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Background: To evaluate the diagnostic characteristics of tryptophanyl tRNA synthetase (WRS) for the diagnosis of septic arthritis of the knee joint and to determine whether it is a reliable and sensitive synovial biomarker for discriminating septic arthritis from other types of arthritis. Methods: Patients joint effusions for which septic arthritis was suspected were prospectively recruited between January 2019 and September 2020. A total of 9 patients had septic arthritis, 6 had acute gout attack, 1 had an acute flare of chronic rheumatic arthritis, and 46 had pseudogout or reactive arthropathy. Traditional inflammatory markers were measured, and their diagnostic abilities were compared. Neutrophil count, C-reactive protein (CRP) level, WRS, and human neutrophil α-defensin levels were assessed in the synovial fluids. Demographic parameters and biomarkers with a P < 0.05 in differentiating septic from nonseptic arthritis were included in a multivariable model. A multivariable logistic regression with a stepwise selection was performed to build the final combined model. Receiver operating characteristic curves were used to establish optimal thresholds for the diagnosis of septic arthritis of the knee joint, and the area under the curve was calculated to determine the overall accuracy of these tests compared with patients with nonseptic inflammatory arthritis. Results: Patients with septic arthritis were more likely to display higher serum WBC and CRP levels, synovial neutrophil counts, and levels of two synovial biomarkers, including WRS and α-defensin. WRS showed the highest specificity (87.5%) and sensitivity (83.3%) with α-defensin among the three synovial biomarkers. Conclusions: Synovial fluid WRS is a relevant biomarker in discriminating septic arthritis from other inflammatory arthritis and should be tested in an independent cohort. Level of evidence: prospective observational study, III. [ABSTRACT FROM AUTHOR]

Background: The optimal management of first-time patellar dislocations remains a subject of debate. While surgical intervention is often recommended to reduce the risk of redislocation, the benefits over conservative treatment regarding knee function and complication rates are not clearly established. This systematic review aims to compare the effectiveness of surgical versus conservative treatment in preventing redislocation and improving knee function, while also considering complication rates. Methods: A comprehensive search of databases, including PubMed, Scopus, and Web of Science, was conducted up to July 2024. Seven randomized controlled trials involving 411 participants were included. The primary outcome was the redislocation rate, with secondary outcomes including knee function, complication rates, and the need for re-interventions. The quality of the studies was assessed using the PEDro scale. Results: Surgical treatment generally resulted in lower redislocation rates compared to conservative management. However, the improvement in knee function was inconsistent, with some studies showing no significant differences or even favoring conservative treatment. Surgical intervention was associated with a higher risk of complications and re-interventions, particularly in older studies with less advanced techniques. Conclusions: Surgical intervention appears effective in reducing redislocation rates but comes with a risk of complications. Conservative treatment remains a viable option, particularly for patients with lower activity levels or higher surgical risks. The decision between surgical and conservative management should be individualized, taking into account patient-specific factors and potential risks. Further high-quality research is needed to provide more definitive guidance. [ABSTRACT FROM AUTHOR]

Background/Objectives: There is a gap between the very positive opinion of patients and doctors regarding knee viscosupplementation (VS) and the contrasting results of controlled studies. The objective of this study was to evaluate the overall satisfaction and predictors of satisfaction with VS in patients with knee osteoarthritis treated with VS. Methods: Post-hoc analysis of a cross-sectional study in patients with knee OA treated with one injection of a mannitol-modified cross-linked HA (HANOX-M-XL). The primary outcome was satisfaction, self-assessed semi-quantitatively by the patients. Demographics, radiological features, comorbidities, OA and comorbidities treatments, and lifestyle associated with satisfaction were studied in bivariate and multivariate analysis. Results: 89 patients (124 knees) were analyzed. A total of 88.7% were satisfied with the treatment. Satisfaction was correlated with duration of effectiveness (DoE) and negatively correlated with BMI. Satisfaction was higher in active versus sedentary patients, in tibiofemoral involvement, in Kellgren-Lawrence grade 1–3 versus 4, and in subjects not requiring intraarticular corticosteroid (IACS) concomitantly to VS. Satisfied subjects were older than dissatisfied ones. In multivariate analysis, older age, K–L grade < 4, absence of IACS, and longer DoE were associated with higher rates of satisfaction. Conclusions: We identified several predictive factors of patient satisfaction after VS of the knee. Alongside these objective factors, there are probably subjective factors linked to patient beliefs, fears, and expectations impacting satisfaction. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of this study was to assess lower limb muscle strength in older adults during the transfer from sitting to standing (STS) using an inertial measurement unit (IMU). Muscle weakness in this population can severely impact function and independence in daily living and increase the risk of falls. By using an IMU, we quantified lower limb joint moments in the STS test to support health management and individualized rehabilitation program development for older adults. (2) Methods: This study involved 28 healthy older adults (13 males and 15 females) aged 60–70 years. The lower limb joint angles and moments estimated using the IMU were compared with a motion capture system (Mocap) (pair t-test, ICC, Spearman correlations, Bland–Altman plots) to verify the accuracy of the IMU in estimating lower limb muscle strength in the elderly. (3) Results: There was no significant difference in the lower limb joint angles and moments calculated by the two systems. Joint angles and moments were not significantly different (p > 0.05), and the accuracy and consistency of the IMU system was comparable to that of the Mocap system. For the hip, knee, and ankle joints, the ICCs for joint angles were 0.990, 0.989, and 0.885, and the ICCs for joint moments were 0.94, 0.92, and 0.89, respectively. In addition, the results of the two systems were highly correlated with each other: the r-values for hip, knee, and ankle joint angles were 0.99, 0.99, and 0.96, and the r-values for joint moments were 0.92, 0.96, and 0.85. In the present study, there was no significant difference (p > 0.05) between the IMU system and the Mocap system in calculating lower limb joint angles and moments. (4) Conclusions: This study confirms the accuracy of the IMU in assessing lower limb muscle strength in the elderly. It provides a portable and accurate alternative for the assessment of lower limb muscle strength in the elderly. [ABSTRACT FROM AUTHOR]

The existing in vitro and in vivo models for studying osteoarthritis have significant limitations in replicating the complexity of joint tissues. This research aims to validate a Tissue-On-a-Chip system for osteoarthritis research. Osteochondral tissues obtained from knee replacement surgeries of patients with osteoarthritis were cultured in an Organ-On-a-Chip system. This system was designed to supply oxygen and glucose to the cartilage from the bone. The distribution of oxygen and glucose was evaluated by fluorescence using Image-iT Green Hypoxia and 2-NBDG, respectively. Cytotoxicity was measured using lactate dehydrogenase (LDH) levels in chip cultures compared to plate cultures (12 tissues per method). Glycosaminoglycans (GAGs), alkaline phosphatase (ALP), Coll2-1, and procollagen type II N-terminal propeptide (PIINP) were measured in the perfused medium of the Tissue-On-a-Chip over a period of 70 days. Fluorescence of Image-iT Green Hypoxia was observed only in the cartilage area, while 2-NBDG was distributed throughout the tissue. An increase in LDH levels was noted in the plate cultures on day 24 and in the Tissue-On-a-Chip cultures on day 63. Compared to the start of the culture, GAG content increased on day 52, while ALP showed variations. A notable increase in GAG, ALP, and Coll2-1 levels was observed on day 59. PIINP levels remained stable throughout the experiment. The validated osteochondral Tissue-On-a-Chip system can replicate the joint microenvironment, with hypoxic conditions in cartilage and normoxic conditions in bone. Tissue survival and component stability were maintained for approximately two months. This platform is a useful tool for evaluating new drugs and represents a viable alternative to animal models. [ABSTRACT FROM AUTHOR]

