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A 13-year-old female recreational soccer player presented with spontaneous left knee effusion approximately 2 weeks after the start of soccer season. Radiographic imaging was negative, and a complete blood count identified an increase in inflammatory markers. Additional two-tier testing confirmed a Lyme disease diagnosis, which was unusual for an athlete residing in the southeast region of the United States. The presentation of knee effusion, and subsequently Lyme arthritis, is a common clinical manifestation of late-stage Lyme disease. Early recognition of this infection and prompt treatment by a variety of specialists reduce the severity or chronicity of symptoms.

Objectives To evaluate the self-reported incidence of sleep disturbances, defined as ≤7 hours of sleep per 24-hour period, in patients undergoing arthroscopic-assisted knee surgery. Methods Patients who underwent arthroscopic knee surgery over the course of a 4-month period were prospectively included. Patients were excluded if a history of insomnia or other sleep altering medical history was reported. Self-reported sleep metrics included average number of hours of sleep per night, average number of awakenings during sleep per night, perceived quality of sleep, average pain level during sleep and number of hours of physical activity/therapy per week. Data were collected at weeks 1, 3, and 6 postoperatively. Joint circumference was measured on postoperative day 1 and served as an indicator of a knee effusion. Paired t-tests were used to compare preoperative to postoperative hours of sleep. Simple and multiple linear regression were used to evaluate relationships between surgical variables and postoperative sleep metrics. Results There were 123 patients who underwent arthroscopic knee surgery during the prospective enrolment period; 83 patients were included in the final analysis. The overall incidence of preoperative sleep disturbances was 20% (n=17). The overall incidence of self-reported postoperative sleep disturbances was 99%, 96% and 90% at weeks 1, 3 and 6, respectively. The average number of hours slept was significantly reduced at 1, 3 and 6 weeks postoperatively compared with the preinjury state (p 0.05). Conclusion Sleep disturbances were commonly reported in patients following arthroscopic knee surgery without correction of sleep metrics by 6 weeks postoperatively. The majority of sleep disturbances in this cohort correlated with an increased knee effusion. A multidisciplinary team approach is recommended to counsel patients regarding the potential for and problems with acute sleep disturbances following arthroscopic knee surgery. Level of evidence: 3.

The present study aims to report a symptomatic rare anatomical variation of the posterior cruciate ligament (PCL) that was encountered during arthroscopy. A 34-year-old female suffered from dull anterior pain in the right knee, along with stiffness and the presence of an audible click and occasionally locking during deep knee flexion. Physical examination revealed only slight pain during single-leg squatting and mild knee effusion with painful limitation of the last degrees of flexion. Following unsuccessful conservative treatment, knee arthroscopy was performed in which the PCL was found to be hypertrophic, having a broad femoral insertion that almost completely occupied the intercondylar notch and impinged the anterior cruciate ligament. Moreover, the PCL presented a large medial synovial fold that formed a plica inserting to the medial meniscus's posterior horn. Ligamentoplasty was performed by excising one-third of the PCL lateral portion. The PCL medial synovial fold and the plica attaching to the medial meniscus were resected. The patient was allowed to return to full activity when her symptoms resolved, and the knee function was restored, at 5 weeks post-operatively. The current study presented a rare and complex anatomical variation of the PCL that was symptomatic and recalcitrant to conservative treatment. Magnetic resonance imaging (MRI) can reveal the variant morphology of the PCL, and arthroscopy provides the definite treatment. This case report may be useful for orthopaedic surgeons and radiologists to consider anatomical PCL variations during differential diagnosis in patients with non-specific clinical presentation and findings.

