Search

Context: Poor knee biomechanics contribute to knee joint injuries. Neuromuscular control over knee position is partially derived from the hip. It is unknown whether isolated activation training of the gluteal muscles improves lower-extremity frontal plane mechanics. This study examined if a home-based hip muscle activation program improves performance on the Forward Step-Down Test as well as increases surface electromyography (sEMG) activation of the gluteal muscles. Design: The study utilized a single-group repeated-measures design. Methods: Thirty-five participants (24 females, mean age = 23.17 [SD 1.36] years) completed an 8-week hip muscle activation program. The Forward Step-Down Test score and sEMG of gluteus maximus and medius were assessed preintervention and postintervention. Results: Forward Step-Down Test scores improved significantly from preintervention (Mdn = 3.5) to postintervention (Mdn = 3.0, T = 109, P =.010, r =.31.), but this result did not meet clinical significance. sEMG analysis revealed a significant increase in mean gluteus maximus activation (P =.028, d = 1.19). No significant dose–response relationship existed between compliance and the Forward Step-Down Test scores or sEMG results. Conclusions: A home-based hip activation program increases gluteus maximus activation without clinically significant changes in frontal plane movement quality. Future studies may find clinical relevance by adding motor learning to the activation training program to improve functional muscle use. [ABSTRACT FROM AUTHOR]

The purpose was to examine (1) the effect of measurement position and sex on femoral cartilage outcomes, and (2) the association between gait biomechanics and cartilage outcomes. Fifty individuals participated (25 males and 25 females; age = 20.62 [1.80] y). Ultrasound measured femoral cartilage thickness and echo-intensity at 90°, 115°, and 140° of knee flexion. Gait outcomes included the external knee adduction and knee flexion moments. Cartilage outcomes were compared using 2 (sex) × 3 (position) repeated-measures analysis of variance. Gait and cartilage associations were assessed using stepwise regression. Medial cartilage was thicker when measured at 90° compared with 115° (P =.02) and 140° (P <.01), and 115° compared with 140°, (P <.01) in males but not in females. Cartilage was thicker at 90° compared with 140° across both sexes within all regions (P <.01). Males had thicker cartilage than females in all positions (P <.01). Echo-intensity was lower at 90° than 115° (P <.01) and 140° (P =.01) in the central and lower at 90° than at 115° (P <.01) and 140° (P =.03) in lateral regions. No association was found between gait and cartilage outcomes. Ultrasound imaging position effects cartilage features more in males compared with females. Imaging position and sex influence cartilage outcomes and should be considered in study designs and clinical evaluation. [ABSTRACT FROM AUTHOR]

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤.012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P =.009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis. [ABSTRACT FROM AUTHOR]

We proposed an end-to-end deep learning convolutional neural network (DCNN) for region-of-interest based multi-parameter quantification (RMQ-Net) to accelerate quantitative ultrashort echo time (UTE) MRI of the knee joint with automatic multi-tissue segmentation and relaxometry mapping. The study involved UTE-based T1 (UTE-T1) and Adiabatic T1ρ (UTE-AdiabT1ρ) mapping of the knee joint of 65 human subjects, including 20 normal controls, 29 with doubtful-minimal osteoarthritis (OA), and 16 with moderate-severe OA. Comparison studies were performed on UTE-T1 and UTE-AdiabT1ρ measurements using 100%, 43%, 26%, and 18% UTE MRI data as the inputs and the effects on the prediction quality of the RMQ-Net. The RMQ-net was modified and retrained accordingly with different combinations of inputs. Both ROI-based and voxel-based Pearson correlation analyses were performed. High Pearson correlation coefficients were achieved between the RMQ-Net predicted UTE-T1 and UTE-AdiabT1ρ results and the ground truth for segmented cartilage with acceleration factors ranging from 2.3 to 5.7. With an acceleration factor of 5.7, the Pearson r-value achieved 0.908 (ROI-based) and 0.945 (voxel-based) for UTE-T1, and 0.733 (ROI-based) and 0.895 (voxel-based) for UTE-AdiabT1ρ, correspondingly. The results demonstrated that RMQ-net can significantly accelerate quantitative UTE imaging with automated segmentation of articular cartilage in the knee joint.

Excessive growth hormone (GH) has been shown to promote joint degeneration in both preclinical and clinical studies. Little is known about the effect of disrupted GH or GH receptor (GHR) on joint health. The goal of this study is to investigate joint pathology in mice with either germline (GHR-/-) or adult inducible (iGHR-/-) GHR deficiency. Knee joints from male and female GHR-/- and WT mice at 24 months of age were processed for histological analysis. Also, knee joints from male and female iGHR-/- and WT mice at 22 months of age were scanned by micro-CT (μCT) for subchondral bone changes and characterized via histology for cartilage degeneration. Joint sections were also stained for the chondrocyte hypertrophy marker, COLX, and the cartilage degeneration marker, ADAMTS-5, using immunohistochemistry. Compared to WT mice, GHR-/- mice had remarkably smooth articular joint surfaces and an even distribution of proteoglycan with no signs of degeneration. Quantitatively, GHR-/- mice had lower OARSI and Mankin scores compared to WT controls. By contrast, iGHR-/- mice were only moderately protected from developing aging-associated OA. iGHR-/- mice had a significantly lower Mankin score compared to WT. However, Mankin scores were not significantly different between iGHR-/- and WT when males and females were analyzed separately. OARSI scores did not differ significantly between WT and iGHR-/- in either individual or combined sex analyses. Both GHR-/- and iGHR-/- mice had fewer COLX+ hypertrophic chondrocytes compared to WT, while no significant difference was observed in ADAMTS-5 staining. Compared to WT, a significantly lower trabecular thickness in the subchondral bone was observed in the iGHR-/- male mice but not in the female mice. However, there were no significant differences between WT and iGHR-/- mice in the bone volume to total tissue volume (BV/TV), bone mineral density (BMD), and trabecular number in either sex. This study identified that both germline and adult-induced GHR deficiency protected mice from developing aging-associated OA with more effective protection in GHR-/- mice.

Context: The hamstrings are the most commonly injured muscle in sports and are especially injury prone in lengthened positions. Measuring knee muscle strength in such positions could be relevant to establish injury risk. Handheld dynamometry has been shown to be a valid, reliable, and practical tool to measure isometric muscle strength clinically. The aim of this study was to assess the validity and reliability of the assessment of isometric knee muscle strength with a handheld dynamometer (HHD) at various muscle lengths, by modifying the hip and knee angles during testing. Design: Concurrent validity and test--retest reliability. Methods: Thirty young healthy participants were recruited. Hamstring and quadriceps isometric strength was measured with a HHD and with an isokinetic dynamometer, over 2 testing sessions, in a randomized order. Isometric strength was measured on the right lower limb in 6 different positions, with the hip at either 0° or 80° of flexion and the knee at either 30°, 60°, or 90° of flexion. Pearson and Spearman correlations were used to assess the validity, and intraclass correlation coefficients were calculated to establish the test--retest reliability of the HHD. Results: Good to excellent reliability and moderate to high validity were found in all the tested muscle length positions, except for the hamstrings in a seated position with the knee extended at 30°. Conclusions: The use of a HHD is supported in the clinical setting to measure knee muscle strength at varying muscle lengths in healthy adults, but not for the hamstrings in a lengthened position (hip flexed and knee extended). These results will have to be confirmed in sport-specific populations. [ABSTRACT FROM AUTHOR]

