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The purpose of this study was to examine the comparative precision of the augmented reality (AR)-assisted navigation system and the accelerometer-based navigation system in total knee arthroplasty (TKA). We performed noninferiority analysis in a retrospective cohort. The coronal alignment of femoral prosthesis was compared between 109 TKAs performed using the AR-assisted navigation system and 118 TKAs performed using the accelerometer-based navigation system. All femoral prostheses were planned to be positioned perpendicular to the mechanical axis of the femur. The primary outcome was the success rate of coronal alignment of the femoral prosthesis defined as alignment error relative to neutral alignment <3°. We calculated the noninferiority margin as 7%-points using the 95%–95 % method and also confirmed the validity of the noninferiority margin using the fixed margin method. Noninferiority would be shown if the lower boundary of the 95 % confidence interval (CI) for the between-group difference in percentage of the success rate was not less than 0.93 (i.e., 1.00 − 0.07). Treatment success was achieved in 104 of 109 patients (95.4 %) in the AR-assisted navigation group and 110 of 118 (93.2 %) in the accelerometer-based navigation group. The risk ratio of success between the AR-assisted navigation group versus accelerometer-based navigation group was 1.02 (95 % CI, 0.96 to 1.09): the CIs did not include the noninferiority margin of 0.93. The AR-assisted navigation system was noninferior to the accelerometer-based navigation system in terms of coronal alignment of the femoral prosthesis in TKA. [ABSTRACT FROM AUTHOR]

Cosmic rays around the so-called knee in the spectrum at around PeV primary energy are generally galactic in origin. Observations on the form of their energy spectrum and their mass composition are fundamental tools to understand the origin, acceleration and propagation mechanism of high-energy cosmic rays. In addition, it is required to find signatures to clarify the transition from galactic to extragalactic sources, which are believed to be responsible for the highest-energy cosmic rays above EeV. This brief review focuses on recent experimental results around the knee of the all-particle energy spectrum and composition in the energy range of the knee up to EeV energies. [ABSTRACT FROM AUTHOR]

To identify and synthesise the content of knee bracing interventions in randomised controlled trials (RCTs) of knee osteoarthritis (OA). In this scoping review, three electronic databases (PubMed, Web of Science, Cochrane) were searched up to 10th June 2024. Nineteen previous systematic reviews of knee bracing for knee OA and four recent international clinical practice guidelines were also hand searched. Identified studies were screened for eligibility by two independent reviewers. Information on bracing interventions was extracted from included RCT reports, informed by Template for Intervention Description and Replication (TIDieR) guidelines. Data were synthesised narratively. Thirty-one RCTs testing 47 different bracing interventions were included. Braces were broadly grouped as valgus/varus, patellofemoral, sleeve, neutral hinged, or control/placebo knee braces. Brace manufacturer and models varied, as did amount of recommended brace use. Only three interventions specifically targeted brace adherence. Information on brace providers, setting, number of treatment sessions, and intervention modification over time was poorly reported. Adherence to brace use was described for 32 (68%) interventions, most commonly via self-report. Several mechanisms of action for knee braces were proposed, broadly grouped as biomechanical, neuromuscular, and psychological. Many different knee brace interventions have been tested for knee OA, with several proposed mechanisms of action, a lack of focus on adherence, and a lack of full reporting. These issues may be contributing to the heterogeneous findings and inconsistent guideline recommendations about the clinical effectiveness of knee bracing for knee OA to date. [ABSTRACT FROM AUTHOR]

Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (C in) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients. Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year C in (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression. A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year C in for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year C in for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small. The 10-year C in showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA. [ABSTRACT FROM AUTHOR]

• fMRI bilateral motor control task was used to evaluate longitudinal changes in brain activity. • Neuromuscular training induced movement adaptations in MC and HxSRC groups. • MCs demonstrate increased cerebellar activity associated with improved frontal plane ROM. • HxSRCs demonstrate increased somatosensory activity associated with improved frontal plane ROM. Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC. [ABSTRACT FROM AUTHOR]

To detect ultrasonographic findings in the knees of end stage kidney disease (ESKD) patients on regular hemodialysis. Thirty adult ESKD patients on regular hemodialysis for more than one year were studied. Patients with gout, knee joint replacement or injection with steroids were excluded. Knee ultrasonography was done to evaluate the femoral cartilage as regards its thickness, sharpness or urate crystal deposition. This study included 13 male (43.3 %) and 17 females (56.7 %) with mean age 45 ± 12 years, body mass index (BMI) 26.4 ± 5.4 Kg/m2, duration of hemodialysis 1.5–27 years and serum uric acid 3.6 (1–10). Femoral cartilage double contour sign was present in 11 (36.7 %) patients, suprapatellar effusion in 20 (66.7 %), suprapatellar aggregates in 10 (33.3 %), medial patellar effusion in 8 (26.7 %), lateral patellar effusion in 12 (40 %) and lateral patellar aggregate was in 6 (20 %). Serum uric acid (SUA) level tended to correlate with body mass index (BMI), total cholesterol, LDL, fasting blood sugar (FBS), and platelet counts without significance and negatively correlated to age, hemoglobin (Hb) level, total leucocytic count (TLC), size of suprapatellar effusion and duration of hemodialysis. Effusion, urate crystal deposition, double contour and aggregate were frequently observed in knee ultrasound in ESRD patients on hemodialysis. Both double contour and aggregates were the most common combined ultrasound finding. The ultrasonographic findings were not related to the duration of hemodialysis or uric acid level. [ABSTRACT FROM AUTHOR]

In the knee, synovial fibrosis after ligamentous injury is linked to progressive joint pain and stiffness. The objective of this study was to evaluate changes in synovial architecture, mechanical properties, and transcriptional profiles following naturally occurring cruciate ligament injury in canines and to test potential therapeutics that target drivers of synovial inflammation and fibrosis. Synovia from canines with spontaneous cruciate ligament tears and from healthy knees were assessed via histology (n = 10/group) and micromechanical testing (n = 5/group) to identify changes in tissue architecture and stiffness. Additional samples (n = 5/group) were subjected to RNA-sequencing to define the transcriptional response to injury. Finally, synovial tissue samples from injured animals (n = 6 (IL1) or n = 8 (IL6)/group) were assessed in vitro for response to therapeutic molecules directed against interleukin (IL) signaling (IL1 or IL6). Cruciate injury resulted in increased synovial fibrosis, vascularity, inflammatory cell infiltration, and intimal hyperplasia. Additionally, the stiffness of both the intima and subintima regions were higher in diseased compared to healthy tissue. Differential gene expression analysis showed that diseased synovium had an upregulation of immune response and cell adhesion pathways and a downregulation of Rho protein transduction pathways. In vitro application of small molecule therapeutics targeting IL1 (anakinra) or IL6 (tocilizumab) dampened expression of inflammatory and matrix deposition mediators. Spontaneous cruciate ligament injury in canines is associated with synovial inflammation and fibrosis in a relevant model for testing emerging intra-articular treatments. Small molecule therapeutics targeting IL pathways may be ideal interventions for delivery to the joint space after injury. [ABSTRACT FROM AUTHOR]

To investigate relationships between static foot posture, dynamic plantar foot forces and knee pain in people with medial knee osteoarthritis (OA). Data from 164 participants with symptomatic, moderate to severe radiographic medial knee OA were analysed. Knee pain was self-reported using a numerical rating scale (NRS; scores 0–10; higher scores worse) and the Knee Injury and Osteoarthritis Outcome Score pain subscale (KOOS; scores 0–100; lower scores worse). Static foot posture was assessed using clinical tests (foot posture index, foot mobility magnitude, navicular drop). Dynamic plantar foot forces (lateral, medial, whole foot, medial-lateral ratio, arch index) were measured using an in-shoe plantar pressure system while walking. Relationships between foot posture and plantar forces (independent variables) and pain (dependent variables) were evaluated using linear regression models, unadjusted and adjusted for sex, walking speed, Kellgren & Lawrence grade, shoe category, and body mass (for dynamic plantar foot forces). No measure of static foot posture was associated with any knee pain measure. Higher medial-lateral foot force ratio at midstance, and a higher arch index during overall stance, were weakly associated with higher knee pain on the NRS (regression coefficient = 0.69, 95% confidence interval (CI) 0.09 to 1.28) and KOOS (coefficient=3.03, 95% CI 0.71 to 5.35) pain scales, respectively. Dynamic plantar foot forces, but not static foot posture, were associated with knee pain in people with medial knee OA. However, the amount of pain explained by increases in plantar foot force was small; thus, these associations are unlikely to be clinically meaningful. [ABSTRACT FROM AUTHOR]