Introduction: Knee pain and swelling are known amongst orthopedic surgeons as symptoms of a local pathology arising from the knee joint area. It is also often used by patients as an ‘umbrella term’. Although in most cases the causative pathology may be the knee joint itself, however, this umbrella term can cause prejudice among clinicians to look at only locally and not think of a lumbar pathology as a cause of knee pain and swelling. The objective of this pilot study was to make clinicians aware that causes knee pain and swelling may be beyond the anatomical confinements of the knee. Material and Methods: This is a prospective study in which we evaluated consecutive patients with non-traumatic knee joint pain and effusion coming in our hospital from 1st January to 1st February 2020. Detailed history and clinical examination were taken. After ruling out obvious causes of non-traumatic knee pain and effusion in these patients, we included 38 patients based on our inclusion and exclusion criteria. Written informed consent was taken. They were evaluated for knee joint with radiographs and lumbar spine with radiographs and MRI. Arthrocentesis and synovial fluid evaluation were done.Results: After synovial fluid examination, 2 patients were found to have subclinical inflammatory arthritis and were excluded out of the study. 36 of the 38 patients had a normal study on arthrocentesis. 2 out of these 36 patients had no abnormalities on spine MRI. Out of the remaining 34, 30 had disc degenerative disease at L45 or L5S1 (25 patient L4-5, 3 patient L5-S1, 4 patients with both L4-5 and L5-S1), 1 patient had a L34 disc degenerative disease, 3 patients had Grade 2 L45 spondylolisthesis with mild or no back pain. Conclusion: Although a disc degeneration can be seen incidentally in many asymptomatic patients, based on our observations we think that causes like “autonomic” overload can be one of the unheard reasons of knee pain and effusion. The clinician must be aware of possible causes of knee pain and swelling beyond the anatomical confinements of knee and that lumbar spine pathology need also to be ruled out. The clinician must not let prejudice rule his clinical judgement. We don’t claim direct association of lumbar disc degeneration and knee pain and swelling in this study. Further studies are needed.

Aim of this work: To assess the magnetic resonance imaging (MRI) findings compared to plain X-ray in patients with primary nodal osteoarthritis (OA) of first the carpometacarpal (CMC) joint of the thumb. Patients and methods: This study included 35 Egyptian patients with primary nodal hand OA (HOA) and 15 healthy subjects of matched age. Each subject had plain X-rays graded by Kellgren and Lawrence (K–L) score for HOA. MRI testing of both hands done by using T1/T2 weighted axial and coronal images. Results: The mean age was 57.2 ± 8.3 years (45–72 years) and they were 24 females and 11 males. Disease duration of patients ranged (8 months to 10 years, 2.04 ± 1.06 years). In all HOA patients there were signs of knee OA involvement; synovial thickening in 51.4% of patients, knee effusion in 8.6%, limited knee ROM in 28.6% and night pain in 60%. There was a superiority of the MRI in detecting synovitis (71.4%), flexor tenosynovitis (71.4%), collateral ligament (60%), bone marrow lesion (85.7%) and cysts (57.1%) compared to the X-ray which could not detect them. MRI significantly detected osteophytes (88.6%), joint space narrowing (91.4%), erosions (85.7%) and malalignment (57.1%) compared to X-ray (51.4%, 62.9%, 34.3% and 14.3% respectively) (p

A 9‐month‐old baby presented with sudden inability to stand and unable to move his leg. Clinical examination showed edema and knee effusion. Blood tests and MRI confirmed septic knee arthritis without bone involvement. He was treated with arthroscopic lavage. He had a complete recovery and normal growth., Appropriate evaluation of clinical and laboratory findings combined with the MRI results in accurate diagnosis of septic arthritis in infants. Arthroscopic management is a convenient method, leaving a minimal scar.

Objective: A review of the anatomy of the synovial recesses of the knee is important to better understand the different effusion presentations, update the diagnosis criteria of knee effusion based on the measured synovial recesses and discuss the differentiation of some effused recesses from other lesions around the knee. Method: This review focuses on the anatomy of the synovial recesses of the knee and classifies them into three groups (anterior, parameniscal, and posterior recesses), as well as provides an overview on the etiology of knee effusion, its sonographic detection, and diagnosis criteria. Results: Knee effusion is a very common pathological finding in sonography of the knee. The unique joint structure of the knee provides the possibility to host complex synovial recesses. Fluid in some of the synovial recesses is valuable for the diagnosis of knee effusion, while in certain situations, some recesses may impose diagnostic uncertainty. Knowledge of these synovial recesses is essential to avoid diagnostic pitfalls. Conclusion: This review provides an important discussion of the differentiation of some recesses effusions from other lesions around the knee.