Context: The purpose of the study was to develop normative ranges and standards for knee and shoulder isokinetic and anthropometric values. These standards can be qualitatively interpreted and allow practitioners to classify isokinetic and anthropometric values more objectively for university-level netball players. Design: Posttest only observational study design. All players were only evaluated once during the in-season to generate normative ranges. Methods: A total of 51 female players volunteered. Participants were evaluated on an isokinetic dynamometer at 60° per second to obtain knee-extensor and knee-flexor values as well as shoulder-flexor and shoulder-extensor values. A total of 16 anthropometric variables were collected including stature, body mass, 8 skinfolds, and 6 circumferences. Between-group differences were calculated to determine whether playing level was a differentiating factor in data. Results: Normative standards were developed for isokinetic parameters associated with the knee and shoulder joints as well as skinfolds and circumference measures. No statistically significant between-group differences were evident (χKruskal-Wallis²[2] = 3.96, P = .140). Conclusion: These standards can be used by coaches and practitioners to set attainable goals for individual players or those from secondary leagues, classify individual and team-based performances, and facilitate decision-making processes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Adipose tissue has been associated with knee osteoarthritis (KOA) pathogenesis, but the longitudinal changes in adipose tissue with KOA progression have not been carefully evaluated. This study aimed to determine if longitudinal changes of systemic and local adipose tissue is associated with radiographic progression of KOA. METHODS: This case-control study used data from the Osteoarthritis Initiative (OAI) and included 315 cases (all the right knees with a minimum of Kellgren-Lawrence score (KL) of 0 and an increase of ≥ 1 KL from baseline to 48 months) and 315 controls matched by age, sex, race, and baseline KL. Cross sectional area of IPFP (IPFP CSA) and subcutaneous adipose tissue around the distal thigh (SCATthigh) were measured using MRI images at baseline and 24 months. Conditional logistic regression models were fitted to estimate associations of obesity markers, IPFP CSA, and SCATthigh with radiographic KOA progression. Mediation analysis was used to assess whether IPFP CSA or SCATthigh mediates the relationships between baseline BMI and radiographic KOA progression. RESULTS: 24-month changes of IPFP CSA (ΔIPFP CSA) and SCATthigh (ΔSCATthigh) were significantly greater in cases compared to controls, whereas Δ BMI and Δ abdominal circumference were similar in both groups during follow-up. Adjusted ORs for radiographic KOA progression were 9.299, 95% CI (5.357-16.141) per 1 SD increase of Δ IPFP CSA and 1.646, 95% CI (1.288-2.103) per 1 SD increase of Δ SCATthigh. ΔIPFP CSA mediated the association between baseline BMI and radiographic KOA progression (87%). CONCLUSIONS: Subjects with radiographic progression of KOA, had significant increases in IPFP CSA and subcutaneous adipose tissue while BMI and abdominal circumference remained stable. Additional studies are needed to confirm these associations.

BACKGROUND: The polyarticular nature of Osteoarthritis (OA) tends to manifest in multi-joints. Associations between cartilage health in connected joints can help identify early degeneration and offer the potential for biomechanical intervention. Such associations between hip and knee cartilages remain understudied. PURPOSE: To investigate T1p associations between hip-femoral and acetabular-cartilage subregions with Intra-limb and Inter-limb patellar cartilage; whole and deep-medial (DM), deep-lateral (DL), superficial-medial (SM), superficial-lateral (SL) subregions. STUDY TYPE: Prospective. SUBJECTS: Twenty-eight subjects (age 55.1 ± 12.8 years, 15 females) with none-to-moderate hip-OA while no radiographic knee-OA. FIELD STRENGTH/SEQUENCE: 3-T, bilateral hip, and knee: 3D-proton-density-fat-saturated (PDFS) Cube and Magnetization-Prepared-Angle-Modulated-Partitioned-k-Space-Spoiled-Gradient-Echo-Snapshots (MAPSS). ASSESSMENT: Ages of subjects were categorized into Group-1 (≤40), Group-2 (41-50), Group-3 (51-60), Group-4 (61-70), Group-5 (71-80), and Group-6 (≥81). Hip T1p maps, co-registered to Cube, underwent an atlas-based algorithm to quantify femoral and acetabular subregional (R2-R7) cartilage T1p. For knee Cube, a combination of V-Net architectures was used to segment the patellar cartilage and subregions (DM, DL, SM, SL). T1p values were computed from co-registered MAPSS. STATISTICAL TESTS: For Intra-and-Inter-limb, 5 optimum predictors out of 13 (Hip subregional T1p, age group, gender) were selected by univariate linear-regression, to predict outcome (patellar T1p). The top five predictors were stepwise added to six linear mixed-effect (LME) models. In all LME models, we assume the data come from the same subject sharing the same random effect. The best-performing models (LME-modelbest) selected via ANOVA, were tested with DM, SM, SL, and DL subregional-mean T1p. LME assumptions were verified (normality of residuals, random-effects, and posterior-predictive-checks). RESULTS: LME-modelbest (Intra-limb) had significant negative and positive fixed-effects of femoral-R5 and acetabular-R2 T1p, respectively (conditional-R2 = 0.581). LME-modelbest (Inter-limb) had significant positive fixed-effects of femoral-R3 T1p (conditional-R2 = 0.26). DATA CONCLUSION: Significant positive and negative T1p associations were identified between load-bearing hip cartilage-subregions vs. ipsilateral and contralateral patellar cartilages respectively. The effects were localized on medial subregions of Inter-limb, in particular. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

Clinical Scenario: Hamstring extensibility plays a significant role in maintaining postural alignment essential for a functional musculoskeletal system. When hamstring extensibility is lacking, individuals are placed at a higher risk for developing various lumbar spine, pelvis, knee, and foot dysfunctions. Limited hamstring extensibility is common, occurring in as much as 40% of college students and 86% of the adult population. Therefore, it is essential to maintain hamstring extensibility, which can be aided by understanding intervention effectiveness for improving flexibility. Purpose: To critically appraise the literature on the effectiveness of Active Release Technique (ART) for the treatment of hamstring extensibility deficits. Clinical Question: What is the effect of ART in a healthy population with or without hamstring extensibility deficits? Summary of Key Findings: Three studies were included for critical appraisal. Two studies concluded a single treatment session of ART that individuals possessing limited straight leg raise range of motion experienced improved active knee extension, popliteal angle, and sit-and-reach test measures. In the third study, a single session of ART was effective at improving hamstring extensibility in males without hamstring extensibility dysfunction. Clinical Bottom Line: Based on the current level 1 and level 3 evidence, ART may be an effective treatment to produce acute increases in hamstring extensibility. Future research is still needed. Strength of Recommendation: Level B evidence exists to support the use of ART to improve hamstring extensibility in the healthy population. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Context: The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. Design: This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. Methods: This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. Results: BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P=.02). amstring tendon: ACLR-only (P=.03) and ACLR-resect (P=.003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). Conclusions: The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery. [ABSTRACT FROM AUTHOR]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The incidence of periprosthetic distal femur fractures (PDFF) is increasing as the number of total knee replacements becomes more common. This study compared the demographics, fracture characteristics, treatment, and outcomes of periprosthetic versus native distal femur fractures (NDFF). MATERIALS AND METHODS: This was a retrospective cohort study of patients ≥ 18 who underwent surgical fixation of NDFF or PDFF from 2012 to 2020 at a level-1 trauma center. The main variables collected included demographics, AO/OTA fracture classification, fixation construct, concomitant fractures, polytrauma rates, bone density, and reduction quality. Primary outcomes were unexpected return to the operating room (UROR), hospital length of stay, and quality of reduction. T-tests, Fishers exact tests, and multivariate analyses were used for statistical analysis. RESULTS: 209 patients were identified, including 70 PDFF and 139 NDFF. PDFF patients were elderly females (81%) with isolated (80%) and comminuted (85%) 33 A.3 (71%) fractures. NDFF patients included 53% females, were commonly middle-aged, and displayed comminuted (92%) 33 C.2 fractures. 48% of NDFF patients had concomitant fractures. Intramedullary nailing was the primary fixation for both groups, followed by nail-plate combination (37%) for PDFF and lateral locking plates (21%) for NDFF. NDFF patients experienced significantly longer hospital stays, higher UROR rates, and worse quality of reduction (p

