Affected Knee Joint Research Articles

Effects of Lumbar Mobilization and Transcutaneous Electrical Nerve Stimulation on Proprioception and Muscular Strength in Volleyball Players with Chronic Knee Pain

Background: The spinal nerves, which start at the lumbar level, are connected to the nerve innervation in the knees. Currently, there is a lack of research on the treatment of knee pain through lumbar mobilization. Objectives: To investigate the effects of lumbar joint mobilization (LJM) and transcutaneous electronic nerve stimulation (TENS) on proprioception and muscular strength in volleyball players with chronic knee pain. Design: Two group pre-posttest. Methods: A total of 26 professional volleyball players with chronic knee pain were allocated to the LJM (n=13) and TENS (n=13) groups. In the LJM group, grade III - IV amplitude was applied 3 times for 1 minute (80 times per minute) at the affected lumbar (L2-3) facet joint in the prone position. In the TENS group, the TENS treatment device was used to directly apply or 15 minutes to the area of chronic knee pain (100 Hz, 150 ㎲). Proprioception was measured by knee flexion and extension angles, and muscle strength was evaluated using an isokinetic test. Measurements were taken before and after interventions. Results: In the eye opened conditiond, proprioception significantly increased during both knee extension and flexion after LJM, while only knee extension was significantly increased in the TENS group. There was also a significant difference in knee extension between the two groups. In the eye close conditiond, proprioception was significantly improved only during knee extension in the LJM group, and the difference in knee extension between the groups was also significant (P<.05). The maximum torque of the affected knee joint was significantly improved at 60°/sec in both groups (P<.05); however, there was no difference between the two groups. There was no significant difference in the maximum flexion torque within or between the groups. Conclusion: This study suggests that LJM improved proprioception and muscular strength in volleyball players with chronic knee pain.

The Influence of Specific Bioactive Collagen Peptides on Knee Joint Discomfort in Young Physically Active Adults: A Randomized Controlled Trial.

First evidence indicates that the supplementation of specific collagen peptides is associated with a significant reduction in activity-related joint pain in young adults. The purpose of the current investigation was to confirm the efficacy of the same collagen peptides in a comparable study population. In total, 180 active men and women aged between 18 and 30 years with exercise-related knee pain but no diagnosed joint disease completed the trial over a period of 12 weeks. Participants were randomly assigned to the group receiving 5 g of specific collagen peptides (CP-G) or to the placebo group (P-G). For the primary outcome, changes in pain during or after exercise from pre- to post-intervention were assessed by the participants using the Visual Analog Scale (VAS). These changes were additionally evaluated by the examining physician by means of anamnesis and physical examination of the affected knee joint. As secondary outcomes, pain under resting conditions and after 20 squats were compared between the study groups. In addition, the mobility of the knee joint and the use of alternative therapies (e.g., ointments or physiotherapy) were recorded. The supplementation of specific collagen peptides derived from type I collagen with a mean molecular weight of 3 kDa led to a significantly (p = 0.024) higher reduction of exercise-induced knee pain (−21.9 ± 18.3 mm) compared with the placebo group (−15.6 ± 18.5 mm). These findings were consistent with the physician’s evaluation (−23.0 ± 19.2 mm vs. −14.6 ± 17.9 mm, p = 0.003). The decrease in pain under resting conditions and after squats did not significantly differ between the groups, as only a small number of participants suffered from pain under these conditions. Due to the clinically unremarkable baseline values, the mobility of the knee joint did not change significantly after the intervention. In conclusion, the current investigation confirmed that the oral intake of bioactive collagen peptides used in the current investigation led to a statistically significant reduction of activity-related joint pain in young active adults suffering from knee joint discomfort.

Quantitative proteomics reveal the protective effects of EDS against osteoarthritis via attenuating inflammation and modulating immune response

Ethnopharmacological relevanceEpimedium brevicornu Maxim, Dioscorea nipponica Makino, and Salvia miltiorrhiza Bunge formula (EDS) are three traditional Chinese medicines commonly combined and used to treat osteoarthritis (OA). However, the mechanism of its therapeutic effect on OA is still unclear. Aim of the studyThe aim of this study was to investigate the potential anti osteoarthritis mechanism of EDS in the treatment of OA rats’ model by quantitative proteomics. Materials and methodsA papain-induced rat OA model was established, and then EDS was intragastrically administered for 28 days. A label-free quantification proteomics was performed to evaluate the holistic efficacy of EDS against OA and identify the possible protein profiles mechanisms. The expression levels of critical changed proteins were validated by RT-qPCR and Western blotting. The effects of EDS were then assessed by evaluating pathologic changes in the affected knee joint and measuring pressure pain threshold, acoustic reflex threshold, angle of joint curvature. ResultsProteomics analysis showed that 62 proteins were significantly upregulated and 208 proteins were downregulated in OA group compared to control group. The changed proteins were involved in activation of humoral immunity response, complement cascade activation, leukocyte mediated immunity, acute inflammatory response, endocytosis regulation, and proteolysis regulation. The EDS treatment partially restored the protein profile changes. The protective effects of EDS on pathologic changes in OA rats’ knee joint and pain threshold assessment were consisted with the proteomics results. ConclusionsThe results suggest that EDS exerted synergistic therapeutic efficacies to against OA through suppressing inflammation, modulating the immune system, relieving joint pain, and attenuating cartilage degradation.