Low-dose aspirin is an effective venous thromboembolism (VTE) prophylactic medication in primary total joint arthroplasty, but the efficacy and safety of the formulations of chewable and enteric-coated aspirin have not been compared. The purpose of this study was to investigate the VTE and gastrointestinal (GI) complication rates of chewable and enteric-coated 81 mg aspirin bis in die for VTE prophylaxis in primary total joint arthroplasty. A retrospective, single-institution cohort study was performed on patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2017 to 2021. Comparisons were made between 4,844 patients who received chewable, noncoated aspirin 81 mg and 4,388 patients who received enteric-coated 81 mg aspirin. Power analysis demonstrated 1,978 and 3,686 patients were needed per group to achieve a power of 80% for 90-day VTE rates (using inferiority testing) and GI complications (using superiority testing), respectively. Patients had similar baseline characteristics. Statistical analyses were done using t -tests and Chi- squared tests, with statistical significance defined as a P value <.05. There were no significant differences in the incidences of postoperative VTE (0.31% versus 0.55%; P =.111) or GI complications (0.14% versus 0.14%; P = 1.000) between patients who received either chewable or enteric-coated 81 mg aspirin bis in die in the overall comparison that included both THA and TKA patients combined, or THA patients alone. However, the VTE incidence for TKA patients alone was significantly lower with chewable than enteric-coated aspirin (0.22% versus 0.62%; P =.037), with no difference in GI complications (0.13% versus 0.19%; P =.277). Low-dose aspirin in enteric-coated formulation is inferior to chewable aspirin for VTE prophylaxis in primary TKA, but not inferior in THA patients. Both formulations have a similar GI complication rate. Therefore, it is reasonable to consider a transition from enteric-coated to uncoated chewable low-dose aspirin. [ABSTRACT FROM AUTHOR]

Deep cascaded networks have been extensively studied and applied to accelerate Magnetic Resonance Imaging (MRI) and have shown promising results. Most existing works employ a large cascading number for the sake of superior performances. However, due to the lack of proper guidance, the reconstruction performance can easily reach a plateau and even face degradation if simply increasing the cascading number. In this paper, we aim to boost the reconstruction performance from a novel perspective by proposing a parallel architecture called DIRECTION that fully exploits the guiding value of the reconstruction residual of each subnetwork. Specifically, we introduce a novel Reconstruction Residual-Based Feature Modulation Mechanism (RRFMM) which utilizes the reconstruction residual of the previous subnetwork to guide the next subnetwork at the feature level. To achieve this, a Residual Attention Modulation Block (RAMB) is proposed to generate attention maps using multi-scale residual features to modulate the image features of the corresponding scales. Equipped with this strategy, each subnetwork within the cascaded network possesses its unique optimization objective and emphasis rather than blindly updating its parameters. To further boost the performance, we introduce the Cross-Stage Feature Reuse Connection (CSFRC) and the Reconstruction Dense Connection (RDC), which can reduce information loss and enhance representative ability. We conduct sufficient experiments and evaluate our method on the fastMRI knee dataset using multiple subsampling masks. Comprehensive experimental results show that our method can markedly boost the performance of cascaded networks and significantly outperforms other compared state-of-the-art methods quantitatively and qualitatively. [ABSTRACT FROM AUTHOR]

To explore the relationship between knee crepitus, quadriceps muscle thickness and isometric strength in individuals with patellofemoral pain (PFP). Cross-sectional. Individuals with PFP. Participants with PFP underwent assessments for presence, frequency and severity of knee crepitus. Real-time ultrasound images of the quadriceps muscles (rectus femoris, vastus medialis and lateralis) at rest and during contraction were obtained, muscle thickness was measured in both conditions. Maximal voluntary isometric contraction tests were performed to measure knee extensor strength. The relationship between knee crepitus and quadriceps muscle thickness and knee extensor strength was explored using logistic and linear regressions. Sixty individuals with PFP were included (age: 24; 60% women; 38% with crepitus). Knee crepitus severity was related to rectus femoris and vastus medialis thickness during rest (R2 = 0.19 and 0.09, respectively) and contraction (R2 = 0.16 and 0.07, respectively) and with vastus lateralis during contraction (R2 = 0.08). Isometric knee extensor strength was not related to knee crepitus presence, frequency, or severity. Higher severity of knee crepitus is related to lower quadriceps muscle thickness in individuals with PFP. There is no relationship between the presence and frequency of knee crepitus with quadriceps muscle thickness or knee extensor strength. • Knee crepitus severity is related to quadriceps muscle thickness in individuals with patellofemoral pain. • Knee crepitus presence and frequency are not related to quadriceps muscle thickness in individuals with patellofemoral pain. • Knee crepitus is not related to knee extensor muscle torque in individuals with patellofemoral pain. [ABSTRACT FROM AUTHOR]

To determine whether clinical screening tests can predict lower limb joint kinematics and kinetics outcomes eliciting anterior cruciate ligament (ACL) injury risk in single-leg landings. Cross-sectional study. Laboratory research. Twenty-six professional male futsal athletes. Participants completed the Modified Star Excursion Balance Test (mSEBT), Lateral Step Down (LSD), Lunge, Hop tests, and isometric strength tests for clinical screening of lower extremity injury risk and performed single-leg landings to assess lower extremity 3D kinematics and kinetics outcomes. mSEBT, LSD, and isometric strength were the more important tests when constructing the prediction models. The predictive power of clinical tests for screening injury risk significantly increases when combined with strength measurements (p = 0.005, f2 = 0.595). We discerned 11 biomechanical predictions, six explicitly related to the sagittal plane's biomechanics. Some predictions were leg-dependent, with muscle strength tests predominantly predicting biomechanical outcomes of the preferred leg. Combining clinical screening tests with strength measures enhances ACL injury risk factors prediction during single-leg landings. Clustering at least two tests improves prediction accuracy, aiding injury prevention planning and decision-making. • Clinical and strength tests predict frontal and sagittal plane biomechanics in single-leg landing. • A single clinical test poorly predicts injury risk, but combining tests enhances predictions. • Clustering strength and clinical tests improve single-leg landing biomechanics predictions. • Knee strength outcomes strongly predict impact forces. [ABSTRACT FROM AUTHOR]

To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes. Data were from the 2013–2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race. In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m2) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals. Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses. [ABSTRACT FROM AUTHOR]

To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability. Secondary analysis of randomized clinical trial data. A tertiary teaching hospital. Patients undergoing TKA (N=114). Not applicable. The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates. The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker–Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower). The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA. [ABSTRACT FROM AUTHOR]

To investigate whether duration of knee symptoms influenced the magnitude of the effect of exercise therapy compared to non-exercise control interventions on pain and physical function in people with knee osteoarthritis (OA). We undertook an individual participant data (IPD) meta-analysis utilising IPD stored within the OA Trial Bank from randomised controlled trials (RCTs) comparing exercise to non-exercise control interventions among people with knee OA. IPD from RCTs were analysed to determine the treatment effect by considering both study-level and individual-level covariates in the multilevel regression model. To estimate the interaction effect (i.e., treatment x duration of symptoms (dichotomised)), on self-reported pain or physical function (standardised to 0–100 scale), a one-stage multilevel regression model was applied. We included IPD from 1767 participants with knee OA from 10 RCTs. Significant interaction effects between the study arm and symptom duration (≤1 year vs >1 year, and ≤2 years vs>2 years) were found for short- (∼3 months) (Mean Difference (MD) −3.57, 95%CI −6.76 to −0.38 and −4.12, 95% CI-6.58 to −1.66, respectively) and long-term (∼12 months) pain outcomes (MD −8.33, 95%CI −12.51 to −4.15 and −8.00, 95%CI −11.21 to −4.80, respectively), and long-term function outcomes (MD −5.46, 95%CI −9.22 to −1.70 and −4.56 95%CI −7.33 to-1.80, respectively). This IPD meta-analysis demonstrated that people with a relatively short symptom duration benefit more from therapeutic exercise than those with a longer symptom duration. Therefore, there seems to be a window of opportunity to target therapeutic exercise in knee OA. [ABSTRACT FROM AUTHOR]

Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States. Thus, this study assessed the current and projected future trends of UKA and robotic UKA in the United States through 2035, along with postoperative outcomes. A collaborative healthcare research network was queried to identify patients who had undergone UKA. Primary outcomes measured included prevalence (P), incidence proportion (IP), and incidence rate (IR) from 2012 to 2022. Chi -squared analyses were done to compare outcomes across categorical data. Regression modeling was performed to project UKA to the year 2035. Statistical significance was held at P <.05 for all analyses. In 2022, 1,662 UKAs were performed within the network, a 590% increase from 2012 (241 performed). The IP increased on an average annual basis by 41.8%, the IR by 50%, and the P by 51.3%. A year following UKA, conversion to TKA was the most common orthopaedic complication (39.9%). As of 2022, there were 68 robotic UKAs performed, a 518% increase from the 11 performed in 2012. Regression analysis for UKA through 2035 showed that IP will be 0.04%, IR will be 1.75 × 10−6 cases/person-day, and P will be 0.3%. These findings are consistent with prior studies indicating a higher utilization of UKA over the past decade. Reported complications were not uncommon, as nearly 40% of patients required a conversion to a TKA. Further research is needed to optimally identify criteria for appropriate patients and determine the benefits robotic UKA may provide, specifically reducing the risk of conversion to a TKA. [ABSTRACT FROM AUTHOR]

Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes. This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score. A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the "daily living": 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P <.05) and "Quality of life" Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P <.05). This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA. III, Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

There is an unambiguous sex disparity in the field of orthopaedic surgery, with women making up only 7.4% of practicing orthopaedic surgeons in 2022. This study seeks to evaluate the sex distribution among orthopaedic surgeons engaged in primary total knee arthroplasty (TKA) between 2013 and 2020, as well as the procedural volume attributed to each provider. We retrospectively queried the Medicare dataset to quantify all physicians reporting orthopaedic surgery as their specialty and performing primary TKA from 2013 to 2020. Healthcare Common Procedure Coding System codes for primary TKA procedures were used to extract associated utilization and billing provider information. Trend analyses were performed with 2-sided correlated Mann-Kendall tests to evaluate trends in the number of surgeons by sex and the women-to-men surgeon ratio. During the study period, 6,198 to 7,189 surgeons billed for primary TKA. Of this number, an average of 2% were women. The mean number of procedures billed for by men was 39.02/y (standard deviation: 34.54), and by women was 28.76/y (standard deviation: 20.62) (P <.001). There was no significant trend in the number of men or women surgeons who billed for primary TKA during the study period. Trend analysis of the women-to-men ratio demonstrated an increasing trend of statistical significance (P =.0187). There was a significant upward trend in the women-to-men ratio of surgeons who billed for primary TKA. However, there remains a colossal gender gap, as women only made up 2.4% of surgeons who billed for the procedure. The current study raises awareness of the notable discrepancy in the average number of TKAs performed by women as compared to men. The orthopaedic community should aim to determine ways to increase the number of women arthroplasty surgeons along with the opportunities that women have to perform TKAs. [ABSTRACT FROM AUTHOR]

In 2011, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). The purpose of our study was to examine (1) incidences of postoperative complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion rates; (2) trends from 2016 to 2021 in VTE prophylaxis; and (3) independent risk factors for 90-day total complications following TKA between aspirin, enoxaparin, rivaroxaban, and warfarin. Using a national, all-payer database from 2016 to 2021, we identified all patients who underwent primary TKA. Exclusions included all patients who had prescribed anticoagulants within 1 year prior to TKA, hypercoagulable states, and cancer. Data were collected on baseline demographics, including age, sex, diabetes, and a comorbidity index, in each of the VTE prophylaxis cohorts. Postoperative outcomes included rates of PE, DVT, and transfusion. Multivariable regressions were performed to determine independent risk factors for total complications at 90 days following TKA. From 2016 to 2021, aspirin was the most used anticoagulant (n = 62,054), followed by rivaroxaban (n = 26,426), enoxaparin (n = 20,980), and warfarin (n = 13,305). The cohort using warfarin had the highest incidences of PE (1.8%) and DVT (5.7%), while the cohort using aspirin had the lowest incidences of PE (0.6%) and DVT (1.6%). The rates of aspirin use increased the most from 2016 to 2021 (32.1% to 70.8%), while the rates of warfarin decreased the most (19.3% to 3.0%). Enoxaparin, rivaroxaban, and warfarin were independent risk factors for total complications at 90 days. An epidemiological analysis of VTE prophylaxis use from 2016 to 2021 shows an increase in aspirin following TKA compared to other anticoagulant cohorts in a nationally representative population. This approach provides more insight and a better understanding of anticoagulation trends over this time period in a nationally representative sample. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the stress and strain changes of the anterior cruciate ligament (ACL) at different knee flexion angles using a three-dimensional finite element model. Computed tomography and magnetic resonance imaging scans were performed on the right knee of 30 healthy adult volunteers. The imaging data were used to construct a three-dimensional finite element model of the knee joint. The magnitude and concentration area of stress and strain of ACL at knee flexion angles 0°, 30°, 60° and 90° were assessed. The magnitude of stress remained consistent at 0–30° (P > 0.999) and decreased at 30–90° (P < 0.001, P = 0.005, respectively), while the magnitude of strain increased between 0° and 30° (P = 0.004) and decreased between 30° and 90° (P < 0.001, P = 0.004, respectively). The stress concentration area remained consistent at the proximal end, midsubstance, and distal end between 0° and 60° (P > 0.05). The concentration area of strain increased at the proximal end, decreased at the midsubstance between 0° and 30°, and remained consistent between 30° and 90° (P < 0.001). At the low knee flexion angle, ACL's magnitude of stress and strain reached the peak, and the concentration area of ACL strain gradually shifted from midsubstance to the proximal end. [ABSTRACT FROM AUTHOR]

We aimed to investigate the relationship between quantitative evaluation by compositional MRI, including T1ρ, and histological and macroscopic assessments, to verify the validity of compositional MRI, and examine the relationship between compositional MRI evaluation reconstructed in three dimensions (3D) and histological and visual assessments. Twenty-seven patients with knee osteoarthritis underwent T1ρ and T2 magnetic resonance imaging (MRI). Histological and gross tissue evaluations were performed on the excised bone sections of total knee arthroplasty. Semi-quantitative histological evaluation of tissue changes were assessed by measuring the optical density of digitally captured safranin O-stained and Collagen type II antibody-stained paraffin sections. Macroscopic cartilage severity was determined on a 5-grade scale (G0–G5). T1ρ and T2 values (3D and 2D), and their correlation with each of these parameters were investigated. 3D T1 ρ is negatively correlated with histological evaluations and positively correlated with visual assessments. Only 3D T1ρ values correlated with histological quantitative evaluation (Safranin-O staining; r = −0.53, P = 0.014, Collagen type II antibody staining; r = −0.60, P = 0.019). 2D T1ρ and 3D, 2D T2 values did not correlate with histological evaluation results. Macroscopic cartilage severity grade correlated with all T1ρ and T2 values (3D T1ρ; r = 0.61, P < 0.001, 2D T1ρ; r = 0.52, P < 0.001, 3D T2; r = 0.33, P = 0.045, 2D T2; r = 0.41, P = 0.01). 3D T1ρ mapping reflects the changes in the molecular structure of the cartilage matrix that occur in arthropathic changes and may be an effective tool for detecting cartilage degeneration. • Radiography cannot effectively quantify cartilage degeneration. • It cannot also assess the degree of degenerative changes in the cartilage in situ in early knee OA. • We aimed to histologically validate 3D T1ρ mapping for these purposes. • 3D T1ρ values were negatively correlated with pathological staining levels. • This is the first study to histologically assess the validity of 3D compositional MRI evaluation. [ABSTRACT FROM AUTHOR]