PURPOSE: Advancing age is one of the strongest risk factors for osteoarthritis (OA). DNA methylation-based measures of epigenetic age acceleration may provide insights into mechanisms underlying OA. METHODS: We analyzed data from the Multicenter Osteoarthritis Study in a subset of 671 participants ages 45-69 years with no or mild radiographic knee OA. DNA methylation was assessed with the Illumina Infinium MethylationEPIC 850K array. We calculated predicted epigenetic age according to Hannum, Horvath, PhenoAge, and GrimAge epigenetic clocks, then regressed epigenetic age on chronological age to obtain the residuals. Associations between the residuals and knee, hand, and multi-joint OA were assessed using logistic regression, adjusted for chronological age, sex, clinical site, smoking status, and race. RESULTS: Twenty-three percent met criteria for radiographic hand OA, 25% met criteria for radiographic knee OA, and 8% met criteria for multi-joint OA. Mean chronological age (SD) was 58.4 (6.7) years. Mean predicted epigenetic age (SD) according to Horvath, Hannum, PhenoAge, and GrimAge epigenetic clocks was 64.9 (6.4), 68.6 (5.9), 50.5 (7.7), and 67.0 (6.2), respectively. Horvath epigenetic age acceleration was not associated with an increased odds of hand OA, odds ratio (95% confidence intervals) = 1.03 (0.99-1.08), with similar findings for knee and multi-joint OA. We found similar magnitudes of associations for Hannum epigenetic age, PhenoAge, and GrimAge acceleration compared to Horvath epigenetic age acceleration. CONCLUSIONS: Epigenetic age acceleration as measured by various well-validated epigenetic clocks based on DNA methylation was not associated with increased risk of knee, hand, or multi-joint OA independent of chronological age.

PURPOSE: Hip osteoarthritis (OA) is a major cause of pain and disability worldwide. Lack of effective therapies may reflect poor knowledge on its aetiology and risk factors, and result in the management of end-stage hip OA with costly joint replacement. The Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) consortium was established to pool and harmonise individual participant data from prospective cohort studies. The consortium aims to better understand determinants and risk factors for the development and progression of hip OA, to optimise and automate methods for (imaging) analysis, and to develop a personalised prediction model for hip OA. PARTICIPANTS: World COACH aimed to include participants of prospective cohort studies with ≥200 participants, that have hip imaging data available from at least 2 time points at least 4 years apart. All individual participant data, including clinical data, imaging (data), biochemical markers, questionnaires and genetic data, were collected and pooled into a single, individual-level database. FINDINGS TO DATE: World COACH currently consists of 9 cohorts, with 38 021 participants aged 18-80 years at baseline. Overall, 71% of the participants were women and mean baseline age was 65.3±8.6 years. Over 34 000 participants had baseline pelvic radiographs available, and over 22 000 had an additional pelvic radiograph after 8-12 years of follow-up. Even longer radiographic follow-up (15-25 years) is available for over 6000 of these participants. FUTURE PLANS: The World COACH consortium offers unique opportunities for studies on the relationship between determinants/risk factors and the development or progression of hip OA, by using harmonised data on clinical findings, imaging, biomarkers, genetics and lifestyle. This provides a unique opportunity to develop a personalised hip OA risk prediction model and to optimise methods for imaging analysis of the hip.

ObjectiveCartilage degeneration involves structural, compositional, and biomechanical alterations that may be detected non-invasively using quantitative MRI. The goal of this study was to determine if topographical variation in T1rho values correlates with indentation stiffness and biochemical contents of human patellar cartilage.DesignCadaveric patellae from unilateral knees of 5 donors with moderate degeneration were imaged at 3-Telsa with spiral chopped magnetization preparation T1rho sequence. Indentation testing was performed, followed by biochemical analyses to determine water and sulfated glycosaminoglycan contents. T1rho values were compared to indentation stiffness, using semi-circular regions of interest (ROIs) of varying sizes at each indentation site. ROIs matching the resected tissues were analyzed, and univariate and multivariate regression analyses were performed to compare T1rho values to biochemical contents.ResultsGrossly, superficial degenerative change of the cartilage (i.e., roughened texture and erosion) corresponded with regions of high T1rho values. High T1rho values correlated with low indentation stiffness, and the strength of correlation varied slightly with the ROI size. Spatial variations in T1rho values correlated positively with that of the water content (R2 = 0.10, p

Context: To assess the reliability of a remote 2D markerless motion tracking method (Kinovea) to quantify knee and hip angles during dynamic tasks. Methods: Fourteen healthy adults performed body weight squats and lateral lunges while video recording themselves at home. Knee and hip angles were quantified in the sagittal plane for the squats and in the frontal plane for the lateral lunges. Two students each performed the video analysis procedure twice, 2 weeks apart. Intraclass correlation coefficients were used to calculate the intrarater and interrater reliability for angles at maximum depth. The intrarater and interrater agreement over the joint angle-time signals were quantified using a validation metric; an acceptable agreement threshold was set at a validation metric of 0.803 or higher. Standard error of measurement (SEM) was also calculated. Results: Reliability was good to excellent (intraclass correlation coefficients = .80-.98) for all angle comparisons at maximum depth. The agreement over the entire joint angle-time signal was acceptable for all squat variables except for the interrater hip angle comparison (validation metric = 0.797). None of the lateral lunge variables met the threshold of acceptable agreement. The mean SEM across participants for all joint angle-time signal and for maximum depth was acceptable (<5°) for all measurements (SEM = 1.2°-4.9°). Conclusions: Overall, the reliability, agreement, and SEM quantified in this study support the integration of remote methods to quantify lower-extremity kinematics into research and clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine i) pain phenotypes (PP) in people with early-stage knee osteoarthritis (EKOA); ii) the longitudinal association between the phenotypes and pain worsening at two years. DESIGN: We studied participants with EKOA from the Multicenter Osteoarthritis Study defined as pain intensity ≤3/10, Kellgren and Lawrence grade ≤2, intermittent pain none to sometimes, and no constant pain. Two models of PP were explored. Model A included pressure pain thresholds, temporal summation, conditioned pain modulation, pain catastrophizing, sleep quality, depression, and widespread pain (WSP). In Model B, gait characteristics, quadriceps strength, comorbidities, and magnetic resonance imaging features were added to Model A. Latent Class Analysis was used to create phenotypes, and logistic regression was used to determine their association with pain worsening. RESULTS: 750 individuals (60% females), mean age [standard deviation (SD)]: 60.3 (9.4) were included in Model A and 333 individuals (60% females), mean age (SD): 59.4 (8.1) in Model B. 3-class and 4-class solutions were chosen for Model A and Model B. In Model A, the most severe phenotype was dominated by psychosocial factors, WSP, and measures of nervous system sensitization. Similarly in Model B, the Model A phenotype plus gait variables, quadriceps strength, and comorbidities were dominant. Surprisingly, none of the phenotypes in either model had a significant relationship with pain worsening. CONCLUSION: Phenotypes based upon various factors thought to be important for the pain experience were identified in those with EKOA but were not significantly related to pain worsening. These phenotypes require validation with clinically relevant endpoints.