The tibia is an atypical site of osteomyelitis (OM) in adults, and patients with this infection experience a significant degree of morbidity as well as the need for prolonged aggressive antibiotic therapy. The early diagnosis of OM remains challenging, and often relies on imaging modalities which are of variable sensitivity. We present a case of a 49-year-old male with a methicillin resistant Staphylococcus aureus (MRSa) left tibial OM, contiguous left knee septic arthritis, and concurrent bacteraemia. Eight days after the onset of pain in the left knee and lower limb, conventional radiography and computed tomography (CT) imaging had only subtleties of a soft tissue collection and a knee effusion. A MRI demonstrated significant involvement of his tibial bone with a collection, from which surgical specimens confirmed MRSa. This case demonstrates the difficulty of diagnosing early acute OM with conventional radiography and CT imaging, even after a week of symptoms in the affected limb. Given the poor sensitivity of conventional radiography and CT in the diagnosis of early acute OM, this case report illustrates how MRI is the imaging modality of choice in this setting.

Basaran, Murat Alper/0000-0001-9887-5531 WOS: 000551478900021 PubMed: 31771037 BACKGROUND: Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain. OBJECTIVE: To evaluate pain-related soft tissue structures of the knee with ultrasonography. METHODS: This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated. RESULTS: Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times. CONCLUSION: Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.

Introduction: Osteoarthritis (OA) is a common joint disorder, with the knee being one of the most frequently involved sites. Knee OA causes pain and stiffness and can lead to considerable disability and consequently to impaired quality of life. Aim of the work: Clinical evaluation of participant with painful knee OA to detect the possible causes of pain knee OA.Patients and Methods: Our study included 50 knee OA patients, attending to Sohag university hospitals rheumatology and rehabilitation outpatient clinic. They were divided according to pain into 2 groups. Group 1 with painful OA and group 2 with painless OA. Both groups were age and sex-matched.Results: Our study showed that the group 1 participants had more varus deformities, more and significant effusion and Baker cyst. Among painful OA patients, all factors showed non-significant relation to the degree of VAS.Conclusion: Our study found that knee effusion and Baker cyst were the main possible causes of pain in knee OA.

Aim of the work: To investigate serum and synovial fluid levels of IL-17 in rheumatoid arthritis (RA) patients, and its correlation with disease activity and severity. Patients and methods: 20 RA patients together with 20 primary knee osteoarthritis (KOA) patients and 15 healthy individuals matched for age and sex as control groups were enrolled in this study. Both RA and KOA patients presented with knee effusion. Paired samples of serum and synovial fluid (SF) were collected from RA, OA patients and serum samples from the healthy individuals. RA disease activity was assessed using DAS-28 score and power Doppler ultrasound (PDUS) according to the European League against Rheumatism (EULAR). Radiographic damage was evaluated according to Larsen score. Results: Serum levels of IL-17 were significantly elevated in RA patients compared to controls (p