Vitamin D is crucial for ideal bone health and good muscle function, both essential requirements for successful joint arthroplasty. Hence, vitamin D deficiency has recently been identified as a predictor of poorer outcomes in patients scheduled to undergo total joint arthroplasty (TJA). Moreover, there is ample evidence today that vitamin D deficiency is associated with periprosthetic joint infection. Yet, vitamin D deficiency seems to be frequent in patients who are scheduled to undergo TJA. However, the prevalence of hypovitaminosis D in patients who require revision arthroplasty (rTJA) is largely unknown. Further, risk factors of vitamin D deficiency in these patients remain to be elucidated. For this reason, the primary objective of this study was to assess the vitamin D status of patients scheduled to undergo rTJA of the hip, knee and shoulder. The secondary objective was to identify potential risk factors for hypovitaminosis D in these patients. Serum vitamin D [25(OH)D] levels of 249 patients who were scheduled for rTJA were assessed over a period of twelve months at a high-volume TJA centre. Collectively, 23% of patients reported a routine intake of vitamin D supplements (58/249). Notably, 81% of patients (155/191) who did not report a routine vitamin D intake presented with insufficient vitamin D levels (below 30 ng/mL), while only 19% of patients (36/191) had sufficient vitamin D levels. Of those who reported a routine vitamin D intake, 75% (43/58) had sufficient vitamin D levels, while 25% (15/58) showed insufficient vitamin D status. Patients who did not routinely take any vitamin D supplements had significantly lower vitamin D levels compared to patients who reported regular vitamin D intake (19.91 ng/mL vs. 40.66 ng/mL). Further, BMI and nicotine abuse were identified as potential risk factors for hypovitaminosis D in patients without vitamin D supplementation. Moreover, the season of spring seems to be a risk factor in patients with vitamin D supplementation, while age itself did not appear to be a significant risk factor for low vitamin D levels. In conclusion, we found an alarmingly high rate of vitamin D deficiency in patients scheduled to undergo rTJA. Notably, reported routine vitamin D supplementation showed significantly increased serum vitamin D levels compared to patients with no reported supplementation. Due to the high prevalence of vitamin D deficiency, we believe that vitamin D status should routinely be assessed in patients who are scheduled to undergo rTJA. [ABSTRACT FROM AUTHOR]

This document is an editorial for a special issue on recent advances in the biomechanics of human movement and its clinical applications. It discusses the challenges of linking research projects to clinical practice and highlights the gaps between potential research activities and clinical applications. The special issue includes 10 articles on various aspects of the research field, providing insights into topics such as postural control adaptations in Parkinson's disease, gait analysis, and the relationship between humans and robots. These articles reflect current progress in the research field and offer valuable information for clinical applications. The document also emphasizes the importance of considering electromyographs (EMGs) and electroencephalograms (EEGs) in clinical practice, as well as the potential applications of artificial intelligence (AI) in biomechanics. It encourages further exploration of new research directions in human movement and its clinical applications. [Extracted from the article]

This document is a summary of a special issue titled "Advanced Imaging in Orthopedic Biomechanics" published in the journal Applied Sciences. The special issue highlights the increasing use of advanced imaging techniques in orthopedics and biomechanical studies. These techniques, such as high-resolution visualization and three-dimensional printing, have improved clinical assessments, reduced invasiveness, and decreased costs. The special issue includes studies on various anatomical areas, such as the spine, hip, knee, and ankle, and explores the applications of advanced imaging in diagnosing and treating various orthopedic conditions. The authors emphasize the multidisciplinary nature of these investigations and the potential benefits for patients and society as a whole. [Extracted from the article]

In this study, we investigated the capability of the Nakagami transformation to detect changes in vastus lateralis muscle-tendon stiffness (k) during dynamic (and intense) contractions. k was evaluated in eleven healthy males using the gold-standard method (a combination of ultrasound and dynamometric measurements) during maximal and sub-maximal voluntary fixed-end contractions of the knee extensors (20, 40, 60, 80, and 100% of maximum voluntary force), while Nakagami parameters were analysed using the Nakagami transformation during the same contractions. Muscle-belly behaviour was investigated by means of B-mode ultrasound analysis, while Nakagami parameters were obtained in post-processing using radiofrequency data. k was calculated as the slope of the force-muscle-belly elongation relationship. Three contractions at each intensity were performed to calculate the intra-trial reliability and the coefficient of variation (CV) of the Nakagami parameters. At all contraction intensities, high values of intra-trial reliability (range: 0.92–0.96) and low CV (<9%) were observed. k and Nakagami parameters increased as a function of contraction intensity, and significant positive correlations were observed between these variables. These data suggest that changes in mechanical properties (e.g., stiffness) at the muscle level could be investigated by means of Nakagami parameters. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions In many countries, pain is the most common indication for use of antidepressants in older adults. We reviewed the evidence from randomized controlled trials on the efficacy and safety of antidepressants, compared to all alternatives for pain in older adults (aged ≥65 years).Trials published from inception to 1 February 2024, were retrieved from 13 databases. Two independent reviewers extracted data on study and participant characteristics, primary efficacy (pain scores, converted to 0–100 scale) and harms. Estimates for efficacy were pooled using a random effects model and reported as difference in means and 95% CI. Quality of included trials was assessed using the Cochrane risk of bias tool.Fifteen studies (n = 1369 participants) met the inclusion criteria. The most frequently studied antidepressants were duloxetine and amitriptyline (6/15 studies each). Pain related to knee osteoarthritis was the most studied (6/15 studies). For knee osteoarthritis, antidepressants did not provide a statistically significant effect for the immediate term (0–2 weeks), (−5.6, 95% confidence interval [CI]: −11.5 to 0.3), but duloxetine provided a statistically significant, albeit a very small effect in the intermediate term, (≥6 weeks and <12 months), (−9.1, 95% CI: −11.8 to −6.4). Almost half (7/15) of the studies reported increased withdrawal of participants in the antidepressant treatment group vs. the comparator group due to adverse events.For most chronic painful conditions, the benefits and harms of antidepressant medicines are unclear. This evidence is predominantly from trials with sample sizes of <100, have disclosed industry ties and classified as having unclear or high risk of bias. [ABSTRACT FROM AUTHOR]

Introduction: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. Results: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. Conclusion: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. Trial registration: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022. [ABSTRACT FROM AUTHOR]

A disk-shaped meniscus is a commonly known alternative to the C-shaped meniscus, which is defined by a larger-than-normal meniscus body.However, the enlarged meniscus has a severe disadvantage, which is the increase in shearing forces exerted on it, which can lead to a tear in its body. The Wrisberg form of discoid lateral meniscus is a rare abnormality. The absence of the posterior meniscotibial ligament results in an excessive range of movement and instability of the meniscus, with only its meniscofemoral ligament (Wrisberg’s ligament) remaining intact and attached to the posterior horn of the meniscus. Additionally, a Wrisberg variant can exhibit a significant disorder in its microstructure due to an abnormal collagen network, mucosal disintegration, and a lack of vascularity.This study includes 32 skeletally immature patients who came to our institution with symptomatic discoid lateral meniscus. The initial evaluation of every knee included magnetic resonance imaging (MRI), followed by arthroscopy. MRI enables the classification of discoid meniscus based on meniscal morphology, stability or instability, meniscal intrasubstance degradation, and the occurrence of meniscal rupture. The discoid meniscus was reshaped, excising the hypertrophied central portion of the meniscus. The International Knee Documentation Committee (IKDC) system, which is an online system for the evaluation of knee function, was utilized. Twenty-four discoid menisci were assessed as being stable and having a tear in their body. Eight discoid menisci were determined to be unstable (Wrisberg variant) with degeneration within their substance but no meniscus tear.At surgery, the mean age of the patients was 11.81+/-2.62 years (range 5–14 years). The average follow-up was 3.71+/-0.92 years (range, 3–6). The mean preoperative IKDC score was 44.71+/-14.42 (range, 21–57) points. Postoperatively, the mean IKDC score was 81.56+/-1.70 (range, 79–84) points. The two-tailed p-value was < 0.0001.The assumption that MRI assessment is essential not only for detecting the Wrisberg alternate but also for uncovering possible meniscal disintegration and intra-substance alterations that are not usually observed through arthroscopy is supported by our data. [ABSTRACT FROM AUTHOR]