BackgroundObesity influences the development of osteoarthritis via low-grade inflammation. Progression of local inflammation (= synovitis) increased with weight gain in overweight and obese women compared to stable weight. Synovitis could be associated with subcutaneous fat (SCF) around the knee. Purpose of the study was to investigate the effect of weight loss on synovitis progression and to assess whether SCF around the knee mediates the relationship between weight loss and synovitis progression.MethodsWe included 234 overweight and obese participants (body mass index [BMI] ≥ 25 kg/m2) from the Osteoarthritis Initiative (OAI) with > 10% weight loss (n = 117) or stable overweight (

OBJECTIVE: As one of the serious complications after total hip arthroplasty or total knee arthroplasty, periprosthetic joint infection has always been the focus of joint surgeons. Albumin/globulin ratio is emerging as a promising biomarker for the diagnosis of periprosthetic joint infection. This study aimed to investigate the diagnostic value of albumin/globulin ratio in diagnosing periprosthetic joint infection. METHODS: A systematic search was conducted in PubMed, Embase, and Cochrane Library databases on July 29, 2023. The literature was screened according to the inclusion and exclusion criteria, and the literature related to diagnostic trials of albumin/globulin ratio was included in this study. QUADAS-2 method was used to evaluate the quality of the included articles. Bivariate mixed-effect model was applied to combine the sensitivity, specificity, likelihood ratio, and diagnostic odds ratio of the included articles, and the receiver operating characteristic curve and area under the curve were integrated to specifically evaluate the accuracy of D-dimer in the diagnosis of periprosthetic joint infection. Subgroup analysis was used to explore the sources of heterogeneity. RESULTS: We included eight eligible diagnostic studies, all of which were of medium to high quality. The sensitivity and specificity of the combined diagnosis were 0.78 (95%CI: 0.66-0.86) and 0.83 (95%CI: 0.78-0.88), respectively. The combined positive and negative likelihood ratios were 4.63 (95%CI: 3.43-6.22) and 0.27 (95%CI: 0.17-0.42), respectively. The combined diagnostic scores and diagnostic odds ratio were 2.85 (95%CI: 2.23-3.48) and 17.35 (95%CI: 9.29-32.45), respectively. The area under the summary receiver operating characteristic curve was 0.88 (95%CI: 0.85-0.90). CONCLUSION: The albumin/globulin ratio is of guiding significance in the diagnosis of periprosthetic joint infection. However, it is not universal in clinical practice, so it should be combined with specific clinical practice. In addition, there are relatively few studies on the threshold of albumin/globulin ratio, different sampling types, different laboratory detection methods, and different races, so more prospective clinical trials with large samples, multi-centers, and scientific design should be carried out for verification in the future. [ABSTRACT FROM AUTHOR]

Background: Fixed-frame dynamometry systems are used worldwide to assess isometric strength in both general and athletic populations. There is currently a paucity of published work where reliability estimates for fixed-frame dynamometry systems have been estimated. The aim of this study was to determine the inter-and intra-rater reliability of the KangaTech (KT360) fixed frame dynamometry system when measuring maximal isometric strength of the knee flexor muscles. Study Design: Inter and intra-rater reliability single cohort study. Methods: Twenty healthy university-level athletes (age= 21.65 ± 3 years, weight= 74.465 ± 30kg, height= 170.1 ± 7.0cm) took part in two testing sessions where two raters collected data during a 90° hip and knee flexion protocol. Participants performed each test twice, building to a maximal isometric contraction holding over a 5 second period with 30 second rest between sets. Data were checked for normality using a Shapiro-Wilk test. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Finally, a Bland-Altman analysis was used to determine the levels of agreement for intra-and inter-rater measurements. Results: High levels of agreement were demonstrated between left and right knee flexion as 95% of the differences were less than two standard deviations away from the mean. 'Almost perfect' intraclass correlation coefficient (ICC) values were demonstrated (Knee flexion: Inter-rater: Left, 0.99; Right, 0.99; Intra-rater: Left, 0.99; Right:0.99). Standard error of measurement (SEM) for inter-and intra-rater strength ranged from 0.26-0.69 kg, SEM% ranged from 1.34-2.71% and minimal detectable change (MDC) ranged from 1.14-2.31kg. Conclusion: Overall, high level of inter-and intra-rater reliability were demonstrated when testing maximal isometric knee flexion. Therefore, the KT360 fixed frame dynamometry system may be considered a viable tool for measuring maximal isometric contraction of the knee flexors when repeat measures are required in clinical settings. Level of Evidence: 3b [ABSTRACT FROM AUTHOR]

Background and Purpose: The comprehensive treatment for an athlete who sustains a complete posterior cruciate ligament (PCL) injury remains unclear. The purpose of this case report is to describe the effects of an isokinetic exercise program on muscle performance and physical function in a professional soccer player with a PCL injury. Study Design: Case Report Case Description: A 23-year-old male professional soccer player injured his right knee (non-dominant) during a soccer match, with magnetic resonance imaging confirming a complete PCL rupture. The athlete completed 23 sessions of isokinetic treatment over nine weeks to improve physical function and muscle performance. The concentric mode was used to evaluate quadriceps and hamstrings performance isokinetically at angular velocities of 60 °/s, 120 °/s, and 300 °/s. The LEFS questionnaire was used to evaluate physical function. The assessment occurred before starting the treatment and at the end of nine weeks. An athlete with similar anthropometric characteristics was invited to participate and serve as a control, in order to better understand the athlete's assessment results. Outcomes: After nine weeks, peak torque normalized to body mass (PT/BM) improved to 4.0 N.m/kg for knee extensors (control: 3.6 Nm/kg) and 2.3 N.m/kg for knee flexors (control: 1.9 Nm/kg) at 60 °/s. This increase in PT was reflected in the hamstrings-to-quadriceps (H:Q) ratio post-treatment (57 %). At the end of treatment, the athlete returned to sports activities with 98.7 % restored physical function as measured by the LEFS (Score: 79 points). Discussion: The results demonstrated that the isokinetic treatment improved knee functional capacity, with increased PT/BM for knee extensors and flexors and enhanced torque-holding capacity, indicating improved muscle performance. Level of evidence: 5 [ABSTRACT FROM AUTHOR]