Background Joint injury is a major risk factor for osteoarthritis and provides an opportunity to prospectively examine early processes associated with osteoarthritis. We investigated whether predefined baseline demographic and clinical factors, and protein analytes in knee synovial fluid and in plasma or serum, were associated with clinically relevant outcomes at 2 years after knee injury. Methods This longitudinal cohort study recruited individuals aged 16–50 years between Nov 1, 2010, and Nov 28, 2014, across six hospitals and clinics in London, UK. Participants were recruited within 8 weeks of having a clinically significant acute knee injury (effusion and structural injury on MRI), which was typically treated surgically. We measured several predefined clinical variables at baseline (eg, time from injury to sampling, extent and type of joint injury, synovial fluid blood staining, presence of effusion, self-reported sex, age, and BMI), and measured 12 synovial fluid and four plasma or serum biomarkers by immunoassay at baseline and 3 months. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS4) at 2 years, adjusted for baseline score, assessed in all patients. Linear and logistic regression models adjusting for predefined covariates were used to assess associations between baseline variables and 2-year KOOS4. This study is registered with ClinicalTrials.gov, number NCT02667756. Findings We enrolled 150 patients at a median of 17 days (range 1–59, IQR 9–26) after knee injury. 123 (82%) were male, with a median age of 25 years (range 16–50, IQR 21–30). 98 (65%) of 150 participants completed a KOOS4 at 2 (or 3) years after enrolment (50 participants were lost to follow-up and two were withdrawn due to adverse events unrelated to study participation); 77 (51%) participants had all necessary variables available and were included in the core variable adjusted analysis. In the 2-year dataset mean KOOS4 improved from 38 (SD 18) at baseline to 79 (18) at 2 years. Baseline KOOS4, medium-to-large knee effusion, and moderate-to-severe synovial blood staining and their interaction significantly predicted 2-year KOOS4 (n=77; coefficient −20·5, 95% CI −34·8 to −6·18; p=0·0060). The only predefined biomarkers that showed independent associations with 2-year KOOS4 were synovial fluid MCP-1 (n=77; −0·015, 0·027 to −0·004 per change in 1 pg/mL units; p=0·011) and IL-6 (n=77; −0·0005, −0·0009 to −0·0001 per change in 1 pg/mL units; p=0·017). These biomarkers, combined with the interaction of effusion and blood staining, accounted for 39% of outcome variability. Two adverse events occurred that were linked to study participation, both at the time of blood sampling (one presyncopal episode, one tenderness and pain at the site of venepuncture). Interpretation The combination of effusion and haemarthrosis was significantly associated with symptomatic outcomes after acute knee injury. The synovial fluid molecular protein response to acute knee injury (best represented by MCP-1 and IL-6) was independently associated with symptomatic outcomes but not with structural outcomes, with the biomarkers overall playing a minor role relative to clinical predictors. The relationship between symptoms and structure after acute knee injury and their apparent dissociation early in this process need to be better understood to make clinical progress. Funding Versus Arthritis, Kennedy Trust for Rheumatology Research, and NIHR Oxford Biomedical Research Centre.

Background: Intra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion. Material and methods: Patients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS). Result: 132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P

Aim of the work: To investigate the vascular endothelial growth factor (VEGF) levels in serum and synovial fluid of patients with knee osteoarthritis (KOA) and to determine the relationship of VEGF levels with clinical manifestation, physical function, radiographic grading and ultrasonography (US) findings. Patients and methods: 45 patients with KOA and 15 matched control subjects were enrolled. Western Ontario McMaster Osteoarthritis index (WOMAC) was scored, knee X-rays assessed using Kellgren and Lawrence (KL) scale and superficial gray scale and colour Doppler US were done. Serum and synovial VEGF levels were analyzed. Results: The 45 patients mean age was 56.5 ± 11.2 years; 39 females and 6 males (F:M 6.5:1). 30 (66.7%) patients had bilateral symptomatic KOA. Knee effusion was mild in 4, moderate in 26 and severe in 21. The mean WOMAC score was 70.9 ± 10.7; pain (14.7 ± 3.4); stiffness (6.2 ± 1.4) and disability (49.2 ± 12.4). The serum VEGF level was 0.29 ± 1.02 pg/ml and the synovial 0.48 ± 0.1 pg/ml both significantly increased compared to the control (0.14 ± 0.7 pg/ml and 0.33 ± 0.1 respectively, p

IntroductionSymptomatic treatments for osteoarthritis (OA) provide only small-to-moderate efficacy over placebo in randomised controlled trials (RCTs). Treatment guidelines therefore have emphasised the need to identify predictors of treatment response through subgroup and multiple regression analysis. Individual participant data (IPD) meta-analysis is recommended as an efficient approach for this purpose. To our knowledge, this has not been undertaken for oral non-steroidal anti-inflammatory drugs (NSAIDs), including paracetamol, in OA. In this IPD meta-analysis, we aim to identify RCTs with specific mechanistic features related to OA pain, such as joint inflammation. We hypothesise that NSAIDs may work better for participants with joint inflammation, whereas paracetamol may not.Methods and analysisA comprehensive literature search will be conducted on the databases of Web of Science, Embase, Medline, CINAHL, AMED and the Cochrane Library from 1 January 1998 to 1 December 2020. All RCTs related to oral NSAIDs or paracetamol including placebo-controlled trials in people with OA that have evaluated pain-related peripheral risk factors (eg, clinically detected knee effusion, synovial hypertrophy or effusion on imaging, knee morning stiffness, elevated serum C-reactive protein (CRP) level) and/or central pain risk factors (eg, pain elsewhere, depression, anxiety, sleep disturbance) will be retrieved. The outcome will be change in pain from baseline. Change in function and patient global assessment will also be included as outcomes if available. Investigators of all eligible trials will be contacted for IPD. Multilevel regression models will be used to identify predictors for the specific (active–placebo) and the overall treatment effect (change from baseline in active group).Ethics and disseminationNo identifiable data will be included in this study and no formal ethics approval is required as no new data collection will be processed. Results of this hypothesis-driven IPD meta-analysis will be disseminated through conference presentations and publication in peer-reviewed journals.PROSPERO registration numberCRD42020165098.