Although the back handspring step out (BHS) is a foundational skill in balance beam routines, it can be performed using different take-off techniques. Back injuries are highly prevalent in the BHS due to the combination of high spine extension and joint loading. However, it is unclear which technique minimises injury risk or leads to better BHS performance. The purpose of the study was to identify techniques used for the BHS take-off and analyse the resulting BHS performance. Gymnasts were found to use either: Simultaneous Flexion—trunk and knees flex at the same time; Sequential Flexion—trunk reaches its maximum flexion followed by knee flexion; or Double-Bounce—knees and trunk both flex and then the knees extend and flex again. To assess performance, point deductions were calculated, and dynamic balance, ground reaction forces (GRFs) and relevant joint angles were analysed. The techniques had no differences in point deductions or dynamic balance, but there were differences in GRFs, spine extension and knee flexion. The Sequential Flexion technique had the lowest spine extension, which potentially reduces back injuries and the lowest knee flexion, which is a BHS requirement. These results support the use of Sequential Flexion technique when performing the BHS. [ABSTRACT FROM AUTHOR]

Aseptic loosening is a feared and not yet fully-understood complication of total knee arthroplasty (TKA). Hypersensitivity reactions may be the underlying cause within some susceptible patients. Metal-free implants have been developed as a possible solution. The aim of this prospective, observational long-term study was the assessment of a completely metal-free ceramic knee replacement system compared to its identical metal counterpart 8 years after implantation, conducted as a follow-up of a previous report. A total of 88 patients (mean age 69 years) were enrolled in this prospective, observational long-term 8-year follow-up study. The "ceramic group" with a completely metal-free total knee replacement system was compared to the "conventional group" with an identical metal TKA system at the final follow-up. Clinical assessment included Knee Society Score (KSS), Oxford Knee Score (OKS), European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-L), European Quality of Life 5 Dimension Visual Analogue Scale (EQ-VAS) and High Activity Arthroplasty Score (HAAS) as well as perioperative or postoperative complications and need for revision. The tibial/femoral positioning, signs of periprosthetic fissures/fractures or radiolucent lines were documented radiographically. All postoperative clinical scores in the ceramic group primarily improved from baseline to 4-year follow-up, but then decreased at the final 8-year follow-up. At the final follow-up, statistically non-significant differences were found in comparison of both groups for the KSS (ceramic: 166 ± 31, conventional: 162 ± 29; p > 0.05), OKS (ceramic: 37, conventional: 39; p > 0.05), EQ-VAS (ceramic: 77 ± 17, conventional: 72 ± 18; p > 0.05), and HAAS (ceramic: 8.29 ± 3.32, conventional: 9.28 ± 4.44; p > 0.05). A significant difference was found for EQ-5D-L (ceramic: 0.819 ± 0.284, conventional: 0.932 ± 0.126; p ≤ 0.05). Progressive radiolucent lines have been found around the uncemented tibial stem (0.8 mm at initial diagnosis (mean 19 months); 1.3 mm at 4-year follow-up; 1.6 mm at 8-year follow-up) without any clinical signs of loosening. One revision surgery was performed after a traumatic polyethylene inlay-breakage. No allergic reactions could be detected. The used ceramic TKA system meets the functional performance standards of an established identical metal TKA system after an 8-year follow-up period, offering a safe option for patients with prior hypersensitivity reactions to metallic materials. Full cementation of ceramic components is recommended. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess radiolucent lines (RLLs) and to determine their effect on clinical outcomes of the newly introduced cementless mobile-bearing total knee arthroplasty (TKA) system. This was prospective, multicentre study. Seventy-eight patients with knee osteoarthritis who underwent primary TKA were enrolled. Patient-reported outcome measures (PROMs) and radiographic assessments were evaluated at preoperative baseline and at 6 weeks, 1 year, and 2 years after surgery. KOOS, PKIP, 2011KSS, EQ-5D-3L and SKO improved from preoperative baseline to all postoperative timepoints, with no loosening of components. No RLLs were detected at 6 weeks after surgery. However, RLLs ≥ 1 mm developed in 2.8% of the patients for the femur and 9.7% for the tibia at 1 year after surgery, and values were 5.7% and 10.9%, respectively, at 2 years after surgery. RLL incidence was not correlated with PROMs. Age, sex, body mass index, range of motion knee flexion, posterior cruciate ligament treatment and β angle did not impact the occurrence of RLLs. There were no intraoperative complications, revisions or reoperations. This TKA system improved PROMs and showed less incidence of RLLs compared to the previous reported TKA without implant-related complications. [ABSTRACT FROM AUTHOR]

In a randomized, controlled study, whole-body electromyostimulation (WB-EMS) was investigated as a promising alternative treatment technique compared to conventional strength training for the management of knee osteoarthritis (OA). Seventy-two overweight participants with symptomatic knee OA were randomly assigned to WB-EMS (n = 36) or a usual care group (UCG, n = 36). For seven months, the WB-EMS group received three times per fortnight a WB-EMS training, while the UCG was prescribed six-times physiotherapeutic treatments. We observed significant effects for the primary outcome "pain", as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS), with more favourable changes in the WB-EMS group vs UCG (between-group difference 9.0 points, 95%CI 2.9–15.1, p = 0.004). Secondary outcomes, including the other KOOS subscales (symptoms, function in daily living, function in sports/recreational activities and quality of life), 7 day pain diary, hip/leg extensor strength and lower limb function (30s sit-to-stand test), were also statistically significant in favour of the WB-EMS group. Overall, WB-EMS was found to be effective in relieving knee pain symptoms and improving physical function in individuals with symptomatic knee OA compared to usual care treatment. WB-EMS could be used as an alternative therapy in the management of knee OA; particularly for patients that cannot be motivated for conventional training. [ABSTRACT FROM AUTHOR]

Background: Studies comparing the effectiveness of arthroscopic knee surgery and conservative treatment on knee osteoarthritis (OA) came up with inconsistent results. Systematic review on this topic still is still lacking. This systematic review and meta-analysis aimed to evaluate the effectiveness of arthroscopic knee surgery on knee OA, compared to conservative treatments. Materials and methods: Literature searches were performed in PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published before on 1st July 2024. Studies comparing the effectiveness of arthroscopy and conservative treatments only on knee OA were included. Quality of included studies was evaluated by risk of bias 2 (ROB2). Long-term results in terms of pain relief, functional recovery and patients reported satisfaction were meta-analyzed to evaluate the therapeutic effectiveness. Results: Ten studies were included in this review, among which only 1 was considered as low risk of bias. Five studies were involved in meta-analyses and no difference was found in therapeutic effectiveness of arthroscopic surgery and conservative treatment on knee OA, in the evaluation of VAS (p = 0.63), WOMAC (p = 0.38), SF-36 (p = 0.74) and patient satisfaction (p = 0.07). Conclusion: The evidence does not support the effectiveness of arthroscopic knee surgery compared to conservative treatments in knee OA. [ABSTRACT FROM AUTHOR]

This case study aims to examine changes in the lower limb joint kinematic profile and performance stability induced by repeated ski runs in two world‐class alpine skiers. Two Olympic medallist alpine skiers were tested during their slalom training, with continuous recording of right knee and hip angles, along with turn time and run time. The eight runs of the training session were analysed with linear mixed models. Results showed no effect of runs repetition on performance (i.e., run and turn time; P ≥ 0.279). There was no global effect of runs repetition on minimal and maximal angles for either the knee or the hip (P > 0.151). There was an interaction between run and leg for the maximal angle of both the knee and hip (P ≤ 0.047), which increased across runs for the outside leg and decreased for the inside leg. The maximal angular velocity for both the knee and hip increased with runs repetition in extension (P ≤ 0.028). There were no overall changes in maximal angular velocity in flexion with runs repetition (P ≥ 0.264), but there was an interaction between run and leg for the knee (P < 0.001) due to faster eccentric velocities across runs for the outside leg and slower velocities for the inside leg. In conclusion, the observed joint kinematic alterations without concomitant performance impairment support the concept of multiple movement strategies in athletes to achieve similar performance, especially under fatigue conditions. [ABSTRACT FROM AUTHOR]