Purpose: This study aims to measure the peri-incisional numbness developing after Total Knee Arthroplasty (TKA) performed using the midline skin incision. It studies the natural course of the numbness and determines its correlation with the skin incision length (SIL). Materials & methods: 66 knees undergoing primary TKA with a standard midline incision were evaluated. The SIL and the area of numbness (AON) were measured in complete knee extension and 90° of flexion. The area was marked by the patient using a sketch pen and then determined by an independent observer using monofilament testing. The "ImageJ" software was used to calculate the area. Results: All patients developed numbness around the knee after TKA. There was a statistically significant correlation between the SIL and AON in both flexion and extension at two weeks (p < 0.001) and three months (p < 0.001). However, there was a weak and insignificant correlation at six months (p = 0.217). Conclusion: When TKA is performed using the midline skin incision, the SIL positively correlates with the AON postoperatively during the initial short-term follow-up. At six monthly follow-ups, there is no significant correlation between the two. [ABSTRACT FROM AUTHOR]

Purpose: There is limited comparative evidence on patient outcomes following cartilage repair in various knee compartments. The aim of this study was to compare clinical and imaging outcomes after treating cartilage defects in femoral condyles and trochlea with either an aragonite-based scaffold or surgical standard of care (SSoC, i.e., debridement/microfractures) in a large multicentre randomized controlled trial. Methods: 247 patients with up to three knee joint surface lesions (ICRS grade IIIa or above) in the femoral condyles, trochlea or both ("mixed"), were enrolled and randomized to surgery with either a cell-free aragonite scaffold or SSoC. Patients were followed for up to 48 months by analysing subjective scores (KOOS and IKDC), radiological outcomes (defect filling on MRI), as well as treatment failure rates and adverse events. A differential analysis of outcomes for condylar, trochlear and mixed lesions was performed. Results: The scaffold group significantly outperformed the SSoC group regardless of lesion location with statistically significantly better KOOS Overall scores at 24 months (all p ≤ 0.0009) and 48 months (all p ≤ 0.02). Similar results were observed for KOOS subscales and IKDC scores. For KOOS responder rates, superiority of the implant group was demonstrated at 24, 36, and 48 months (all p ≤ 0.004). Higher defect filling on MRI for implants was observed for all locations. Lower treatment failure rates for the implant were observed in condylar and mixed lesions. Conclusion: The aragonite-based scaffold was safe and effective regardless of the defect location, providing superior clinical and radiological outcomes compared to SSoC up to four years follow-up. Level of evidence: I – Randomized controlled trial. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate tibial cartilage thickness (TCT), T1ρ and T2 values within both loaded and baseline configurations in a cadaveric knee model using a 3D bone based tibial coordinate system. Ten intact cadaveric knees were mounted into an magnetic resonance imaging (MRI) compatible loading device. Morphologic and quantitative MRI (qMRI) images were acquired with the knee in a baseline configuration and after application of 50% body weight. The morphologic images were evaluated for cartilage degeneration using a modified Noyes scoring system. A 3D bone‐based tibial coordinate system was utilized to evaluate regional changes of tibial T1ρ, T2, and cartilage thickness values among regions covered and uncovered by the meniscus. Inter‐regional differences in medial and lateral MRI outcomes were found between loaded and baseline configurations. Cartilage regions covered by the meniscus demonstrated disparate qMRI and TCT results as compared to cartilage regions not covered by the meniscus. The regions covered by meniscus experienced a ~3.5%, ~0.5%, and ~5.5% reduction of T1ρ (p < 0.05, medial and lateral compartments), T2 and TCT, respectively, in both compartments while regions not covered by the meniscus experienced larger reductions of ~10%, ~2%, and ~10.5% reduction of T1ρ (p < 0.05, medial and lateral compartments), T2 and TCT (p < 0.05, lateral compartment only), respectively, in both compartments. T1ρ and T2 decreases following application of 50% body weight load were substantially larger in the tibial regions with modified Noyes grade 3 (n = 2) compared to either healthy regions (n = 85, p < 0.0.003) or regions with modified Noyes grade 2 (n = 13, p < 0.004). Interregional differences in MRI outcomes reflect variations in structure and function, and largely followed a pattern in cartilage regions that were covered or not covered by the meniscus. Results of the current study suggest that ΔT1ρ and ΔT2 values may be sensitive to superficial fissuring, more than baseline or loaded T1ρ or T2 values, or TCT alone, however future studies with additional specimens, with greater variability in OA grade distribution, may further emphasize the current findings. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate the reliability of cartilage T2 relaxation time measurements and to identify focal changes in T2 relaxation on the affected knee from 6 to 24 months after anatomic anterior cruciate ligament reconstruction (ACLR). Data from 41 patients who received anatomic ACLR were analyzed. A bilateral 3.0‐T MRI was acquired 6 and 24 months after ACLR. T2 relaxation time was measured in subregions of the femoral condyle and the tibial plateau. The root‐mean‐square coefficient of variation (RMSCV) was calculated to evaluate the reliability of T2 relaxation time in the contralateral knee. Subregion changes in the affected knee T2 relaxation time were identified using the contralateral knee as a reference. The superficial and full thickness layers of the central and inner regions showed good reliability. Conversely, the outer regions on the femoral side and regions in the deep layers showed poor reliability. T2 relaxation time increased in only 3 regions on the affected knee when controlling for changes in the contralateral knee, while changes in T2 relaxation time were identified in 14 regions when not using the contralateral knee as a reference. In conclusion, evaluation of cartilage degeneration by T2 relaxation time after ACLR is most reliable for central and inner cartilage regions. Cartilage degeneration occurs in the central and outer regions of the lateral femoral condyle from 6 to 24 months after anatomic ACLR. [ABSTRACT FROM AUTHOR]