A 40-year-old previously healthy woman presented to the Rheumatology department with suspected arthritis because of bilateral lower limb pain, swelling, and difficulty walking for the last six months. Physical examination revealed multiple subcutaneous hematomas, gingival hyperplasia, bilateral knee effusion, lower extremities muscle weakness, and right hip joint movement limitation. The laboratory tests were remarkable only for iron and folate deficiency normocytic anemia (Hemoglobin 9 mg/dl). The Magnetic Resonance Imaging (MRI) findings in the coronal STIR sequence of the hips (Image A) revealed bone marrow edema in the right proximal femur (femoral head, neck, intertrochanteric and subtrochanteric regions), right hip joint effusion, edema of the right buttock muscles and bilateral proximal thigh muscles, and perifascial edema around bilateral external obturator muscles; similar changes were demonstrated on the right knee coronal and sagittal T2-weighted fat saturated MRI (Images B, C). Vitamin C's undetectable blood levels confirmed Scurvy; treatment with Vitamin C and Multivitamins led to full recovery. Subsequently, we found out that the patient suffers from a selective eating disorder and has restricted her diet to rice and non-fortified yogurt.

Knee effusion can be detected by physical examination, ultrasound and MRI, but the utility of each test is unclear. This study aimed to analyze the diagnostic value of physical examination and ultrasound for knee effusion. A systematic literature search of electronic databases was completed. Bivariate mixed-effects regression modelling was used to estimate sensitivity, specificity and diagnostic odds ratio of physical examination and ultrasound diagnosis of knee effusion. Sensitivity of ultrasound diagnosis of knee effusion was higher than the bulge sign and patellar tap, leading to improved positive and negative predictive values.

A 7-year-old boy presented with a 1-week history of a limp, low grade temperature and mildly elevated inflammatory markers. He sustained a fall 2 weeks ago but was relatively symptom free for a week. The inital physical exam demonstrated a knee effusion clinically, radiographs did not demonstrate any overt pathology and biochemical testing demonstrated an elevated C reactive protein of 8 mg/L. An arthroscopy was conducted, with a plan for synovial biopsies to investigate for infective versus inflammatory arthritis as a cause for the effusion. An isolated lateral meniscal tear was discovered. This was repaired using all inside technique with Smith and Nephew’s FastFix 360 (R) suture anchors. It is quite uncommon to find isolated lateral meniscus tears in this population, but the learning point demonstrates it is important to arthroscopically examine the whole knee, even while performing synovial biopsies as there may be unexpected findings.

Background To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models. Methods A population-based cohort (n = 122) with knee pain, aged 40–79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike’s information criterion. Results Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50–59 vs. 40–49 OR = 0.31 [0.11, 0.85]; 60–69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46). Conclusion Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.