To explore the ability of three-dimensional texture analyses based on gray-level run-length matrix (GLRLM) for examining the spatial distribution of pixel values on magnetic resonance imaging (MRI) relaxation time maps and detecting the compositional variation of cartilage repair following treatment with allogeneic human adipose-derived mesenchymal progenitor cells (haMPCs). Participants with knee osteoarthritis were randomly divided into three groups with intra-articular haMPCs injections: low-, medium-, and high-dose groups. We analyzed five GLRLM parameters in the T1rho, T2 and T2star maps, including run length non-uniformity (RLNonUni), gray-level non-uniformity (GLevNonU), long run emphasis (LngREmph), short run emphasis (ShrtREmp), and fraction of images in runs. We used the relative D values (the ratio of difference values to baseline) as the objective to avoid errors caused by individual differences. We calculated the two-tailed Pearson's linear correlation coefficient (r) to investigate the correlations of the texture parameters with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Compared with the base time, significant reduction of WOMAC score was observed in both high and medium doses groups at terminal time, indicating relief of pain symptoms in high and medium groups with the treatment of allogeneic haMPCs. Significant differences were observed in the GLRLM parameters of cartilage MR relaxation time maps in different doses groups. In both T1rho and T2 relaxation time maps, the high-dose group showed significant increases in relative D values of RLNonUni, GLevNonU, LngREmph and ShrtREmp, which indicated significant changes in the uniformity of relaxation time maps. For T2star map, GLRLM parameters such as GLevNonU and ShrtREmp, especially LngREmph, showed significant increases in relative D values in high-dose group. Among all GLRLM features, LngREmph of three relaxation time maps had performed excellent linear correlations with WOMAC scores. Texture analysis of the cartilage may allow the detection of compositional variation in cartilage repair with the treatment of allogeneic haMPCs. This technique displays potential applications in understanding the mechanism of stem cell repair of the cartilage and assessing the treatment response. [ABSTRACT FROM AUTHOR]

Measurement of success following anterior cruciate ligament reconstruction (ACLR) hinges on the appropriate use of high quality and meaningful outcome measures. We identified and categorized over 100 outcome measures for ACLR using the International Classification of Functioning, Disability and Health (ICF) model. The ICF model is a useful framework to facilitate decisions about outcome selection and describe recovery following ACL injury. We outline key considerations when selecting outcome measures during study design (purpose, measurement properties, sample size, global assessment) or evaluating reported outcomes (measurement properties, sample size, magnitude/precision, clinical relevance, applicability), and discuss challenges in outcome measurement following ACLR. [ABSTRACT FROM AUTHOR]

The rise of periprosthetic joint infections (PJIs) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed the direct health care costs of PJI for total hip arthroplasty and total knee arthroplasty (TKA) in Europe. The databases PubMed, Scopus, Embase, Cochrane, and Google Scholar were systematically screened for direct costs of PJI in Europe. Publications that defined the joint site and the procedure performed were further analyzed. Mean direct health care costs were calculated for debridement, antibiotics, and implant retention (DAIR), one-stage, and 2-stage revisions for hip and knee PJI, respectively. Costs were adjusted for inflation rates and reported in US-Dollar (USD). Of 1,374 eligible publications, 12 manuscripts were included in the final analysis after an abstract and full-text review. Mean direct costs of $32,933 were identified for all types of revision procedures for knee PJI. The mean direct treatment cost including DAIR for TKA after PJI was $19,476. For 2-stage revisions of TKA, the mean total cost was $37,980. For all types of hip PJI procedures, mean direct hospital costs were $28,904. For hip DAIR, one-stage and 2-stage treatment average costs of $7,120, $44,594, and $42,166 were identified, respectively. Periprosthetic joint infections are associated with substantial direct health care costs. As detailed reports on the cost of PJI are scarce and of limited quality, more detailed financial data on the cost of PJI treatment are urgently required. [ABSTRACT FROM AUTHOR]

Polymyositis (PM) is a systemic connective tissue disorder that can lead to early onset degenerative joint disease and a need for total knee arthroplasty (TKA). Outcomes of TKA in patients who have PM are not well documented in the literature. The purpose of this study was to evaluate PM as a risk factor for complications after TKA. Using a national private payer insurance database from 2010 to 2022, PM patients undergoing primary TKA were compared to 10:1 matched controls based on age, sex, and comorbidities. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. 90-day emergency department visits and inpatient readmissions were also documented. A total of 25,039 patients undergoing primary TKA were queried, of which 2,290 had PM. Compared to the matched controls, patients who had PM demonstrated higher rates of medical and surgical complications, including pulmonary embolism (1.0% versus 0.5%, P =.001), cerebrovascular accident (1.3% versus 0.7%, P =.002), wound complications (3.4% versus 2.1%, P <.001), and periprosthetic joint infection at 1 year (1.7% versus 1.3%, P =.042) and 2 years (2.6% versus 1.9%, P =.006). Patients who had PM displayed elevated 90-day emergency department (14.9% versus 13.3%, P =.032) and hospital readmission rate (7.1% versus 4.8%, P <.001). Patients who have PM are at higher risks of postoperative medical and surgical complications, including pulmonary embolism, cerebrovascular accident, wound complication, and periprosthetic joint infection. Given these results, it is helpful for orthopedic surgeons and patients to consider these risks when considering TKA for patients who have PM. [ABSTRACT FROM AUTHOR]

Patellofemoral Pain (PFP) is a common dysfunction that can compromise the performance of daily activities. Neuromuscular electrical stimulation (NMES) has been proposed as a complementary tool in the therapeutic approach. To analyze the effects of adding NMES to therapeutic exercises in women with PFP. Randomized controlled trial involving 34 women with PFP (mean age 23.8 ± 4.1), randomly assigned to two groups: exercises combined with NMES (ESG) and exercises only (ExG). The ExG followed an exercise protocol, while the ESG performed the same exercises combined with NMES. Interventions were performed twice a week for eight weeks. Primary outcome measures included pain and functional disability, while secondary outcomes encompassed electromyographic activity of the quadriceps and hip abductors, along with isokinetic performance. Assessments were performed before the intervention, after 4 and 8 weeks from the start of the protocol and 8 weeks after the conclusion of the treatment. We did not observe difference between the groups in any of the analyzed variables. Both groups showed a reduction in pain and an improvement in functional disability during intragroup comparisons. A reduction in pain and an improvement in functional disability were observed; however, there was no additional effect of NMES. NCT03918863. • Exercises are effective in reducing pain and improving function. • Effects remain eight weeks after treatment ends. • Addition of NMES does not increase the effects of exercises. [ABSTRACT FROM AUTHOR]

Knee joint injuries may result from compromised quadriceps muscle strength or diminished knee joint proprioception. The application of Kinesio tape (KT) on the quadriceps muscle from origin to insertion (OTI-KT) or insertion to origin (ITO-KT) could impact knee joint proprioception and quadriceps muscle strength. This study aims to assess the effects of different tensions and directions of KT application on active and passive knee joint repositioning errors (AJRE and PJRE) and peak concentric and eccentric peak torque (CPT and EPT) of the quadriceps muscles in healthy males. Twenty-one healthy males participated in this repeated-measures study design. CPT, EPT, AJRE, and PJRE of the dominant limb were measured by a Biodex dynamometer before and after applying OTI-KT with 0%, 15%, and 40% extra tensions and ITO-KT with 0% tension. ITO-KT demonstrated a significant reduction in AJRE (p < 0.05). Meanwhile, for OTI-KT, a statistically significant difference was observed in both AJRE and PJRE concerning time (F1,126 = 19.74, p < 0.05 for AJRE; F1,126 = 9.96, p < 0.05 for PJRE) and tension (F2,126 = 22.14, p < 0.05 for AJRE; F2,126 = 20.67, p < 0.05 for PJRE). Applying KT, especially OTI KT with 40% and 15% extra tension, shows potential in enhancing knee proprioception without immediate impacts on quadriceps muscle torque. This suggests applications in sports performance and knee injury rehabilitation. [ABSTRACT FROM AUTHOR]