Sesamoids are variably present skeletal elements found in tendons and ligaments near joints. Variability in sesamoid size, location and presence/absence is hypothesized to enable skeletal innovation, yet sesamoids are often ignored. Three knee sesamoids—the cyamella, medial fabella and lateral fabella—are present in primates, but we know little about how they evolved, if they are skeletal innovations, or why they are largely missing from Hominoidea. Our phylogenetic comparative analyses suggest that sesamoid presence/absence is highly phylogenetically structured and contains phylogenetic signal. Models suggest that it is easy to gain but difficult/impossible to lose knee sesamoids and that the fabellae may have similar developmental/evolutionary pathways that are distinct from the cyamella. Sesamoid presence/absence is uncorrelated to the mode of locomotion, suggesting that sesamoid biomechanical function may require information beyond sesamoid presence, such as size and location. Ancestral state reconstructions were largely uninformative but highlighted how reconstructions using parsimony can differ from those that are phylogenetically informed. Interestingly, there may be two ways to evolve fabellae, with humans evolving fabellae differently from most other primates. We hypothesize that the 're-emergence' of the lateral fabella in humans may be correlated with the evolution of a unique developmental pathway, potentially correlated with the evolution of straight-legged, bipedal locomotion. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic Data Evaluation Panel (ODEP) ratings of total hip (TH) and total knee (TK) implants are informative for assessing implant performance. However, the validity of ODEP ratings across multiple registries is unknown. Therefore, we aimed to assess, acrossmultiple registries,whether TH and TK implants with a higher ODEP rating (i.e., an A* rating) have lower cumulative revision risks (CRRs) than those with a lower ODEP rating (i.e., an A rating) and the extent to which A* and A-rated implants would be A*-rated on the basis of the pooled registries' CRR. Methods: Implant-specific CRRs at 3, 5, and 10 years that were reported by registries were matched to ODEP ratings on the basis of the implant name. A meta-analysis with random-effects models was utilized for pooling the CRRs. ODEP benchmark criteria were utilized to classify these pooled CRRs. Results: A total of 313 TH cups (54%), 356 TH stems (58%), 218 TH cup-stem combinations (34%), and 68 TK implants (13%) with unique brand names reported by registries were matched to an ODEP rating. Given the low percentage that matched, TK implants were not further analyzed. ODEP-matched TH implants had lower CRRs than TH implants without an ODEP rating at all follow-up time points, although the difference for TH stems was not significant at 5 years. No overall differences in CRRs were found between A* and A-rated TH implants, with the exception of TH cup-stem combinations, which demonstrated a significantly lower CRR for A*A*-rated cup-stem combinations at the 3-year time point. Thirty-nine percent of A*-rated cups and 42% of A*-rated stems would receive an A* rating on the basis of the pooled registries' CRR at 3 years; however, 24% of A-rated cups and 31% of A-rated stems would also receive an A* rating, with similar findings demonstrated at longer follow-up. Conclusions: At all follow-up time points, ODEP-matched TH implants had lower CRRs than TH implants without an ODEP rating. Given that the performance of TH implants varied across countries, registries should first validate ODEP ratings with use of country-specific revision data to better guide implant selection in their country. Data source transparency and the use of revision data from multiple registries would strengthen the ODEP benchmarks. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs. Methods: Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors. Results: The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ‡30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group. Conclusions: The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group. [ABSTRACT FROM AUTHOR]

Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable. [ABSTRACT FROM AUTHOR]

Recent years have witnessed breakthroughs in assistive exoskeletons; both passive and active devices have reduced metabolic costs near preferred walking speed by assisting muscle actions. Metabolic reductions at multiple speeds should thus also be attainable. Musculoskeletal simulation can potentially predict the interaction between assistive moments, muscle-tendon mechanics, and walking energetics. In this study, we simulated devices' optimal assistive moments based on minimal muscle activations during walking with prescribed kinematics and dynamics. We used a generic musculoskeletal model with tuned muscle-tendon parameters and computed metabolic rates from muscle actions. We then simulated walking across multiple speeds and with two ideal actuation modes–motor-based and spring-based–to assist ankle plantarflexion, knee extension, hip flexion, and hip abduction and compared computed metabolic rates. We found that both actuation modes considerably reduced physiological joint moments but did not always reduce metabolic rates. Compared to unassisted conditions, motor-based ankle plantarflexion and hip flexion assistance reduced metabolic rates, and this effect was more pronounced as walking speed increased. Spring-based hip flexion and abduction assistance increased metabolic rates at some walking speeds despite a moderate decrease in some muscle activations. Both modes of knee extension assistance reduced metabolic rates to a small extent, even though the actuation contributed with practically the entire net knee extension moment during stance. Motor-based hip abduction assistance reduced metabolic rates more than spring-based assistance, though this reduction was relatively small. Our study also suggests that an assistive strategy based on minimal muscle activations might result in a suboptimal reduction of metabolic rates. Future work should experimentally validate the effects of assistive moments and refine modeling assumptions accordingly. Our computational workflow is freely available online. Author summary: We used simulation to identify ideal assistance at major lower limb joints that can potentially be produced by motor-based or spring-based assistive devices in slow, normal, and fast walking. We found that assistance from both actuation modes decreased muscle activations and net muscle moments to varying extents, depending on joint and walking speed, but they did not always reduce metabolic energy of muscles. Motor-based assistance was overall more effective than spring-based assistance, and spring-based assistance at times increased the metabolic energy. The largest metabolic energy reductions occurred with motor-based plantarflexion assistance, followed by motor-based hip flexion assistance, both more notably at higher speeds. Motor-based hip abduction assistance also reduced metabolic energy, somewhat inversely with walking speed. Spring-based assistance was overall less effective than motor-based assistance but did reduce metabolic energy with plantarflexion assistance in slow walking and with hip flexion assistance in fast walking. Knee extension assistance, regardless of actuation mode or walking speed, had little to no influence on metabolic energy. Our simulation findings do not support knee extension assistance at all, nor spring-based hip flexion assistance in slow walking or hip abduction assistance at any speed if a device goal is to reduce muscle activations. [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]

Introduction: Osteoarthritis of the knee is a debilitating disease. In most cases, only the medial compartments are affected. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are the two main procedures commonly used in the surgical treatment of unicompartmental knee osteoarthritis patients not responding to conservative treatment. The aim of our study was to compare UKA and biplanar medial open-wedge HTO in terms of patellofemoral changes and functional score in patients under 60 years of age with medial compartment arthrosis. Materials and methods: A retrospective study. A total of 79 patients (37 HTO, 42 UKA) who received one of the two treatments in a single center were examined preoperatively and at a single postoperative follow-up. Posterior tibial slope, lateral patellofemoral angle (LPFA), Q-angle, patellar height, Cincinnati Rating System and Knee Injury and Osteoarthritis Outcome Score (KOOS) functional scores were evaluated in all patients preoperatively and at the 6-month follow-up examination. Results: Insall-Salvati ratio remained stable in the HTO group, while there was a minor decrease in the UKA group and the changes between the groups were not statistically significant. Caton-Deschamps ratio increased in the UKA group and decreased in the HTO group, and this change was statistically significant (p < 0.001). LPFA did not change in the UKA group in the postoperative period, while it increased in the HTO group (p < 0.001). Changes in Q angle and Cincinnati Rating System scores were statistically similar between the UKA and HTO groups (p = 0.827 and p = 0.340). Conclusions: In our study, biplanar medial open-wedge HTO and UKA performed with appropriate surgical technique had no negative effect on patellofemoral joint. In patients under 60 years of age with medial compartment osteoarthritis of the knee, both surgical treatments can be performed with appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the long-term survivorship and functional outcomes of fixed-bearing lateral unicompartmental knee arthroplasty (UKA) in a young patients' population with osteoarthritis limited to the lateral compartment. Methods: The study included a cohort of consecutive patients who underwent lateral UKA between January 2008 and December 2014 at a single high-volume surgical center. The surgical procedures were performed by experienced surgeons using a lateral parapatellar approach and fixed-bearing implants. Patient follow-up included a retrospective re-evaluation, clinical assessments, patient-reported outcome measures (PROMs), and X-ray analysis. Results: A total of 40 lateral UKAs were analyzed, with 19 performed on the left and 21 on the right knee. The mean age of the patients at the time of surgery was 57.6 years, and the mean BMI was 24.8. At the final follow-up, 80% of patients achieved excellent outcomes (OKS > 41), and 20% had good outcomes (OKS: 34–41). No patients exhibited fair or poor outcomes. The mean FJS at the final follow-up was 82.8. The mean WOMAC was 10.5. Kaplan–Meier survival analysis revealed a survivorship rate of 93.1% at 10 years, considering revision for any reason as endpoint. Conclusions: Lateral UKA proved to be an effective treatment option for osteoarthritis affecting the lateral compartment of the knee. The study demonstrated a high survivorship rate and favorable functional outcomes at a mean follow-up of 132.7 months. These findings highlight the potential benefits of fixed-bearing lateral UKA in selected patients with lateral compartment knee pathology. [ABSTRACT FROM AUTHOR]