This study aimed to elucidate the relationship between the quantitative value of suprapatellar effusion and the longitudinal changes in lower-extremity muscle mass (MM) in a cohort with knee osteoarthritis (KOA). Fifty-three subjects (106 legs) with bilateral radiographic KOA at baseline (BL) were enrolled. MM was calculated by bioimpedance analysis three times at BL, and at the one-year (1Y) and three-year (3Y) follow-ups. The longitudinal change in the lower-extremity MM was calculated by subtracting MMBL from MM1Y, and MM1Y from MM3Y. Subjects with ≥1.0 z-score loss were defined as having severe MM loss (SMML). Effusion was evaluated as the sagittal area of suprapatellar pouch (mm2) by ultrasonography. The ROC curve was drawn to determine the cut-off of effusion area. General estimating equations (GEEs) were conducted with the prevalence of SMML as the dependent variable and with the cut-off of effusion area as the independent variable. Sixteen legs (15.1%) demonstrated SMMLBL-1Y and another sixteen legs demonstrated SMML1Y-3Y. GEEs revealed that individuals with ≥90 mm2 effusion had significantly higher odds of SMMLBL-1Y prevalence (Odds ratio: 21.561; P-value: 0.003). Individuals with leachate knee effusion at BL had a significant risk of losing MM through the first year of the initial knee effusion assessment.

There is a continual need for improvement of patient outcomes in the current healthcare system. Improved patient outcomes may be considered on large or small scales, ranging from improving a patient’s experience interacting with their healthcare provider, to improving the survival rate of patients with a certain condition. This need is highlighted in the case of patients with End-stage Liver Disease, many of whom die every year waiting for a liver transplant. Which patients receive donated livers for transplant depends on where the patients live and is often associated with socioeconomic class. On a smaller scale, a procedure called arthrocentesis, which removes excess, painful fluid from the knee is uncomfortable for both the patient and physician. In my technical research, I approach this smaller scale problem by developing technology to improve arthrocentesis. My sociotechnical research addresses a larger scale issue by exploring how technological and political progress interact to improve patient outcome and address inequalities in the healthcare system. Together my research provides insight into how engineers can best help improve patient outcome within our current healthcare system. A knee effusion is a condition in which excess synovial fluid, a natural joint lubricant, accumulates in the joint. Knee effusions may result from conditions such as osteoarthritis and are extremely painful for the patient. Currently, arthrocentesis, the only treatment and diagnostic procedure used, is performed using a needle and syringe. This process is not efficient for a single set of physician hands: one hand is used for holding the syringe in place, another for pulling back the plunger of the syringe to extract the fluid. Since the fluid buildup is not localized, the physician must also manipulate, or “milk,” the knee in order to concentrate fluid to facilitate removal. Currently, physicians are unable to stabilize the needle, pull the plunger, and maneuver the fluid simultaneously. The resulting procedure is lengthy and cumbersome for both the patient and physician. The goal of my technical project was to develop a more efficient protocol by developing a device to facilitate arthrocentesis. After many iterations, we developed a partially functional prototype through 3D modeling using CAD software and 3D printing. This gun-shaped device works using a bar-ratchet mechanism that pulls back the plunger of the syringe, allowing the physician to work the syringe using one hand, leaving their other hand free to manipulate the knee as needed. A motorized version of this device, intended to be easier for the physician to use, was modeled but never prototyped. The final fully functional version of the mechanical device as well as a full physical prototype of the motorized version and any subsequent testing was never completed due to limitations due to COVID-19. Due to the differing supply and demand for organs, there are poor patient outcomes for those in need of a liver transplant. The organ distribution system, which is based on policy established by the Organ Procurement and Transplantation Network (OPTN), works to match organ donors and recipients based on a number of factors including medical match, medical need and location of the recipient relative to the donated organ. These geographic factors lead to inequalities in the organ distribution system, resulting in those in lower socioeconomic classes less likely to receive a lifesaving transplant. Originally, geographic factors were important because of the limited viability time of donated livers, and therefore limited time to safely transport the liver from donor to recipient. But a number of developing technologies have the potential to extend organ viability, allowing organs to be transported farther and therefore be more widely shared. These technologies have the potential to alleviate geographic based disparities. My sociotechnical research paper addresses the question “How has and will organ transplant technology interact with liver transplant policy to address inequalities in the current liver distribution system?”. My findings demonstrated a strong correlation between change in liver transplant policy the development of technologies since the 1980s. The most recent developments in liver transplant policy, as of February 2020, show potential for additional flexibility in organ sharing as emerging technologies are adopted by clinicians. In short, my sociotechnical research demonstrated a case successful interaction of technology and policy and told the story of the two working together to save more lives through liver transplants, improving patient outcome. This work may help engineers understand how to maximize the positive impact of their technology. Due to unforeseen limitations, a final functional prototype and testing of the knee aspiration device was not completed. If future refinements result in a device useful for clinical application, similar methods must be utilized to understand and optimize the sociotechnical network surrounding arthrocentesis.

