persistent pain, suggesting that they were candidates for active treatment. There were about twice as many women as men with symptomatic osteoarthritis of the knee. A comparative study of a group of women with, and a group of women without, radiographic progression in arthritic changes, indicated that the factors correlated with worsening osteoarthritis of the knee included aging, obesity, varus deformity of the knee, severity of inflammation, and flexion contracture of the knee.