Introduction: This study was aimed to assess the return to sport (RTS) rate in patients who underwent CT-based robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and to evaluate the clinical performance and the assocition between patients' sport activity levels and Patient Reported Outcome Measures after surgery. Materials and methods: This retrospective study included 218 patients undergoing medial RA-UKA with fixed-bearing implants, performed at a single center between 2014 and 2019. Patients were allocated into two groups based on sport's practice and were administered the University of California, Los Angeles (UCLA) activity scale, Forgotten Joint Score-12 (FJS-12), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and the 5-Level Likert Scale. Results: A total of 136 patients were included for assessment. The overall RTS rate after surgery was 93.1%. Six subjects who did not practice sport preoperatively, were able to start sport activities after surgery and all patients performing sports preoperatively, returned to same activity level. The mean UCLA and FJS-12 scores in the group of patients practicing sports were significantly higher than in the no-sport group (p < 0.001 and p < 0.05, respectively). Patients who practiced sports were more likely to attain higher FJS-12 and UCLA scores than those who were not performing physical activity. Conclusions: Patients undergoing RA-UKA showed a 93.1% RTS rate after surgery. Differences were detected in terms of postoperative UCLA and FJS-12 scores between patients who performed and who did not practice sport activities after surgery. High levels of postoperative UCLA scores were associated with higher KOOS-JR and patients' satisfaction. [ABSTRACT FROM AUTHOR]

Background and aims: To our hypothesis on the evolutionary relationships of Cheilanthoid ferns, based on molecular data and partially on morphological and reproductive data, we add here a study of root anatomy in the genera of the subfamily occurring in South America. M&M: Root characters were analyzed anatomically in 48 South American species representing the 12 genera of Cheilanthoideae occurring in South America. Techniques of plant histology were used for anatomical analysis and tissue characterization. Characters with possible diagnostic value were identified and mapped on a molecular phylogeny of Cheilanthoideae based on three plastidial markers (rbcL, trnL-F and rps4). Results: The character "type of root cortex" showed a distribution of states that fit to the major clades or genera in the phylogeny of the subfamily. The homogeneous cortex state was plesiomorphic for Cheilanthoideae, whereas the heterogeneous cortex state was acquired by some genera of the hemionitoid clade: Hemionitis and the genera of the Adiantopsis-Doryopteris clade (except Mineirella). In addition, we discuss the role of different tissues in the root mechanics of this group. Conclusions: The character "type of root cortex" could contribute to the characterization of genera and the generic assignment of confusing species in the classification of Cheilanthoideae. However, the complete resolution of the relationship of hemionitds clade in the global phylogeny of the subfamily is necessary. [ABSTRACT FROM AUTHOR]

Leg health is an important consideration in a person's overall well-being, and knee osteoarthritis (OA) is one of the problems that reduces leg health. Thermotherapy therapy has long been recognized as one of the methods for treating knee OA pain. This study recruited 30 subjects with OA (aged 45–80, height of 155–175 cm, weight of 60–95 kg and body mass index of 18–40) to participate in a repeated measure for inter-subject and intra-subject analysis on pre- and post-treatment-based thermotherapy sessions where SpO2, pulse rate (PR) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were measured within 4 weeks of explorative study. When a subject is subjected to thermotherapy, SpO2 increases and PR decreases compared with those of the control group, which did not present significant differences. The findings show a high degree of inter- and intra-subject repeatability. When a subject received thermotherapy for 4 weeks, his or her overall leg health improved, as indicated by a high KOOS and high KOOS-pain score. This is demonstrated by an increase in KOOS over the course of 4 weeks of thermotherapy. [ABSTRACT FROM AUTHOR]

Gene therapy has the potential to facilitate targeted expression of therapeutic proteins to promote cartilage regeneration in osteoarthritis (OA). The dense, avascular, aggrecan‐glycosaminoglycan (GAG) rich negatively charged cartilage, however, hinders their transport to reach chondrocytes in effective doses. While viral vector mediated gene delivery has shown promise, concerns over immunogenicity and tumorigenic side‐effects persist. To address these issues, this study develops surface‐modified cartilage‐targeting exosomes as non‐viral carriers for gene therapy. Charge‐reversed cationic exosomes are engineered for mRNA delivery by anchoring cartilage targeting optimally charged arginine‐rich cationic motifs into the anionic exosome bilayer by using buffer pH as a charge‐reversal switch. Cationic exosomes penetrated through the full‐thickness of early‐stage arthritic human cartilage owing to weak‐reversible ionic binding with GAGs and efficiently delivered the encapsulated eGFP mRNA to chondrocytes residing in tissue deep layers, while unmodified anionic exosomes do not. When intra‐articularly injected into destabilized medial meniscus mice knees with early‐stage OA, mRNA loaded charge‐reversed exosomes overcame joint clearance and rapidly penetrated into cartilage, creating an intra‐tissue depot and efficiently expressing eGFP; native exosomes remained unsuccessful. Cationic exosomes thus hold strong translational potential as a platform technology for cartilage‐targeted non‐viral delivery of any relevant mRNA targets for OA treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unilateral osteoarthritis (OA) affects single knees and presents a unique scenario where individuals experience varying degrees of symptoms between their affected and unaffected knees. OBJECTIVE: This study aims to investigate differences in muscle tightness between symptomatic and asymptomatic knees in individuals with unilateral knee OA while exploring the interplay among pain, functionality, and muscle tightness. METHODS: In this cross-sectional study, thirty knee OA patients underwent assessments for hamstring (Active Knee Extension, Straight Leg Raise), iliotibial band (Ober Test), and quadriceps tightness (Modified Thomas Test). Pain intensity was measured using the Visual Analog Scale (VAS), and functional limitations were evaluated via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: A negative correlation was observed between participants' pain and AKE (p = 0.004, r = - 0.515), ASLR (p = 0.27, r = - 0.403), Ober (p = 0.010, r = - 0.461) values. However, no significant correlation was found with the Modified Thomas value (p = 0.204, r = - 0.239). There was also a negative correlation between participants' WOMAC scores and AKE (p = 0.019, r = - 0.427), OBER (p = 0.004, r = - 0.510), and Modified Thomas (p = 0.022, r = - 0.416) values, while ASLR (p = 0.286, r = - 0.202) values showed no significant correlation. Comparisons between AKE, Ober, and Modified Thomas values showed higher values in asymptomatic extremities (AKE: p = 0.025, Ober: p = 0.021, Modified Thomas: p = 0.030). CONCLUSION: This study emphasizes the significance of muscle tightness in the symptomatic extremities of individuals with unilateral knee OA. The results indicate that increased muscle tightness makes pain worse and limits movement. It's crucial for healthcare providers treating OA to focus on improving muscle flexibility, reducing pain, and enhancing overall function. [ABSTRACT FROM AUTHOR]