Background: Knee joint effusion is a common adverse event after arthroscopic procedures and its prevention is crucial to achieve better clinical outcomes, such as pain relief, improved range of movement and global satisfaction. Objective: The aim of this study is to compare joint effusion after partial arthroscopic meniscectomy between a common postoperative management and a short period in deep flexion. Methods: A prospective study randomizes 62 patients who underwent arthroscopic partial meniscectomy into 2 groups of postoperative care: compression elastic bandage with elevation for 24 hours (compression group) versus immediate postoperative deep flexion for 2 hours (flexion group). Clinical evaluation of effusion was made at 24 hours, 7 days and 1-month post-surgery. Results: Overall at 24 hours patients showed 53% absent effusion, 35% minimum, 11% had mild or more severe effusion. Effusion rates in the compression group were 13%, 10% and 0%; in the flexion group 10%, 6.4% and 0%, at 24 hours, 7 days and 1 month, respectively. There was no statistically significant difference between them (p > 0.05). Conclusion: In the studied population, position of the knee in deep flexion had similar influence in effusion outcomes than a standard widely used treatment, offering an alternative in the postoperative care of the patients.

Background Rheumatoid arthritis (RA) is a progressive debilitating autoimmune disease, affecting 1% of the world population, leading to cartilage and bone destruction caused by insufficient apoptosis in the inflamed RA synovium. Survivin is a proto-oncogene biomarker known for its anti-apoptotic and cell cycle-regulating properties. Overexpression of survivin in non-cancerous processes has been linked to inflammation, presumably contributing to the decreased apoptosis in the T cells of the cerebrospinal fluid in multiple sclerosis, in skin lesions of patients with psoriasis and in synovial tissue of patients with RA. Aim of the work The aim of this study is to measure the serum and synovial levels of survivin and clarify their relations to disease activity, functional capacity, and radiographic damage in patients with RA. Patients and methods This study was carried out on 50 patients with RA who had a mean age of 46.4±10.94 years. They were 39 females and 11 males. The control group was of matched age and sex, with a mean age of 46.03±10.53 years and female : male ratio of 23 : 7. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity by disease activity score 28 activity score, and assessment of functional capacity and disability using Health Assessment Questionnaire. Plain radiographs of both hands of feet were done, scored and graded by Larsen score. Serum survivin from all the studied participants and survivin levels in the synovial fluid aspirated from 18 patients with RA who presented with knee effusion at the time of examination were measured by enzyme-linked immunosorbent assay, using a pair of matched anti bodies (R&D systems, Abingdon, Uk). Results The mean serum survivin level was highly statistically significantly elevated (P

To determine the association of effusion detected by physical examination with the prevalence of bone marrow lesions (BMLs) on magnetic resonance imaging (MRI), and the incidence/progression of BMLs over 3 years in subjects with knee osteoarthritis.A population-based cohort with knee pain (n = 255) was assessed for effusion on physical examination. On MRI, BMLs were graded 0-3 (none, mild, moderate, severe), and incidence/progression was defined as a worsening of the sum of BML scores over 6 surfaces by ≥1 grade. We analyzed the full cohort and a mild disease subsample with a Kellgren/Lawrence (K/L) grade3. Cross-sectional logistic and longitudinal exponential regression analyses were performed, adjusted for age, sex, body mass index (BMI) and pain. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for effusion detected by physical examination versus BMLs (prevalence and incidence/progression).The weighted mean age was 56.7 years, the mean BMI was 26.5, 56.3% were women, 20.1% had effusion on physical examination, and 80.7% had a K/L grade3. Effusion on physical examination was significantly associated with prevalent BMLs in the full cohort (odds ratio [OR] 6.10 [95% confidence interval (95% CI) 2.77-13.44]) and in the K/L grade3 cohort (OR 6.88 [95% CI 2.76-17.15]). In the full cohort, sensitivity, specificity, PPV, and NPV were 34.6, 92.5, 79.9, and 62.1%, respectively, and in the K/L3 cohort 31.7, 94.0, 75.5, and 70.1%, respectively. Longitudinally, effusion on physical examination was not significantly associated with BML incidence/progression in the full cohort (hazard ratio [HR] 1.83 [95% CI 0.95-3.52]) or in the K/L grade3 cohort (HR 1.73 [95% CI 0.69-4.33]). In the two cohorts, sensitivity, specificity, PPV, and NPV were 32.0, 82.2, 42.2, and 74.9%, respectively, and 21.2, 85.6, 30.1, and 78.8% respectively.BMLs on MRI can be predicted from physical examination effusion cross-sectionally, with a high PPV of 79.9%. Assessment for knee effusion on physical examination is useful for determining potential candidates with BMLs before costly MRI screening for recruitment into clinical trials.