Lameness and leg injuries are both painful and prevalent across the dairy industry, and are a major welfare concern. There has been a considerable amount of research focused on investigating the risk factors associated with lameness and injuries and how they might be prevented and treated. The objectives of this narrative review were to summarize herd-level prevalence estimates, risk factors, strategies for prevention, control, and treatment of these conditions, and the barriers to best practice adoption for lameness and injuries on dairy farms. There is a relatively high within-herd prevalence of lameness on dairy farms globally, with a recent systematic review estimating the mean prevalence at 22.8%. Similarly, there is a relatively high prevalence of hock injuries, with within-herd estimates ranging from 12% to 81% of cows affected. Knee and neck injuries have been reported to be less common, with 6% to 43% and 1% to 33%, respectively. Numerous risk factors have been associated with the incidence of lameness, notably housing (e.g., access to pasture, bedding depth, bedding type, flooring type, stall design), management (e.g., stall cleanliness, frequency of trimming, holding times, stocking density), and cow-level (e.g., body condition, parity, injured hocks) factors. Risk factors associated with hock injuries can be similarly classified into housing (e.g., bedding type and depth, outdoor access, parlor type, stall design), management (e.g., bedding depth, cleanliness), and cow (e.g., parity, days in milk, lameness) factors. Key preventative approaches for lameness include routine preventative and corrective hoof trimming, improving hoof cushioning and traction through access to pasture or adding rubber flooring, deep-bedded stalls, sand bedding, ensuring appropriate stocking densities, reduced holding times, and the frequent use of routine footbaths. Very little research has been conducted on hock, knee, and neck injury prevention and recovery. Numerous researchers have concluded that both extrinsic (e.g., time, money, space) and intrinsic (e.g., farmer attitude, perception, priorities, and mindset) barriers exist to addressing lameness and injuries on dairy farms. There are many diverse stakeholders in lameness and injury management including the farmer, farm staff, veterinarian, hoof trimmer, nutritionist, and other advisors. Addressing dairy cattle lameness and injuries must, therefore, consider the people involved, as it is these people who are influencing and implementing on-farm decisions related to lameness prevention, treatment, and control. [ABSTRACT FROM AUTHOR]

To evaluate whether deep learning reconstruction (DLR) can accelerate the acquisition of magnetic resonance imaging (MRI) sequences of the knee for clinical use. Using a 1.5-T MRI scanner, sagittal fat-suppressed T2-weighted imaging (fs-T2WI), coronal proton density-weighted imaging (PDWI), and coronal T1-weighted imaging (T1WI) were performed. DLR was applied to images with a number of signal averages (NSA) of 1 to obtain 1DLR images. Then 1NSA, 1DLR, and 4NSA images were compared subjectively, and by noise (standard deviation of intra-articular water or medial meniscus) and contrast-to-noise ratio between two anatomical structures or between an anatomical structure and intra-articular water. Twenty-seven healthy volunteers (age: 40.6 ± 11.9 years) were enrolled. Three 1DLR image sequences were obtained within 200 s (approximately 12 minutes for 4NSA image). According to objective evaluations, PDWI 1DLR images showed the smallest noise and significantly higher contrast than 1NSA and 4NSA images. For fs-T2WI, smaller noise and higher contrast were observed in the order of 4NSA, 1DLR, and 1NSA images. According to the subjective analysis, structure visibility, image noise, and overall image quality were significantly better for PDWI 1DLR than 1NSA images; moreover, the visibility of the meniscus and bone, image noise, and overall image quality were significantly better for 1DLR than 4NSA images. Fs-T2WI and T1WI 1DLR images showed no difference between 1DLR and 4NSA images. Compared to PDWI 4NSA images, PDWI 1DLR images were of higher quality, while the quality of fs-T2WI and T1WI 1DLR images was similar to that of 4NSA images. • DLR can reduce image noise and improve the image quality of knee MRI. • For the PDWI, 1DLR images showed higher quality compared to 4NSA images. • 1DLR images and 4NSA images showed similar image quality for fs-T2WI and T1WI. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a devastating complication. Intrawound vancomycin powder has been shown to reduce infection rates in spine surgery, but its role in arthroplasty remains controversial. This prospective randomized control trial aimed to evaluate the efficacy of intrawound vancomycin in preventing PJI after primary TKA. A total of 1,022 patients were randomized to the study group (n = 507, who received 2 grams intrawound vancomycin powder before arthrotomy closure) or to the control group (n = 515, no local vancomycin) with a minimum follow-up of 12-months. The primary outcome was the incidence of PJI or surgical site infection (SSI). Secondary outcomes included associated minor complications such as stitch abscess, persistent wound drainage, and delayed stitch removal. Other parameters evaluated include reoperation rates and incidences of nephrotoxicity. The overall infection rate in 1,022 patients was 0.66%. There was no significant difference in PJI rate in the study group (N = 1; 0.2%) versus the control group (N = 3; 0.58%), P =.264. Reoperation rates in the study group (N = 4; 0.78%) and control (N = 5; 0.97%), and SSI rates in the study (N = 1; 0.2%) and control groups (N = 2; 0.38%) were comparable. The Vancomycin cohort, however, demonstrated a significantly higher number of minor wound complications (n = 67; 13.2%) compared to the control group (n = 39; 7.56%, P <.05). Subgroup analysis showed diabetics in the study group to also have a higher incidence of minor wound complications (24 [14.1%] versus 10 [6.2%]; P < 05]. Multivariate analyses found that vancomycin use (odds ratio = 1.64) and smoking (odds ratio = 1.85) were associated with an increased risk of developing minor wound complications. No cases of nephrotoxicity were reported. Intrawound vancomycin powder does not appear to reduce PJI/SSI rate in primary total knee arthroplasties, including high-risk groups. Although safe from a renal perspective, intrawound vancomycin was associated with an increase in postoperative aseptic wound complications. Intrawound vancomycin may not be effective in reducing the rate of PJI in primary TKA. [ABSTRACT FROM AUTHOR]

Exercise is universally recommended as a primary strategy for the management of knee osteoarthritis (OA) pain. The recommendations are based on results from more than 100 randomized controlled trials (RCTs) that compare exercise to no-attention control groups. However, due to the inherent difficulties with adequate placebo control, participant blinding and the use of patient-reported outcomes, the existing RCT evidence is imperfect. To better understand the evidence used to support a causal relationship between exercise and knee OA pain relief, we examined the existing evidence through the Bradford Hill considerations for causation. The Bradford Hill considerations, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework for assessment of possible causal relationships. There are 9 considerations by which the evidence is reviewed: Strength of association, Consistency, Specificity, Temporality, Biological Gradient (Dose-Response), Plausibility, Coherence, Experiment, and Analogy. Viewing the evidence from these 9 viewpoints did neither bring forward indisputable evidence for nor against the causal relationship between exercise and improved knee OA pain. Rather, we conclude that the current evidence is not sufficient to support claims about (lack of) causality. With our review, we hope to advance the continued global conversation about how to improve the evidence-based management of patients with knee OA. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB)is endemic in various parts of the world and health-care practitioners should have high-end suspicion of TB knee in various cases of monoarthritis of the knee with atypical findings. We present a case of monoarthritis knee with an initial diagnosis being septic arthritis, with TB- cartridge-based nucleic acid amplification test negative for aspirated synovial fluid; followed by radiographic findings and synovial biopsy positive for chronic nonspecific inflammation with giant cells suggestive of TB, hence diagnosed as TB. • Painful swollen knee, with or without symptoms like fever, night sweats, weight loss. • TB knee diagnosis is complex, hindered by antibiotics, atypical presentations, and awareness gaps. • TB knee diagnosis relies on radiographs, fluid, nucleic acid tests, histopathology. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a critical complication after non-major trauma or surgery. While the risk and severity of VTE following major orthopedic surgery is well-documented, there is significant knowledge gap regarding, non-major trauma such as ankle sprains. We analyzed data from the RIETE registry to assess the clinical characteristics, VTE prophylaxis usage, and outcomes in patients with VTE following ankle sprain versus those post elective knee arthroplasty. We aimed to assess the risk and severity of VTE in a population traditionally considered at lower risk. Risk stratification was performed using the TRiP(cast) score. Among 1,250 patients with VTE, those with ankle sprain (n = 459) were much younger than those post knee arthroplasty (n = 791), less often female, had fewer comorbidities, and received VTE prophylaxis less often (27% vs. 93 %). During anticoagulation, 26 patients developed recurrent VTE, 31 had major bleeding, and 12 died (fatal PE 3, fatal bleeding 2). There were no differences between the two groups in the rates of VTE recurrences (rate ratio (RR): 1.65; 95%CI: 0.69–3.88) or death (RR: 1.12; 95%CI: 0.33–3.46), but patients with VTE after ankle sprain had a lower rate of major bleeding (RR: 0.39; 95%CI: 0.13-0.99). Ankle sprain patients are often undertreated for VTE prophylaxis and have similar severity of VTE than those undergoing elective knee surgery, indicating the need for a more customized approach to VTE management. • Patients with ankle sprains were less likely to receive VTE prophylaxis than those who had undergone knee arthroplasty. • Patients with VTE after ankle sprain exhibited a similar severity than those with VTE after knee arthoplasty. • Standard risk prediction models for non-severe lower limb trauma may not capture all individuals at risk. [ABSTRACT FROM AUTHOR]