Background: There have not been any clear studies on the use of mesenchymal stem cells (MSCs) to treat osteoarthritis (OA) in the knee. Materials and Methods: This study investigates the effects of different MSC dosages on pain alleviation in individuals with OA in the knee by conducting a meta-analysis of existing randomized controlled trials. Electronic resources such as Google Scholar, PubMed, Cochrane Library, and Web of Science were searched up until June 2023. Treatment effect sizes were computed using the knee osteoarthritis outcome score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Random or fixed effect models were applied to aggregate the data. We performed a subgroup analysis according to dosage level. The heterogeneity of the research was investigated using the Chi-square test and the I2 index. Results: The meta-analysis included 26 studies with a total sample size of 739 patients. A significant reduction in pain was observed 1 year and 2 years following the injection of MSCs into the injured joint, as indicated by the Visual Analogue Scale, WOMAC, KOOS, and KSS indexes (P < 0.05). Patients on MSCs reported much reduced pain after 1 and 2 years compared to the control group (P < 0.05). Subgroup and meta-regression analyses revealed no statistically significant variations in the effectiveness of MSC dosage (P < 0.05). The studies did not report any adverse effects. Conclusion: Different dosages of MSCs had the same pain-relieving effects on patients with OA in the knee. MSC injections were safe and beneficial in such cases. [ABSTRACT FROM AUTHOR]

This study examined the effect of age and surface on patellofemoral joint (PFJ) stress magnitude and waveform during stair ascent and descent tasks. A total of 12 young and 12 older adults had knee biomechanics quantified while they ascended and descended stairs on normal, slick, and uneven surfaces. The peak of stance (0–100%) PFJ stress and associated components were submitted to a two-way repeated measures ANOVA, while the PFJ stress waveform was submitted to statistical parametric mapping two-way ANOVA. During stair ascent, older adults exhibited greater PFJ stress waveforms, from 55 to 59% and 74 to 84% of stance (p < 0.001) as well as greater PFJ stress–time integral across stance (p = 0.003), and later peak PFJ stress, than young adults (p = 0.002). When ascending on the uneven surface, participants exhibited smaller PFJ stress from 9 to 24% of stance compared to the normal surface, but greater PFJ stress from 75 to 88% and from 63 to 68% of stance (p < 0.001) as well as greater PFJ stress–time integrals compared to normal and slick surfaces (p < 0.032). During stair descent, older adults exhibited a smaller PFJ contact area range (p = 0.034) and peak knee flexion angle (p = 0.022) than young adults. When descending on the slick surface, participants exhibited smaller PFJ stress from 5 to 18% of stance, but greater stress, from 92 to 98% of stance (both: p < 0.001), compared to the normal surface. Negotiating slick and uneven stairs may produce knee biomechanics that increase PFJ stress, and the larger, later PFJ stress exhibited by older adults may further increase their risk of PFJ pain. [ABSTRACT FROM AUTHOR]

Background: Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power. Purpose: To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model. Results: The defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% ± 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up (P <.05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 ± 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P =.142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS (R 2 = 0.41; f 2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State (χ2 = 10.93; P =.012). Conclusion: The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs. [ABSTRACT FROM AUTHOR]

Background: Chondrocyte viability is associated with the clinical success of osteochondral allograft (OCA) transplantation. Purpose: To investigate the effect of distal femoral OCA plug harvest and recipient site preparation on regional cell viability using traditional handheld saline irrigation versus saline submersion. Study Design: Controlled laboratory study. Methods: For each of 13 femoral hemicondyles, 4 cartilage samples were harvested: (1) 5-mm control cartilage, (2) 15-mm OCA donor plug harvested with a powered coring reamer and concurrent handheld saline irrigation ("traditional"), (3) 15-mm OCA donor plug harvested while submerged under normal saline ("submerged"), and (4) 5-mm cartilage from the peripheral rim of a recipient socket created with a 15-mm cannulated counterbore reamer to a total depth of 7 mm with concurrent handheld saline irrigation ("recipient"). The 15 mm–diameter plugs were divided into the central 5 mm and the peripheral 5 mm (2 edges) for comparisons. Samples were stained using calcein and ethidium, and live/dead cell percentages were calculated and compared across groups. Results: Compared with the submerged group, the traditional group had significantly lower percentages of live cells across the whole plug (71.54% ± 4.82% vs 61.42% ± 4.98%, respectively; P =.003), at the center of the plug (72.76% ± 5.87% vs 62.30% ± 6.11%, respectively; P =.005), and at the periphery of the plug (70.93% ± 4.51% vs 60.91% ± 4.75%, respectively; P =.003). The traditional group had significantly fewer live cells in all plug regions compared with the control group (77.51% ± 9.23%; P <.0001). There were no significant differences in cell viability between the control and submerged groups (whole: P =.590; center: P =.713; periphery: P =.799). There were no differences between the central and peripheral 5-mm plug regions for the traditional (62.30% ± 6.11% vs 60.91% ± 4.75%, respectively; P =.108) and submerged (72.76% ± 5.87% vs 70.93% ± 4.51%, respectively; P =.061) groups. The recipient group (61.10% ± 5.02%) had significantly lower cell viability compared with the control group (P <.0001) and the periphery of the submerged group (P =.009) but was equivalent to the periphery of the traditional group (P =.990). Conclusion: There was a significant amount of chondrocyte death induced by OCA donor plug harvesting using a powered coring reamer with traditional handheld saline irrigation, which was mitigated by harvesting the plug while the allograft was submerged under saline. Clinical Relevance: Mitigating this thermally induced damage by harvesting the OCA plug while the allograft was submerged in saline maintained chondrocyte viability throughout the plug and may help to improve the integration and survival of OCAs. [ABSTRACT FROM AUTHOR]

Background: Pain is multifactorial, and pain intensity has been shown to be influenced by patients' thoughts. The Negative Pain Thoughts Questionnaire Short Form (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between negative pain thoughts and orthopaedic surgery outcomes is not known. Purpose: To evaluate the prevalence of negative pain thoughts in patients undergoing arthroscopic meniscectomy using the NPTQ-SF survey and assess the relationship these thoughts have to knee function, general health, pain, and satisfaction before and after surgery. Study Design: Case series; Level of evidence, 4. Methods: In total, 146 patients undergoing arthroscopic meniscectomy were administered the 4-item NPTQ-SF, 12-item Short Form Survey (SF-12), International Knee Documentation Committee (IKDC) questionnaire, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed at a minimum of 3 months and no later than 1 year postoperatively by 92 patients confirmed to have undergone meniscectomy. Results: NPTQ-SF scores were correlated with IKDC, SF-12, and satisfaction score preoperatively and at least 3 months postoperatively (mean, 108.5 ± 43.7 days). Preoperative NPTQ-SF scores were significantly negatively correlated with postoperative IKDC (R = −0.284), SF-12 (R = −0.266 and −0.328), and visual analog scale pain (R = 0.294) scores, while a relationship with postoperative satisfaction did not reach statistical significance (P =.067). Patients with a preoperative NPTQ-SF score >8 were less likely to achieve a Patient Acceptable Symptom State on the postoperative IKDC questionnaire (39% vs 63%; P =.03). Patients with a history of a psychiatric or chronic pain diagnoses have worse NPTQ-SF, SF-12, and IKDC scores pre- and postoperatively. Conclusion: The level of negative pain thoughts in patients undergoing meniscectomy is related to knee function, general health, and pain. Patients with a high level of negative pain thoughts are less likely to achieve a favorable outcome from meniscectomy, with a score ≥8 representing a clinically significant threshold for preoperative screening. [ABSTRACT FROM AUTHOR]