Background: Impaired hip strength may underlie abnormal movement patterns, suggesting that diminished hip strength may increase the risk of ACL injury and re injury after anterior cruciate ligament reconstruction.Aim of Study: To investigate the effect of strengthening of hip extensors and ankle plantar flexors in early Anterior Cruciate Ligament reconstruction on knee effusion, knee function, hip, knee and ankle muscles strength.Methods: The study was conducted on 30 male patients referred from the orthopedic surgeon with early post operative Anteior Cruciate Ligament reconstruction by hamstring graft or patellar tendon graft after acute injuries, their age range from 18-40 years and were randomly assigned into two groups. Group A: Consisted of fifteen patients who had received open kinetic chain strengthening exercises for hip extensors and ankle plantar flexors in addition to the traditional accelerated program. Group B: Consisted of fifteen patients who had received the traditional accelerated program for 6 weeks (three sessions per week), effusion grading scale for effusion to assess effusion, handheld dynamometer to assess muscle power, Westen Ontario and MACmaster universities score and Time Up and Go test for functional assessment.Results: There was no significant difference between both groups for, hip extensors force and (TUG at 3 weeks). There was no significant difference between both groups for knee extensors torque between base line and 3 weeks and the same for plantar flexors force and WOMAC at 3 weeks. There was significant difference between both groups for knee extensors torque between 3 and 6 weeks, WOMAC at 6 weeks, TUG at 6 weeks and plantar flexors force between 3 and 6 weeks.Conclusion: Adding strengthening exercises of hip exten-sors and plantar flexors to the traditional accelerated protocol added more beneficial outcomes in relation to function after 6 weeks.

Knee osteoarthritis is a degenerative disease characterized by cartilage destruction which manifests as pain, stiffness and loss of joint motion. With increasing longevity, aging of population and increased incidence of obesity, osteoarthritis remains a potentially major health problem as well as global economic burden. Intraarticular steroids are frequently & effectively used to treat acute and chronic inflammatory conditions of joints, especially during osteoarthritis flare with evidence of inflammation like increasing pain and joint effusion. This reduces acute episodes of pain and increases joint mobility and rehabilitation. This was a prospective hospital based study of 240 Patient with osteoarthritis knee. Average age was about 54±3 years, knee effusion detectable in 80% of patients and radiographic features of osteoarthritis in 91% cases at time of injection. Results showed significant improvement in pain and joint tenderness at 6 weeks after injection. There is consensus now that intraarticular steroids are extremely helpful in acute episodes of arthritic pain and efficacy is almost similar and equal to other modalities of intrarticular injection therapies. Intraarticular steroid injections are reasonably safe, reliable and time tested treatment of arthritic conditions and thus can be used as first line of treatment in flares of osteoarthritis with features of synovial inflammation to reduces crisis of pain and promote rehabilitaional activities and bring back smiles to patients.

This is a very rare case of posttraumatic chylous joint effusion that has been described only a few times before in the literature.1,2,3,4,5 A 64-year-old White woman presented at the outpatient clinic with persistent knee pain for 5 weeks that she related to a fall. Of note in her medical …