Accurate assessment of knee extension angle relative to sagittal mechanical axis (SMA) during TKA is usually obtained by computer navigation. Whether the lines along anterior cortex of distal femur and proximal tibia in short-knee imaging are accurate in determining knee extension angle has not been investigated. A prospective study was conducted on 106 patients (116 knees) who underwent primary TKA. After complete anesthetization, the leg was elevated 30° and short-knee lateral fluoroscopy was performed. The angles between the anterior cortical line (ACL), and between the mid-shaft line (MSL) of the femur and tibia, were measured. After surgical exposure and bony registration into OrthoPilot navigation system, the leg was elevated again and degree of knee extension was recorded. The angles determined using three methods were compared. The mean extension angle observed by OrthoPilot (5.0° ± 6.8°, range −8°–25°) was not different from ACL method (5.3° ± 7.0°, range −8.1°–24.3°) (p = 0.811), but higher than MSL method (1.7° ± 7.1°, range −13.2°–18.1°) (p < 0.001). The mean absolute difference of ACL method from OrthoPilot was 0.2° ± 1.8° (range 0.0°–5.0°; 95%CI 0.0°–2.0°), and MSL method from OrthoPilot was 3.2° ± 2.6° (range 0.1°–8.2°; 95%CI 2.7°–3.7°). Measurement differences within 2° were found in 83.6% (97/116) and 37.9% (44/116) in the ACL and MSL method respectively (p < 0.001). ACL of femur and tibia in a short-knee imaging is more accurate than MSL for determining knee extension angle relative to SMA. ACL can be assessed intraoperatively as the anterior cutting surface of distal femur after bone cut during TKA and the palpable anterior tibial crest. This ACL measurement in a pre- or postoperative radiograph provides the minimal detectable change of 3.5° and helpful in clinical research that requires high precision measurement. [ABSTRACT FROM AUTHOR]

The article explores the spread of ultrasound-guided injectate from the adductor canal to the genicular branch of the posterior obturator nerve and the popliteal plexus. Topics include cadaveric study and the predictive value of genicular nerve blocks for cooled radiofrequency ablation outcomes in chronic knee pain due to osteoarthritis.

In the literature, there is no evidence suggesting the superiority in clinical performance between all-polyethylene (AP) and metal-backed (MB) tibial implants in total knee arthroplasty. The aim of this study was to systematically review the literature to collect only high-quality studies investigating the differences in terms of clinical and radiostereometric analysis (RSA) outcomes of AP compared to MB implants. Only randomized controlled trials (RCTs) reporting either clinical or RSA outcomes have been included. Data sources were Embase, Medline, and the Cochrane Central Register of Controlled Trials. We included eleven RCTs evaluating the outcomes of 1,377 patients. Of the RCTs, 9 of them showed a low risk and 2 showed moderate risk of bias. There was no statistically significant difference in terms of clinical outcomes and survival rate between the AP and MB group; however, a statistically significant lower mean lift-off in the AP group (0.19 mm) compared to the MB group (0.3 mm) was observed on RSA. The performance of AP total knee arthroplasty in terms of clinical outcomes and 5-year survival was not statistically different when compared to the MB group. However, the RSA showed a statistically significant lower mean lift-off in the AP group. [ABSTRACT FROM AUTHOR]

T 2 mapping of short-T 2 tissues in the knee (meniscus, tendon, and ligament) is needed to aid the clinical MRI knee diagnosis, which is hard to realize using traditional clinical methods. To accelerate the acquisition of T 2 values for short-T 2 tissues in the knee by analyzing the signal equation of balanced steady-state free precession (bSSFP) sequence in MRI. Effect of half-radial acquisition on pixel bandwidth was analyzed mathematically. A modified 3D radial dual-echo bSSFP sequence was proposed for 0.53 mm isotropic resolution knee imaging with 2 different TEs at 3 T, which alleviated the problem of off-resonance artifacts caused by traditional half-radial acquisition scheme. A novel pixel-based optimization method was proposed for efficient T 2 mapping of short-T 2 tissues in the knee given off-resonance values. Simulation was conducted to evaluate the sensitivity of the proposed method to other parameters. Phantom results were compared with 2D spin-echo (SE), and in vivo results were compared with SE and previously studies. Simulation showed that the proposed method is insensitive to T 1 and B 1 variations (estimation error < 1% for T 1 /B 1 error of ±90%), avoiding the need for separated T 1 and B 1 scans. High isotropic resolution knee imaging was achieved using the modified dual-echo bSSFP. The total scan time was within 3.5 min, including a separate off-resonance scan for T 2 measurement. Measured mean T 2 values for phantoms correlated well with SE (R2 = 0.99), and no significant difference was observed (P = 0.45). In vivo meniscus T 2 measurements and ligament T 2 measurements agreed with the literature, while tendon T 2 measurements were much lower (31.7% lower for patellar tendon, and 13.5% lower for quadriceps tendon), which might result in its bi-component property. The proposed method provides an efficient way for fast, robust, high-resolution imaging and T 2 mapping of short-T 2 tissues in the knee. [ABSTRACT FROM AUTHOR]

To develop a deep learning (DL) model for segmentation of the suprapatellar capsule (SC) and infrapatellar fat pad (IPFP) based on sagittal proton density–weighted images and to distinguish between three common types of knee synovitis. This retrospective study included 376 consecutive patients with pathologically confirmed knee synovitis (rheumatoid arthritis, gouty arthritis, and pigmented villonodular synovitis) from two institutions. A semantic segmentation model was trained on manually annotated sagittal proton density–weighted images. The segmentation results of the regions of interest and patients' sex and age were used to classify knee synovitis after feature processing. Classification by the DL method was compared to the classification performed by radiologists. Data of the 376 patients (mean age, 42 ± 15 years; 216 men) were separated into a training set (n = 233), an internal test set (n = 93), and an external test set (n = 50). The automated segmentation model showed good performance (mean accuracy: 0.99 and 0.99 in the internal and external test sets). On the internal test set, the DL model performed better than the senior radiologist (accuracy: 0.86 vs. 0.79; area under the curve [AUC]: 0.83 vs. 0.79). On the external test set, the DL diagnostic model based on automatic segmentation performed as well or better than senior and junior radiologists (accuracy: 0.79 vs. 0.79 vs. 0.73; AUC: 0.76 vs. 0.77 vs. 0.70). DL models for segmentation of SC and IPFD can accurately classify knee synovitis and aid radiologic diagnosis. [ABSTRACT FROM AUTHOR]

Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2–95.6%) was significantly higher than that of the MM classification (73.5–76.5%, p = 0.002–0.01). The fracture detection rate of MRI-based classification (94.1–98.5%) was non-significantly higher than that of the MM classification (83.8–89.7%, p = 0.07–0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2–94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries. [ABSTRACT FROM AUTHOR]

To present a case with extra-articular calcification of the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis. A 53-year-old Saudi male patient presented with acute onset of right-sided knee pain, localized swelling and tenderness along the lateral aspect after sport related activity. He reported a similar attack at the same knee joint a few years earlier. Plain X-ray and magnetic resonance imaging (MRI) after the initial attack showed calcification along the LCL. On examination, the patient had mild knee effusion, painful knee extension, and localized swelling along the LCL. A recent MRI and complementary computerized tomography (CT) showed a fragmented calcific shadow along the LCL. The latter was associated with soft tissue hyperintensity, which indicated extensive local inflammatory reaction. After ruling out internal derangement and infection, it was concluded that the patient had an acute episode of peri -arthritis caused by calcification along the LCL of the affected knee joint. Intramuscular (IM) betemetazone sodium dipropionate/phosphate was used to treat the peri -arthritis and as such deposits may cause a potent neutrophilic chemotactic response and intense inflammation, colchicine was added for its anti-inflammatory properties and other known mechanisms that are effective in treating crystal-induced arthritis. On the second day following treatment, a significant improvement was seen. A case-based review was presented. Despite the rare incidence of symptomatic LCL calcification, fragmentation of the calcific deposits may lead to acute intense inflammatory exacerbation and peri -arthritis. Successful and optimum management may involve IM steroid with oral colchicine. [ABSTRACT FROM AUTHOR]

After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return. To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry. Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb. There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance). Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms. [ABSTRACT FROM AUTHOR]

Genu valgum is a common lower limb deformity seen in children. There are multiple causes for the development of genu valgum but to be able to accurately assess the child it is important to understand the physiological development of the lower limbs. Although often asymptomatic and idiopathic, genu valgum can be associated with underlying pathology, such as rickets, previous proximal tibia fracture leading to valgus deformity, tumours and dysplasias which often require a multidisciplinary approach to management of the condition. This article will review the common causes of genu valgum in children, explain how to clinically assess the child and cover possible management options for each condition. [ABSTRACT FROM AUTHOR]

Peripheral Artery Disease (PAD) affects the lower extremities and frequently results in poor clinical outcomes, especially in the vessels below the knee. Understanding the biomechanical and structural characteristics of these arteries is important for improving treatment efficacy, but mechanical and structural data on tibial vessels remain limited. We compared the superficial femoral (SFA) and popliteal (PA) arteries that comprise the above-knee femoropopliteal (FPA) segment to the infrapopliteal (IPA) anterior tibial (AT), posterior tibial (PT), and fibular (FA) arteries from the same 15 human subjects (average age 52, range 42–67 years, 87 % male). Vessels were imaged using μCT, evaluated with biaxial mechanical testing and constitutive modeling, and assessed for elastin, collagen, smooth muscle cells (SMCs), and glycosaminoglycans (GAGs). IPAs were more often diseased or calcified compared to the FPAs. They were also twice smaller, 53 % thinner, and significantly stiffer than the FPA longitudinally, but not circumferentially. IPAs experienced 48 % higher physiologic longitudinal stresses (62 kPa) but 27 % lower circumferential stresses (24 kPa) and similar cardiac cycle stretch of <1.02 compared to the FPA. IPAs had lower longitudinal pre-stretch (1.12) than the FPAs (1.29), but there were no differences in the stored elastic energy during pulsation. The physiologic circumferential stiffness was similar in the above and below-knee arteries (718 kPa vs 754 kPa). Structurally, IPAs had less elastin, collagen, and GAGs than the FPA, but maintained similar SMC content. Our findings contribute to a better understanding of segment-specific human lower extremity artery biomechanics and may inform the development of better medical devices for PAD treatment. Peripheral Artery Disease (PAD) in the lower extremity arteries exhibits distinct characteristics and results in different clinical outcomes when treating arteries above and below the knee. However, their mechanical, structural, and physiologic differences are poorly understood. Our study compared above- and below-knee arteries from the same middle-aged human subjects and demonstrated distinct differences in size, structure, and mechanical properties, leading to variations in their physiological behavior. These insights could pave the way for creating location-specific medical devices and treatments for PAD, offering a more effective approach to its management. Our findings provide new, important perspectives for clinicians, researchers, and medical device developers interested in treating PAD in both above- and below-knee locations. [Display omitted] [ABSTRACT FROM AUTHOR]

Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = −0.71, 95 %CI:−1.29,−0.14; SMD = −0.63, 95 %CI:−0.94,−0.32) and overall stability index during double-leg stance (SMD = −0.39, 95 %CI:−0.78,−0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:−2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = −0.49, 95 %CI:−0.89,−0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping. • People with PFP present impairments in clinic-based measures of postural control. • People with PFP have worse stability indexes compared to pain-free controls. • There are no alterations in center of pressure parameters in people with PFP. • Kinesio taping improved postural control of people with PFP at short-term. [ABSTRACT FROM AUTHOR]

This case report describes in detail a rehabilitation and exercise program following surgical treatment of patellar tendon rupture and offers postoperative therapeutic goals and recommendations, with the aim of expediting the resumption of activities of daily living and sports participation following the surgical procedure. In addition, this report analyzes the cause of the patellar tendon rupture in this case. Case report. The patient, a 25-year-old male recreational athlete (height: 184 cm; weight: 80 kg; right-hand dominant), experienced a complete rupture of the patellar tendon upon landing on the left lower extremity during an unopposed dribble turn. A well-structured rehabilitation program was implemented. Passive knee flexion range of motion (ROM) exceeded 90° at week 5 and was fully recovered at week 16. A second surgery was performed at week 19 to remove the decompression wires, and the patient progressively resumed basic physical and specialized training at 7 months post-surgery. Morphometric and functional tests were performed to measure the effectiveness of rehabilitation throughout the postoperative process. Early surgical repair and an immediate postoperative rehabilitation program have a positive impact on knee ROM, function, and muscle strength. The causes of the patellar tendon rupture in this patient included long-standing uncontrolled patellar tendinopathy, impaired mobility of the ankle and hip joints, poor landing technique, and muscle strength imbalances. [ABSTRACT FROM AUTHOR]

In primary or idiopathic osteoarthritis (OA), it is unclear which factors trigger the shift of articular chondrocyte activity from pro-anabolic to pro-catabolic. In fact, there is a controversy about the aetiology of primary OA, either mechanical or inflammatory. Chondrocytes are mechanosensitive cells, that integrate mechanical stimuli into cellular responses in a process known as mechanotransduction. Mechanotransduction occurs thanks to the activation of mechanosensors, a set of specialized proteins that convert physical cues into intracellular signalling cascades. Moderate levels of mechanical loads maintain normal tissue function and have anti-inflammatory effects. In contrast, mechanical over- or under-loading might lead to cartilage destruction and increased expression of pro-inflammatory cytokines. Simultaneously, mechanotransduction processes can regulate and be regulated by pro- and anti-inflammatory soluble mediators, both local (cells of the same joint, i.e., the chondrocytes themselves, infiltrating macrophages, fibroblasts or osteoclasts) and systemic (from other tissues, e.g., adipokines). Thus, the complex process of mechanotransduction might be altered in OA, so that cartilage-preserving chondrocytes adopt a different sensitivity to mechanical signals, and mechanic stimuli positively transduced in the healthy cartilage may become deleterious under OA conditions. This review aims to provide an overview of how the biochemical exposome of chondrocytes can alter important mechanotransduction processes in these cells. Four principal mechanosensors, i.e., integrins, Ca2+ channels, primary cilium and Wnt signalling (canonical and non-canonical) were targeted. For each of these mechanosensors, a brief summary of the response to mechanical loads under healthy or OA conditions is followed by a concise overview of published works that focus on the further regulation of the mechanotransduction pathways by biochemical factors. In conclusion, this paper discusses and explores how biological mediators influence the differential behaviour of chondrocytes under mechanical loads in healthy and primary OA. • This review gathers knowledge on how local and systemic soluble factors directly regulate chondrocyte mechanotransduction. • Ca2+ PIEZO channels influx is enhanced by interleukin (IL)-1 β , and it increases pro-catabolic activity of the chondrocytes. • Growth factors regulate the intake of Ca2+ through TRPV4 to maintain balanced levels of this ion in the chondrocytes, favouring chondrogenesis. • Integrin α 5 β 1 has a dual function in chondrocytes regarding the articular cartilage degradation levels (i.e., RGD peptides). • Chondrocyte primary cilia length is increased by IL-1 β and counteracted upon TRPV4 activation following tensile strain. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference −0.35, 95% confidence interval −0.59 to −0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups. [ABSTRACT FROM AUTHOR]