Introduction: Osteoarthritis (OA) of the knee affects millions of people with sizable socioeconomic burden. Conventional treatment modalities are prioritized, turning to surgical intervention only when they have failed. However, these traditional modalities have shortcomings, only aiming to reduce pain rather than targeting the underlying pathophysiology. Recently, the use of biologics, including autologous peripheral blood-derived orthobiologics (APBOs), has increased and demonstrated great promise for the management of knee OA. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy is still uncertain, attributed to lack of standardized formulation protocols, characterization, and patient variables. To overcome the limitations posed by PRP, the use of other APBOs such as platelet lysate (PL) has been considered. This review summarizes the outcomes of clinical studies involving PL to manage OA of the knee. Methods: Multiple databases (Scopus, Embase, PubMed, and Web of Science) were searched employing terms "platelet lysate" and "knee osteoarthritis" for articles published in the English language to August 15, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Only three clinical studies fulfilled our search and inclusion criteria. Intra-articular injection of three doses of PL injected every 3–4 weeks is safe and efficacious, resulting in statistically significant improvements in different patient-reported outcome measures at 6–12 months follow-up. Conclusion: The existing published peer-reviewed literature suggests that intra-articular injection of PL is safe and can decrease pain and increase function in patients with knee OA. Nonetheless, given the dearth of pertinent literature, more adequately powered, multicenter, prospective, non-randomized and randomized controlled studies with extended follow-up are needed to confirm the effectiveness of PL in knee OA. Further comparative studies to help clinicians in choosing the best APBO for knee OA treatment are also warranted. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to compare outcomes between multiple and single debridement, antibiotics, and implant retention (DAIR) procedures for early periprosthetic joint infection (PJI) in hip and knee arthroplasty. Methods: Four databases were searched from inception till January 2024 for original studies investigating the outcomes of multiple DAIR in hip and knee PJI. The primary outcome was the success rate in eradicating joint infection. This review was conducted per PRISMA guidelines. Results: A total of 9 observational studies with 1104 participants were included, with a mean age and BMI of 58.37 years (95%CI: 25.77–90.98) and 31.43 kg/m2 (95%CI: 28.89–34.98), respectively. The mean follow-up period was 58.37 months (95%CI: 25.77–90.98), and the average MINORS score assigned to the review was 17.6 ± 3.46, indicating a low overall risk of bias. An equivalent success rate between single and double DAIR was observed, at 67% (95%CI: 64–71%) and 70% (95%CI: 48–86%), respectively, with no statistically significant difference between the two treatment modalities (p = 0.740). Additionally, the success rate for triple DAIR ranged from 50 to 60%. Conclusion: This study suggests that double DAIR is a valid treatment option for acute PJI after TKA and THA, with a success rate comparable to single DAIR (70% vs. 67%, p = 0.740). Triple DAIR achieved success rates ranging from 50 to 60%. However, caution is warranted when interpreting these results due to heterogeneity in host comorbidity factors, DAIR protocols, and antibiotic regimens. Level of Evidence: Therapeutic, Level III. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the most common online patient questions pertaining to posterior cruciate ligament (PCL) injuries and the quality of the websites providing information. Methods: Four PCL search queries were entered into the Google Web Search. Questions under the 'People also ask' tab were expanded in order and 100 results for each query were included (400 total). Questions were categorized based on Rothwell's Classification of Questions (Fact, Policy, Value). Websites were categorized by source (Academic, Commercial, Government, Medical Practice, Single Surgeon Personal, Social Media). Website quality was evaluated based on the Journal of the American Medical Association (JAMA) Benchmark Criteria. Pearson's chi-squared was used to assess categorical data. Cohen's kappa was used to assess inter-rater reliability. Results: Most questions fell into the Rothwell Fact category (54.3%). The most common question topics were Diagnosis/Evaluation (18.0%), Indications/Management (15.5%), and Timeline of Recovery (15.3%). The least common question topics were Technical Details of Procedure (1.5%), Cost (0.5%), and Longevity (0.5%). The most common websites were Medical Practice (31.8%) and Commercial (24.3%), while the least common were Government (8.5%) and Social Media (1.5%). The average JAMA score for websites was 1.49 ± 1.36. Government websites had the highest JAMA score (3.00 ± 1.26) and constituted 42.5% of all websites with a score of 4/4. Comparatively, Single Surgeon Personal websites had the lowest JAMA score (0.76 ± 0.87, range [0–2]). PubMed articles constituted 70.6% (24/34) of Government websites, 70.8% (17/24) had a JAMA score of 4 and 20.8% (5/24) had a score of 3. Conclusion: Patients search the internet for information regarding diagnosis, treatment, and recovery of PCL injuries and are less interested in the details of the procedure, cost, and longevity of treatment. The low JAMA score reflects the heterogenous quality and transparency of online information. Physicians can use this information to help guide patient expectations pre- and post-operatively. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation. Methods: A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI scores based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from ZIP codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture). Results: In a multivariate regression analysis of 355 patients, increased SDI was independently associated with increased time from clinic visit to MRI order (p = 0.044) and from clinic visit to MRI completion (p = 0.047). Each 10-point increase in SDI (0–100) was associated with a delay of 7.2 days on average. SDI itself was found to be associated with a patient's race (p < 0.001), ethnicity (p < 0.001), and insurance category (p < 0.001). Conclusion: Increased SDI is independently associated with longer time from clinic visit to knee MRI order and longer time from clinic visit to knee MRI completion in our pediatric population. Recognizing potential barriers to orthopedic care can help create the change necessary to provide the best possible care for all individual patients. [ABSTRACT FROM AUTHOR]

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

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

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

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

Introduction: The demipointe dance position puts the ankle at high risk of overuse injury and posteromedial ankle pain due to increased ankle valgus forces. Previous work has shown that creating lower limb external rotation intrinsic to demipointe with hip external rotation reduces foot pronation that causes ankle valgus stress. Therefore, the purpose of this work was to examine long axis rotation kinematics of the hip, knee, and ankle as well as the ankle joint contact forces in demipointe to better understand the biomechanical impact(s) of the specific cue to increase hip external rotation in this position. Methods: Three-dimensional motion capture and force plate data were collected from 23 contemporary or ballet pre-professional dancers (age: 19.94 ± 1.34 years) who each performed 3 dancer-selected (DS) demipointe positions and 3 demipointes with the cue to "externally rotate from the hips." Results: The cue to increase hip external rotation resulted in significantly increased hip external rotation angle [DS: 37.5; 9.42° (median; interquartile range), Cued: 39.9; 10.8°, P <.0001)] and significantly reduced ankle eversion angle (DS: 8.13; 11.4°, Cued: 7.77; 10.3°, P =.023). However, total turnout angle was also significantly decreased (DS: 75.8; 7.91°, Cued: 75.4; 7.73°, P <.0001), which is undesirable for proper esthetic performance of demipointe. Total ankle joint force remained unchanged, but ankle eversion force was significantly reduced (DS: 15.3; 4.18 %bodyweight (BW), Cued: 14.7; 4.99 %BW, P <.0001) with use of the cue. Discussion/Conclusion: Utilization of a cue to increase hip external rotation was successful in increasing hip contribution to turnout angle and reducing injurious ankle eversion force. Further coaching using this cue may allow dancers to produce these advantageous mechanics while maintaining turnout angle. [ABSTRACT FROM AUTHOR]

Background: Restoring maximal muscle strength of the knee extensors (KE) and knee flexors (KF) following anterior cruciate ligament (ACL) injury and ACL reconstruction is of great importance to reduce the re-injury rate after ACL reconstruction and to reduce the risk of knee osteoarthritis. Therefore, it is essential that clinicians and healthcare providers use valid and reliable measures to assess knee muscle strength to ensure a safe return to sport. Purpose: To evaluate the reliability (test-retest reliability, inter-tester reliability and test-retest agreement) and validity (concurrent validity, convergent validity and ForceFrame (FF) vs. isokinetic dynamometer (ID) agreement) of the ForceFrame (FF) dynamometer during isometric testing of the knee extensors and flexors. Study Design: Cross-sectional study Material and Methods: Twenty-seven participants with ACL injury or reconstruction were recruited for participation in this study. maximal voluntary isometric contration (MVIC) of the knee extensors and flexors was tested on two separate days. Day one included validity assessments with FF, a gold-standard ID and a handheld dynamometer (HHD). Day two included reliability assessments with FF performed by two assessors. Main outcome measures were day-to-day test-retest reliability and agreement and inter-tester reliability of FF, and concurrent validity (FF vs. an ID and a HHD). Reliability was tested as test-retest and inter-tester reliability using interclass correlation coefficient (ICC), while agreement was tested using Bland & Altman plots with limits of agreement (LOA), standard error of measurement (SEM) and smallest detectable change (SDC). Concurrent validity between FF, ID, and HHD was assessed using Pearson's correlations and mean difference was evaluated by Bland & Altman plots. Results: Twenty-seven participants (10 females, 17 males) with a median age of 25 years (range 19-60) were included in this study. There was a good day-to-day test-retest reliability for MVIC of KE (ICC=0.77, CI95:0.48-0.90) and KF (ICC=0.83, CI95:0.61-0.92) and excellent inter-tester reliability for MVIC of KE (ICC=0.97, CI95:0.94-0.98) and KF (ICC=0.93, 95CI:0.85-0.97). Standard error of measurement (SEM) was 8% and 9%, while the smallest detectable change (SDC) was 22% and 27% for KE and KF, respectively. FF showed fair concurrent validity compared to ID for KE (r=0.56), poor concurrent validity for knee flexors (KF (r=0.24) and compared to HHD a moderate correlation for KE (r=0.74) and poor correlation for KF (r=0.12). Bland & Altman plots between FF and the ID showed a mean difference of -0.51 Nm/kg for KE and -0.32Nm/kg for KF. Conclusions: FF can be used to obtain reliable and valid results to assess MVIC of the KE, but not the KF. It should be noted that absolute results produced by the FF may be considered an underestimation of actual MVIC. The test position to assess KF in FF does not appear to be optimal, and different test-positions may be considered. Level of evidence: Level 3 [ABSTRACT FROM AUTHOR]