Background: The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients. Purpose: This systematic review and meta-analysis was performed to investigate any association between PTS and ACL tears in the pediatric population. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was performed to identify studies that examined the relationship between PTS, medial tibial slope (MTS), and lateral tibial slope (LTS) and ACL tears in children and adolescents aged ≤18 years. Full-text observational studies comparing PTS, MTS, and/or LTS values between pediatric (≤18 years of age) patients with and without ACL injury were included in this analysis. Review articles and case series were excluded. The authors calculated the mean difference (MD) via a restricted maximum-likelihood estimator for tau square and a Hartung-Knapp adjustment for random-effects model. Results: A total of 348 articles were identified in the initial database search, yielding 10 for final inclusion and analysis. There was no statistically significant association between PTS (MD, 1.13°; 95% CI, –0.55° to 2.80°; P =.10), MTS (MD, 0.36°; 95% CI, –0.37° to 1.10°; P =.27), or LTS (MD, 1.41°; 95% CI, –0.20° to 3.02°; P =.075) and risk for ACL injury in this population. Conclusion: The current study found that unlike what has been shown in adult populations, increased PTS may not be a significant risk factor for ACL tears in pediatric and adolescent patents. LTS was the only measured parameter that neared statistical significance, perhaps suggesting a potential role for this measurement in determining ACL risk if further research is done in this population. [ABSTRACT FROM AUTHOR]

The treatment of osteochondritis dissecans of the knee has always been a challenge for orthopedic surgeons. We present a case report of a 38-year-old male with severe right knee pain after suffering from an indirect trauma and axial rotation of the knee, limiting knee functionality and impeding his ability to walk, with a diagnosis of osteochondritis dissecans in the trochlea of the knee, who underwent arthroscopic treatment with matrix-induced autologous chondrocyte implantation (MACI). After the surgery, a physical therapy protocol for MACI was implemented, and magnetic resonance images with cartilage mapping were used to evaluate the recovery of the lesion. A total recovery was observed and evaluated with the modified Cincinnati knee rating system (mCKRS). A discussion is provided with evidence and general recommendations for the use of MACI in the treatment of adult OCD of the knee as a possible alternative to conventional treatments. Our case shows a rapid improvement in pain and functionality 2 months after surgery that progressed to full recovery within 6 months. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a commonly performed surgery aimed at alleviating pain and improving functionality. However, patients often face uncertainties in selecting the timing, location, and type of TKA implant that best meets their needs. This study aims to comprehensively compare various variables, explore trends, and identify factors potentially influencing TKA outcomes. A cohort of 40 TKA subjects received either unilateral posterior stabilized (Persona) TKA or bi-cruciate stabilized (Journey II) TKA. Additionally, 20 healthy controls matched for age, gender, and BMI were included. Participants underwent patient-reported outcome assessments, range of motion evaluations, balance assessments, proprioception tests, and biomechanical analyses. These analyses covered motion, loading, and electromyography during five daily activities and two clinical tests. Multifactor ANOVA was utilized to compare 283 variables and assess their impact on TKA outcomes. A knee biomechanics index was formulated to evaluate deviations from healthy norms. Significant differences were observed in EMG varus/valgus rotation during both ramp-up and ramp-down phases between the two implant groups. Although significant improvements were noted post-TKA for both implants, the results remained below those of the control group. Gender, age, and BMI exhibited noticeable effects on TKA outcomes across several biomechanical variables and demonstrated significant disparities compared to the controls. [ABSTRACT FROM AUTHOR]

This study evaluates the utility of OpenCap (v0.3), a smartphone-based motion capture system, for performing gait analysis in patients with neurological disorders. We compared kinematic and kinetic gait parameters between 10 healthy controls and 10 patients with neurological conditions, including stroke, Parkinson's disease, and cerebral palsy. OpenCap captured 3D movement dynamics using two smartphones, with data processed through musculoskeletal modeling. The key findings indicate that the patient group exhibited significantly slower gait speeds (0.67 m/s vs. 1.10 m/s, p = 0.002), shorter stride lengths (0.81 m vs. 1.29 m, p = 0.001), and greater step length asymmetry (107.43% vs. 91.23%, p = 0.023) compared to the controls. Joint kinematic analysis revealed increased variability in pelvic tilt, hip flexion, knee extension, and ankle dorsiflexion throughout the gait cycle in patients, indicating impaired motor control and compensatory strategies. These results indicate that OpenCap can effectively identify significant gait differences, which may serve as valuable biomarkers for neurological disorders, thereby enhancing its utility in clinical settings where traditional motion capture systems are impractical. OpenCap has the potential to improve access to biomechanical assessments, thereby enabling better monitoring of gait abnormalities and informing therapeutic interventions for individuals with neurological disorders. [ABSTRACT FROM AUTHOR]

Current surgical practices in total knee arthroplasty (TKA) have advanced and include significant changes and improvements in alignment philosophies, femorotibial implant conformities, and ligament management to replicate in vivo knee kinematics. While corrective measures have emphasized sagittal plane alignment to restore normal flexion–extension (F–E) motion and coronal plane ligament balance, internal–external (I–E) rotation kinematics in the axial plane have been largely neglected. Recent in vivo evidence indicates that the combination of factors necessary to closely restore native tibial rotation as the knee flexes and extends is kinematic alignment (KA), which resurfaces the patient's pre-arthritic knee without releasing ligaments, an insert with medial 1:1 ball-in-socket conformity and a lateral flat surface, and posterior cruciate ligament (PCL) retention. However, the inherent anterior–posterior (A–P) stability provided by the medial 1:1 ball-in-socket limits the surgeon's ability to select the correct insert thickness using manual laxity testing. Accordingly, this review presents the design and validation of an instrument called an insert goniometer that measures I–E tibial rotation for inserts that differ in thickness by 1 mm and uses rotation limits at extension and 90° flexion to select the optimal insert thickness. The optimal thickness is the one that provides the greatest external tibial orientation in extension and internal tibial orientation at 90° flexion without lift-off of the insert. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of technique asymmetry on 500 m straight-track speed skating performance. We analyzed 20 elite skaters, measuring their joint angles, center of mass shift, and times and speeds during the gliding and push-off phases. The technique asymmetry index (ASI) was calculated for each parameter, and paired t-tests were used to compare bilateral asymmetry. Spearman correlation coefficients assessed the relationship between the ASI and both the average straight track speed and overall performance. Significant bilateral asymmetries in the knee, push-off, trunk, and hip angles were found in both male and female participants (p < 0.05). The male participants demonstrated a higher right push-off speed (p = 0.029) and a longer left gliding time (p = 0.048). Significant asymmetry was also observed in the lateral shift of the center of mass during each phase of the straight-track skating gait cycle (p < 0.001). No significant correlation was found between the ASIs and the overall performance (p ≥ 0.067). These findings indicate that while elite speed skaters demonstrated significant bilateral technique asymmetry in straight track skating, these asymmetries did not significantly impact their overall performance. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) is an age-dependent disease dominantly affected by mechanical loading. Balancing the forces acting on the medial knee compartment has been the focus of KOA interventions. This pilot study investigated the effects of functional electrical stimulation (FES) of the biceps femoris and lateral gastrocnemius on reducing peak knee adduction moment (pKAM) in healthy adults and individuals with medial KOA while stepping on an instrumented elliptical system. Sixteen healthy individuals and five individuals with medial KOA stepped on the robotic stepping system, which measured footplate-reaction forces/torques and ankle kinematics and calculated 3-D knee moments in real time using inverse dynamics. Participants performed four different tasks: regular stepping without FES as the baseline condition, stepping with continuous FES of the lateral gastrocnemius (FESLG), biceps femoris (FESBF), and simultaneous FES of both lateral gastrocnemius and biceps femoris (FESLGBF), throughout the elliptical cycle. The 3-D knee moments, tibia kinematics, and footplate-reaction forces were compared between the baseline and the three FES stepping conditions. Healthy participants demonstrated lower pKAM during each of the three FES conditions compared to baseline (FESLG (p = 0.041), FESBF (p = 0.049), FESLGBF (p = 0.048)). Participants with KOA showed a trend of lower pKAM during FES, which was not statistically significant given the small sample available. Incorporating elliptical + FES as a training strategy is feasible and may help to enhance selective force generation of the targeted muscles and reduce the medial knee compartment loading. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bicruciate-retaining (BCR) total knee arthroplasty (TKA) has seen renewed interest due to the potential for more natural knee kinematics with anterior cruciate ligament (ACL) retention. OBJECTIVE: The present study attempts to determine differences in the 2-year survivorship and patient-reported outcomes between two surgical strategies (traditional instrumentation versus robotics) applied to the extensive use of a modern, 2nd generation BCR TKA design. METHODS: We performed a retrospective study with prospectively collected data of 113 patients who underwent primary TKA between 2018 and 2020 using a 2nd generation BCR TKA implant. Patient demographics, PROMS, and intra/post-operative complications were collected. Patients were also evaluated according to the use or not of robotics. A Kaplan-Meier analysis was used to evaluate revision-free survival at follow up. RESULTS: 102 patients were enrolled: 90 received traditional surgery and 12 robotic-assisted surgery. The mean age was 68 years (SD 7.76) with an average BMI of 29.6 kg/m2 (SD 3.56). The mean follow up (FU) was 32.4 ± 6.2 months (range 24–45 months). Survivorship at 2 years was 98% (95% CI: 92.4–99.5). Revisions/reoperations were performed for anterior cruciate ligament (ACL) tear (1/4), pain (1/4), arthrofibrosis (1/4) and acute periprosthetic joint infection (PJI) (1/4). At final FU, 92 patients (90.2%) considered themselves satisfied, showing a mean OKS of 40.6 (SD 5.1) and a mean FKS of 76.7 (SD 11.8). No differences in the outcome were found between traditional and robotic-assisted procedures. CONCLUSION: The modern BCR design evaluated in this study achieved excellent results in terms of implant survivorship, low rate of reoperation and clinical results, independently from the use of enabling technologies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Robotic-assisted total knee arthroplasty (TKA) have shown promising results in recent years with improved clinical outcomes using standard primary implants. OBJECTIVE: The purpose of this study was to assess the experience of a single center in correcting severe coronal deformities with the use of a robotic-assisted TKA system and an increased constrained implant. METHODS: Between July 2020 and December 2022, 30 knees in 28 patients with a major deformity and an associated ligament laxity requiring an increased constrained implant treated using an imageless robotic-assisted TKA were prospectively enrolled. Patients included in the study showed a minimum 15 degrees varus or 10 degrees valgus deviation. RESULTS: 20 cases were varus knees and 10 cases were valgus knees. Postoperative neutral alignment was defined as 0∘ ± 2.5∘. A CCK implant was used in 20 cases while a Constrained Posterior Stabilized implant was used in 10 cases. A neutral alignment was achieved in all patients. At a minimum 6 months follow up (f-u 6–30 months) clinical outcomes including ROM, KSS, HSS, OKS and WOMAC showed significant improvement and no major complications were registered. CONCLUSIONS: The robotic system showed the achievement of a mechanical alignment with reliable radiographic outcomes and clinical results in the treatment of major deformities of the lower limb with the use of higher constrained implants at short term follow up. Further follow up and studies are necessary to confirm and verify these promising outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain. OBJECTIVE: This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA). METHODS: The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis. RESULTS: This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25–2.37]). Overall, most studies showed low risk of bias, except one with higher bias. CONCLUSION: This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures. [ABSTRACT FROM AUTHOR]