Rotationsinstabilitäten könnten neben einer Rekonstruktion des vorderen Kreuzbandes (VKBR) eine zusätzliche Versorgung der anterolateralen Kniestrukturen erfordern. Eine vermeintliche Entlastung und damit verbunden Protektion des VKBR-Transplantates durch eine anterolaterale Tenodese (ALT) wurde bisher unzureichend untersucht. Ziel der Studie war die direkte Messung der Kräfte im VKBR und ALT Transplantat inklusive der Analyse der resultierenden tibiofemoralen Relativbewegung bei anterolateraler Insuffizienz in ausgewählten Beugestellungen. Es sollte untersucht werden, ob eine zusätzliche ALT die auftretenden Kräfte im VKBR Transplantat bei externen Lasten reduziert und etwaige Rotationsinstabilitäten nach isolierter VKBR minimiert. Sechs Humanpräparate wurden in 0°, 30°, 60° und 90° Flexion in folgenden Zuständen mit Hilfe eines Kniesimulators untersucht: 1) nativ; 2) VKB durchtrennt 3) mit zusätzlicher anterolateraler Insuffizienz; 4) isolierte VKBR; 5) kombinierte VKBR+ALT. Die ALT wurde in modifizierte Lemaire Technik durchgeführt und in 60° Flexion mit einer Vorkraft von 20 N fixiert. VKBR und ALT Transplantatkräfte sowie die tibiofemorale Relativbewegung wurden jeweils unter verschiedenen externen Lasten analysiert: a) unbelastet; b) unter anteriorer Zugkraft von 98 N; c) unter einem tibialen Innenrotationsmoment von 5 Nm; d) unter kombiniertem tibialen Innenrotationsmoment von 5 Nm und anteriorer Zugkraft von 98 N. Bei Einleitung eines tibialen Innenrotationsmoments wurden die VKBR-Transplantatkräfte durch eine zusätzliche ALT um bis zu 58% reduziert. Die ALT nahm dabei Kräfte von bis zu 112 N auf. Unter anteriorer Zugkraft war die Wirkung der zusätzlichen ALT auf die VKBR-Transplantatkräfte zu vernachlässigen. Die isolierte VKBR war nicht in der Lage, bei anterolateraler Insuffizienz den nativen Zustand tibialer Innenrotation widerherzustellen. Mittels kombinierter VKBR+ALT konnte dieser erreicht werden. In 30° Flexion zeigte sich eine unphysiologische Reduktion der tibialen Innenrotation nach kombinierter VKBR+ALT. Das VKBR Transplantat wird bei tibialen Innenrotationsbelastungen durch eine ALT entlastet. Dadurch könnte das Risiko einer Ruptur des VKBR-Transplantates bei pivotierenden Belastungen gesenkt werden. Persistente Rotationsinstabilitäten nach isolierter VKBR in anterolateral insuffizienten Kniegelenken können durch eine zusätzliche ALT reduziert werden. Eine Bewegungseinschränkung mit unphysiologisch reduzierter Innenrotation aufgrund zu hoher Spannung der ALT ist dabei nicht auszuschließen und sollte bei der Versorgung berücksichtigt werden. Rotational instability ten could be in addition to a reconstruction of the anterior cruciate ligament (VKBR) an additional supply the anterolateral knee structures require. A supposed relief and associated protection of the VKBR transplant an anterolateral tenodesis (ALT) has so far been insufficiently investigated. The aim of the study was direct Measuring the forces in the VKBR and ALT Transplant including analysis the resulting tibiofemoral Relative movement in anterolateral Insufficiency in selected flexion positions. It should be investigated whether an additional ALT is required forces occurring in the VKBR transplant reduced under external loads and any rotational instabilities minimized after isolated VKBR. Six human preparations were in 0, 30, 60 and 90 Inflection in the following states Investigated with the help of a knee simulator: 1) native; 2) ACL severed 3) with additional anterolateral Insufficiency; 4) isolated VKBR; 5) combined VKBR+ALT. The OLD was modified in Lemaire technique performed and in 60 flexion fixed with a pre-force of 20 N. VKBR and ALT transplant forces as well as the tibiofemoral relative movement were each under different external loads analyzed: a) unencumbered; b) under anterior traction from 98 N; c) under a tibial internal rotation torque of 5 Nm; d) under combined tibial internal rotation moment of 5 Nm and anterior traction force of 98 N. When initiating a tibial internal rotation moment became the VKBR transplant forces by an additional ALT by up to 58% reduced. The ALT absorbed forces of up to 112 N. Under anterior traction was the effect the additional ALT to the VKBR Graft forces can be neglected. The isolated VKBR was not in the situation with anterolateral insufficiency the native state of tibial To restore internal rotation. Means combined VKBR+ALT could this can be achieved. In 30 inflection showed an unphysiological one Reduction of tibial internal rotation after combined VKBR+ALT. The VKBR Graft is used for tibial internal rotation loads by an ALT relieved. This could reduce the risk a rupture of the VKBR transplant reduced in the case of pivoting loads become. Persistent rotational instability after isolated VKBR in anterolaterally insufficient knee joints can be replaced by an additional ALT can be reduced. A movement restriction with unphysiological reduced internal rotation due to excessive voltage on the ALT cannot be ruled out and should be taken into account when providing care become. [ABSTRACT FROM AUTHOR]

• Independent and dose-dependent association of recurrent fall risk with chronic pain. • Recurrent fall risk associated with chronic knee, foot/ankle, and lower back pains. • Differences in association between chronic pain and recurrent fall risk by sex. To determine the longitudinal association between chronic pain in the lower extremities and low back and the odds of recurrent falls in middle-aged and older people. A cohort study. Communities in Japan. Participants were 7540 community-dwelling volunteers aged 40-74 years (N=7540). The baseline survey was a self-administered questionnaire conducted between 2011-2013. Predictors were presence of chronic pain in the knee, foot or ankle, and low back, with the degree of pain categorized as none, very mild/mild, moderate, or severe/very severe. Covariates in the multivariate model of chronic pain in a site were demographics, body mass index, physical activity level, disease history, and chronic pain in the other 2 sites. Logistic regression analysis was used to calculate odds ratios (ORs). None. Recurrent falls in the year before the 5-year follow-up survey. Mean participant age was 60.2 years. Higher degrees of chronic pain were associated with higher odds of recurrent falls for the knee (P =.0002) with a higher OR of 1.48 (95% CI: 1.11-1.97), for the foot or ankle (P =.0001) with a higher OR of 1.97 (95% CI: 1.36-2.86), and for the low back (P =.0470) with a higher OR of 1.45 (95% CI: 1.09-1.91) in those with any degree of pain relative to those without pain. Higher degrees of chronic knee pain were associated with higher odds of recurrent falls in women (P =.0005), but not in men (P =.0813). Meanwhile, higher degrees of chronic low back pain were associated with the odds of recurrent falls in men (P =.0065), but not in women (P =.8735). Chronic pain in the knee, foot or ankle, and lower back was independently and dose-dependently associated with a higher risk of recurrent falls. A marked sex-dependent difference was also noted in the association. [ABSTRACT FROM AUTHOR]