Background: Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. Purpose: To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. Study Design: Cross-sectional Methods: Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. Results: One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. Conclusion: The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

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

Since Ethiopia's 2018 transition, sporadic ethnic and political violence and conflict and inter-group divisions have brought the nation to its knees. This study aims to assess the presence of the Hostile Media Phenomenon (HMP) among audiences of Ethiopian private, regional and federal television channels. Survey data were gathered from 600 participants living in Addis Ababa City, Amhara and Oromia regional states and were purposely chosen based on their historical and political dominance in the country. The study examined six different television channels found in the three regions: Oromia Broadcast Network (OBN), Amhara Broadcast Corporation, Addis TV, Wlata TV, Fana Broadcast Corporation (FBC) and Ethiopian Broadcast Corporation (EBC). The results of this study indicate that the regional states' television channels play a major role in intensifying the hostile media phenomenon as well as in motivating violence and conflict among different regional states and groups of people. [ABSTRACT FROM AUTHOR]

Purpose: To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence of B0$$ {\mathrm{B}}_0 $$ and B1+$$ {\mathrm{B}}_1^{+} $$ field inhomogeneities. Methods: The resilience of RAFF pulses against B0$$ {\mathrm{B}}_0 $$ and B1+$$ {\mathrm{B}}_1^{+} $$ inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity‐resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation (Mz(Tp)/M0$$ {M}_z\left({T}_p\right)/{M}_0 $$), were simulated and validated in phantom experiments. TRAFF$$ {T}_{\mathrm{RAFF}} $$ and TgirRAFF$$ {T}_{\mathrm{girRAFF}} $$ parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility. Results: Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom). TgirRAFF$$ {T}_{\mathrm{girRAFF}} $$ preparations showed in phantom/calf 6.0/4.8 times higher resilience to B0$$ {\mathrm{B}}_0 $$ inhomogeneities than RAFF, and a 4.7/5.3 improved resilience to B1+$$ {\mathrm{B}}_1^{+} $$ inhomogeneities. In the knee cartilage, TgirRAFF$$ {T}_{\mathrm{girRAFF}} $$ (53 ±$$ \pm $$ 14 ms) was higher than TRAFF$$ {T}_{\mathrm{RAFF}} $$ (42 ±$$ \pm $$ 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility across B0$$ {\mathrm{B}}_0 $$/B1+$$ {\mathrm{B}}_1^{+} $$ inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon‐based fat suppression led to a further 15‐fold improvement in the robustness of girRAFF to inhomogeneities. Conclusions: RAFF pulses display residual sensitivity to off‐resonance and pronounced sensitivity to B1+$$ {\mathrm{B}}_1^{+} $$ inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required. [ABSTRACT FROM AUTHOR]

In this work, we present a knee rehabilitation system focusing on the processing of surface electromyography (sEMG) signals measured from the vastus lateralis (VL) and vastus medialis (VM) muscles of rehabilitation participants. A two-channel electromyography (EMG) device and the NI-myRIO embedded device are used to collect real-time sEMG signals in accordance with pre-designed rehabilitation programs. The novelty and contribution of this work is that we develop an sEMG processing function where real-time sEMG data are automatically processed and sEMG results of both VL and VM in terms of root mean square value (RMS), different RMS levels of VL and VM, and maximum RMS for each round of knee movements are provided. The results here indicate how well the rehabilitation users can move their knees during rehabilitation, referring to knee and muscle performances. Experimental results from healthy participants show that we can automatically and efficiently collect and monitor rehabilitation results, allowing rehabilitation participants to know how their knees performed during testing and medical experts to evaluate and design treatment. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) is a leading cause of disability, with current treatment options often falling short of providing satisfactory outcomes. Autologous-cultured adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fractions (SVFs) have emerged as potential regenerative therapies. Methods: A comprehensive search was conducted among multiple databases for studies up to June 2023. The risk of bias was assessed in randomized and non-randomized studies, adhering to PRISMA guidelines. The study has been registered with PROSPERO (CRD 42023433160). Results: Our analysis encompassed 31 studies involving 1,406 patients, of which, 19 studies with 958 patients were included in a meta-analysis, examining both SVF and autologous-cultured ADMSC methods. Significant pain reduction was observed with autologous-cultured ADMSCs starting at 3 months (MD = −2.43, 95% CI, −3.99, −0.86), whereas significant pain mitigation in response to SVF therapy was found to start at 12 months (MD = −2.13, 95% CI, −3.06, −1.21). Both autologous-cultured ADMSCs and SVF provided significant improvement in knee function starting at 12 months (MD = −9.19, 95% CI, −12.48, −5.90 vs. MD = −9.09, 95% CI, −12.67, −5.51, respectively). We found no evidence of severe adverse events linked directly to ADMSC therapy. Conclusion: Autologous-cultured ADMSCs offer a promising alternative for more rapid pain relief in knee OA, with both ADMSCs and SVF demonstrating substantial long-term benefits in joint function and cartilage regeneration, in the absence of any severe ADMSC-related adverse events. [ABSTRACT FROM AUTHOR]

This study aimed to analyze and predict various types of knee pain in knee osteoarthritis (KOA) patients based on Semi-Quantitative MRI Osteoarthritis Knee Score (SQ-MOAKS) features. The goal was to identify structural abnormalities in the knee joint associated with different types of pain, thereby aiding in the development of personalized treatment plans. Subjects were selected from the Osteoarthritis Initiative (OAI) database, including 297 patients who underwent both SQ-MOAKS assessment on knee MRI images and WOMAC knee pain assessment. Univariate and multivariate logistic regression analyses were used for feature selection, followed by the construction of multi-risk factor models and corresponding nomograms for each pain type. The predictive values of the models were evaluated using ROC curves and related metrics (AUC, accuracy, sensitivity, specificity), and the DeLong test was used to assess the significance of differences between various ROCs and AUCs. Significant associations were found between specific SQ-MOAKS features and different types of knee pain. Bone marrow lesions (BML) and cartilage morphology (CM) features were crucial in predicting the walking pain and rest pain, while osteophytes (OS) were more associated with nocturnal pain and pain during stair climbing. The models demonstrated high predictive accuracy, particularly for walking pain and rest pain. This study demonstrated that SQ-MOAKS features could effectively predict different types of knee pain, revealing the structural basis of knee pain in KOA patients. These results prompted the use of SQ-MOAKS in developing personalized treatment strategies, enhancing clinical decision-making, and improving patient quality of life. [ABSTRACT FROM AUTHOR]