BACKGROUND: The extent of the association between vitamin D deficiency and knee osteoarthritis remains inadequately understood. OBJECTIVE: This study aimed to elucidate the relationship between vitamin D levels and knee osteoarthritis through a cross-sectional analysis. METHODS: This retrospective study involved an analysis of knee radiographs and serum 25-hydroxyvitamin D3 (25-(OH) vitamin D3) levels in a cohort of 3424 individuals (2901 women and 523 men). Knee osteoarthritis severity was evaluated using the Kellgren-Lawrence radiological scoring system. RESULTS: Of the participants, 49.2% (n = 1,683) were diagnosed with knee osteoarthritis. Among these patients, the levels of adjusted 25-(OH) vitamin D3 were significantly lower (p < 0.001). Regression analysis revealed a significant association between vitamin D deficiency and knee osteoarthritis, with an adjusted odds ratio (OR) of 1.7 (95% CI: 1.5–2.0; p < 0.001). Notably, a stronger association was observed between vitamin D deficiency and knee osteoarthritis in women under 65 compared to those aged 65 and above. CONCLUSIONS: The findings of this study indicate a higher prevalence of vitamin D deficiency in patients with knee osteoarthritis. Maintaining adequate serum 25-(OH) vitamin D3 levels may prevent knee osteoarthritis, especially in women below 65. [ABSTRACT FROM AUTHOR]

Existing patellofemoral pain (PFP) literature has primarily been focused on quadriceps muscle volume, with limited attention given to the deep and superficial muscle volume of the lower limbs in individuals with unilateral and bilateral PFP. In this paper, we aim to fill this gap. To explore superficial and deep lower extremity muscle volume in women with unilateral or bilateral PFP compared with a normative database of pain-free women. Cross-sectional study. University imaging research center. Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women from a normative database. We quantified lower extremity muscle volume via 3.0-T magnetic resonance imaging. Two separate 1-way analyses of variance were performed: (1) unilateral PFP (painful versus nonpainful limb) versus pain-free control groups and (2) bilateral PFP (more painful versus less painful limb) versus pain-free control groups. We observed no differences in age and body mass index across groups (P >.05). Compared with the pain-free group, the unilateral and bilateral PFP groups had bilaterally smaller volumes of the anterior (iliacus: P ≤.0004; d range, 2.12–2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤.02; d range, 1.25–2.48), posterior (obturator externus, obturator internus, and quadratus femoris: P <.05; d range, 1.17–4.82), and lateral (gluteus minimus: P ≤.03; d range, 1.16–2.09) hip muscles and knee extensors (rectus femoris: P ≤.003; d range, 1.67–2.16) and flexors (long and short head of the biceps femoris: P ≤.01, d range, 1.56–1.93). Women with unilateral and those with bilateral PFP displayed less volume of multiple superficial and deep muscles of the bilateral hips and knees than pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to increase choices for intervention. [ABSTRACT FROM AUTHOR]

Introduction: The key outcome of joint registries is revision events, which inform clinical practice and identify poor‐performing implants. Registries record revision events and reasons, but accuracy may be limited by a lack of standardized definitions of revision. Our study aims to assess the accuracy and completeness of unicompartmental knee arthroplasty (UKA) revision and indications reported to the New Zealand Joint Registry (NZJR) with independent clinical review. Methods: Case record review of 2272 patients undergoing primary UKA at four large tertiary hospitals between 2000 and 2017 was performed, identifying 158 patients who underwent revision. Detailed review of clinical findings, radiographs and operative data was performed to identify revision cases and the reasons for revision using a standardized protocol. These were compared to NZJR data using chi‐squared and Fisher exact tests. Results: The NZJR recorded 150 (95%) of all UKA revisions. Osteoarthritis progression was the most common reason on the systematic clinical review (35%), however, this was underreported to the registry (8%, P < 0.001). A larger proportion of revisions reported to the registry were for 'pain' (30% of cases vs. 5% on clinical review, P < 0.001). A reason for revision was not reported to the registry for 10% of cases. Conclusion: The NZJR had good capture of UKA revisions, but had significant differences in registry‐reported revision reasons compared to our independent systematic clinical review. These included over‐reporting of 'pain', under‐reporting of osteoarthritis progression, and failing to identify a revision reason. Efforts to improve registry capture of revision reasons for UKA could be addressed through more standardized definitions of revision and tailored revision options for UKA on registry forms. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Aerobic exercise may be an effective treatment for knee osteoarthritis and central sensitization, but no interventional studies have examined its effects. In this study, the patient showed improvement in central sensitization, pain, and autonomic nervous system activity after aerobic exercise using an arm ergometer. [ABSTRACT FROM AUTHOR]