Background: Combining arthroscopic microfractures (MF) with platelet-rich plasma (PRP) complexes is a potential approach for treating knee cartilage injuries. However, effective treatment of cartilage injuries in the knee joint remains a challenge. Objective: To evaluate the clinical effects of a platelet-rich complex based on MF surgery for treating knee cartilage injuries. Methods: We selected 120 patients with knee cartilage injury and divided them into observation and experimental groups according to the use of a platelet-rich complex. Preoperative and postoperative follow-up visit data were retrospectively collected and analyzed. Results: Preoperative visual acuity scores between the two groups were comparable (P>0.05). At 3 and 6 months postoperatively, the scores were lower in the experimental group than in the control group (P<0.05). The preoperative Lysholm knee scores and Tegner activity were similar (P>0.05) but greater in the experimental group at 3 and 6 months postoperatively (P<0.05). Postoperative complications were similar between the two groups according to Fisher’s exact test (P=1.00). Conclusion: The platelet-rich complex based on MF surgery treatment of knee cartilage injuries exhibited a better clinical effect and is an easy-to-operate and effective method worthy of clinical consideration. [ABSTRACT FROM AUTHOR]

Background: Despite significant progress in orthopaedic surgery, the prevalence of periprosthetic joint infections (PJIs) remains persistent, and future increases are expected due to the increasing number of joint arthroplasties. PJIs are intricately connected to biofilm-producing bacteria, which encase infected prostheses, impairing the effectiveness of antibiotics and the immune system. Acute PJIs with immature biofilms are traditionally managed with debridement, antibiotics, and implant retention (DAIR). However, to date, there has not been a conclusive direct clinical comparison (in vivo) demonstrating the superiority of one irrigation solution over others. Recently, there has been a growing interest in irrigation solutions with antibiofilm properties demonstrated in in vitro studies, exemplified by the preformulated Bactisure® irrigation solution, which contains ethanol, acetic acid, sodium acetate, benzalkonium chloride, and sterile water. The main objective of this study was to evaluate the effectiveness (infection cure rate) of preformulated Bactisure® irrigation solution in vivo compared with saline solution in a control group of patients with acute knee and/or hip periprosthetic infections treated with DAIR. Methods: Prospective single-centre randomized controlled trial involving patients with acute haematogenous PJI who received standard DAIR surgery from December 2022 to December 2024. The type of irrigation solution used during surgery will include two groups allocated at a 1:1 ratio: a control group (n = 25) with saline solution and an experimental group (n = 25) receiving the Bactisure® preformulated solution. The sample size was calculated based on an expected reduction in reinfection rates from 45% in the control group to 10% in the experimental group. Data on baseline patient characteristics, clinical and radiological information, and healthcare questionnaires will be recorded. All patients will be followed for minimum of 12 months. The infection cure rate at 1 year will be the primary outcome. Discussion: This study is the first to compare the effectiveness of preformulated Bactisure® irrigation solution with that of saline solution in real clinical practice (in vivo) in patients with acute knee and/or hip periprosthetic infections treated with DAIR. Our main hypothesis is that, compared with saline solution, Bactisure® provides a better infection cure rate at 1 year post-DAIR. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN10873696. Registered on December 19, 2023. [ABSTRACT FROM AUTHOR]

Background: As one of the most prevalent chronic degenerative diseases, knee osteoarthritis (KOA) is associated with the progressive degradation of articular cartilage, meniscus, synovium, ligaments, bone, muscles, and tendons. Knee osteoarthritis affects the quality of life and can cause chronic disability worldwide. Magnetic resonance imaging (MRI) is a crucial imaging modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. The objective of this study was to evaluate the effectiveness of the three-dimensional (3D) turbo spin-echo (TSE) MRI and to compare its relevance to two-dimensional (2D) routine MRI in adding additional information and in the early detection of KOA. Results: Total agreement between the two techniques ranged between 82.7% (cartilage degeneration), 91.4% (osteophytes), 98.3% for bone marrow edema and periarticular cyst up to 100% of other several features regarding meniscal injury and ligamentous tear. Conclusions: When compared to standard 2D TSE MRI, 3D TSE MRI demonstrates substantial to almost complete agreement and high accuracy for semiquantitative assessment of knee osteoarthritis (OA). 3D TSE MRI also takes less time, which is important for large OA studies and can be used for the detection of early knee joint changes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of total knee arthroplasty (TKA) on muscle mass and bone density in end-stage knee osteoarthritis (OA). Methods: This prospective study was conducted on 111 patients with Kellgren–Lawrence grade 4 knee OA who underwent TKA after failing to respond to conservative treatment for more than 3 months at a single institution from June 2022 to May 2023. Appendicular lean mass index (ALMI) and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry before and every 6 months after surgery. The average follow-up period was 15.5 ± 2.31 months (range, 11.6–24 months). Results: During the follow-up period after TKA, the ALMI increased relatively continuously and consistently. The BMD of the L-spine and proximal femur did not change significantly until 12 months after TKA surgery but began to increase steeply after 12 months and slowed down after 18 months. The increase in muscle mass showed a significant positive correlation with the increase in BMD. Conclusions: Muscle mass gradually increased after TKA for end-stage knee OA, whereas bone density also increased but not until 12 months after surgery. The significant positive correlation between the increase in muscle mass and bone density suggests that the increase in muscle mass after TKA may be one of the causes of the increase in bone density. [ABSTRACT FROM AUTHOR]

Kinematic alignment (KA) in the short to medium term clinical outcomes is superior to the mechanical alignment (MA), but whether it will improve patients' postoperative gait is still controversial. Understanding whether and how KA influences postoperative gait mechanics could provide insights into optimizing alignment philosophy to improve functional outcomes. To investigate the impact of KA versus MA in total knee arthroplasty (TKA) on the operated and contralateral native lower limbs by analyzing plantar pressure distribution during walking gait. This study was designed as a secondary analysis from a randomized controlled trial. Thirty-seven patients were included, nineteen underwent KA-TKA and eighteen underwent MA-TKA, each with a native knee in the contralateral limb. Pressure-sensitive insoles were used to collect plantar pressure distribution of both limbs simultaneously during walking defined as medial-lateral load ratio (MLR). Perioperative characteristics including radiographic metrics (Hip-Knee-Ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) and clinical outcomes (Oxford Knee Scores (OKS)) were compared between the two groups pre-operatively and 2-year postoperatively. Significant differences were found in postoperative radiographic metrics, with KA showing better OKS 1 year postoperatively (p = 0.021), lower mean HKA (p = 0.009) and mMPTA (p < 0.001). Other perioperative characteristics were similar between groups. In the pedobarographic analysis, the MA group demonstrated greater medial pressure distribution in forefoot compared to both the KA group (p < 0.001) and the contralateral native knee (p = 0.002). Besides, the MA group revealed a more lateral pressure distribution in rearfoot compared to the KA group (p = 0.007) and the contralateral native knee (p = 0.001). While there was no significant difference between KA and native group (p = 0.064 and p = 0.802, respectively). KA offered advantages over MA in restoring a more physiologic plantar pressure distribution at two years postoperatively. These results underscore the potential clinical benefits of adopting KA techniques in TKA procedures. [ABSTRACT FROM AUTHOR]