Research and exploration of ACL injury repair and reconstruction and application of biomaterials

The choice of anterior cruciate ligament reconstruction graft and the histological outcome of the reconstructed graft have been an important research topic in the field of anterior cruciate ligament repair and reconstruction. Anterior cruciate ligament reconstruction is widely used in clinical applications, including autograft, allograft, xenograft, biomaterial, artificial material and tissue engineering graft. Through clinical trials, this paper evaluates knee joint stability and functional recovery during rehabilitation of patients undergoing anterior cruciate ligament reconstruction using different rehabilitation programs. In order to reveal the role of functional training in knee rehabilitation. Fifty-two patients undergoing arthroscopic anterior cruciate ligament reconstruction were randomly divided into a traditional rehabilitation group, a progressive muscle training group, and a functional rehabilitation group. Different rehabilitation intervention programs were given. Before, 6 months, 12 months, and 18 months postoperatively, through an analysis of functional movement analysis, core stability assessment, knee mobility (ROM), knee stability and other rehabilitation indicators, knee joint stability and functional recovery were evaluated after ligament injury and reconstruction. Statistical analysis of the results. The results showed that there was no significant difference between the three groups before surgery (P > 0.05). The test results were significantly different between the postoperative and preoperative groups (p < 0.01). Functional rehabilitation training can be efficient and effective, and safely improve the patient's postoperative muscle strength, joint mobility, joint stability, and other capabilities. In particular, it has obvious advantages in restoring the athletic ability of the affected knee joint, improving rehabilitation efficiency, and shortening the rehabilitation cycle.

Metabolic Syndrome Predisposes to Osteoarthritis: Lessons from Model System.

The present study aims to assess for temporal changes in tibial subchondral bone and cartilage in WNIN/Gr-Ob rats (portraying obesity, insulin resistance, dyslipidemia, impaired glucose tolerance, hypertension) in comparison with Wistar controls (WNIN) using anthropometry, micro-computed tomography (micro-CT), scanning electron microscopy (SEM), histopathology, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence. Body weight, abdominal circumference, body mass index (BMI), lean/fat mass, serum tumor necrosis factor (TNF)-α levels were measured (ELISA), followed by ultrastructural analysis of tibial subchondral bone (micro-CT) and cartilage architecture (histopathology and SEM) in WNIN/Gr-Ob and WNIN rats with age (3, 6 and 9 months). Additionally, primary cultures of articular chondrocytes isolated from 6-month-old WNIN/Gr-Ob and WNIN rats were assessed for matrix metalloproteinase (MMP)-13 and Collagen type II (COL2A1) by immunofluorescence. WNIN/Gr-Ob rats exhibited frank obesity with increased BMI, lean and fat mass vis-à-vis significantly higher levels of serum TNF-α (6>9>3 months) as compared with the controls. With an increase in BMI, WNIN/Gr-Ob rats presented with tibial cartilage fibrillation, erosion, osteophyte formation (6 months) and subchondral bone cyst (9 months) confirmed by histology and SEM. An increase in subchondral trabecular bone volume (sclerosis with decreased plate porosity) was observed in all ages in WNIN/Gr-Ob rats compared to their Control. Gaining insights, primary cultures of articular chondrocytes complemented with altered cellular expressions of COL2A1 and MMP-13 from WNIN/Gr-Ob rats, indicating osteoarthritis (OA) progression. Multiple metabolic perturbations featured in WNIN/Gr-Ob rats were effective to induce spontaneous OA-like degenerative changes affecting knee joints akin to human OA.

The effect of a knee brace in dynamic motion-An instrumented gait analysis.

BackgroundOsteoarthritis (OA) is a common problem in the older population. To reduce pain and stress in the affected knee joint compartment, a functional knee brace is often prescribed by physicians to protect it from high loads.ObjectivesAn instrumented gait analysis should evaluate how the 4-point knee orthosis for varus or valgus load relief (M.4s OA) changes the kinematics of the knee, especially in the frontal plane.Methods17 healthy participants took part and were analyzed with an inertial sensor system (MyoMotion) giving continuous, objective information on the anatomical angles. The measurements were made both without wearing a knee brace and with the brace in different settings.ResultsThe results show a significant reduction in the maximum knee abduction and raised knee adduction. The knee brace, with a strong adjustment in varus or valgus orientation, caused a shift of maximum ab-/adduction in the proposed direction in 69% and 75% of the dynamic tests, respectively. The knee motion in the frontal plane shows individual movement patterns.ConclusionThe use of the brace leads to significant changes in the knee’s movement. Patient-specific movement patterns may explain different effects of functional knee braces on individual persons. Inertial sensors have been shown to be a low-cost, easy-to-use option for individual movement analysis and further personalized therapy.

Evaluation of the Efficacy of Platelet Rich Plasma Injection in Chronic Lateral Epicondylitis

Background: Platelet-rich plasma helps in repair because of its growth factor. Platelet-rich plasma has been used in humans for its healing properties. Increased concentration of growth factors and secretory proteins may increase the process of healing on a cellular level.&#x0D; Aim: This study was done to check the effectiveness of PRP injections in patients with chronic lateral epicondylitis.&#x0D; Methodology: This was accomplished in patients visiting the orthopaedic OPD at the Sree Balaji Medical College and Hospital, Chennai, Tamilnadu. There were 40 physicians in this study, among whom 37 were homosexual and 87 were female. The mean age of the patients was 48.1 years (17-82 years). The study period was 3 months. The analytical method used is a visual analog score.&#x0D; Results: Effective therapy was performed with a decline of more than 20% (24 out of 40 patients) in visual analog score after a dual-month period. After 3 months in boys, the mean VAS score dropped from 6.88 to 9.41.&#x0D; Conclusion: Medication of PRP patients with chronic epicondylitis or PRP tennis elbow reduces pain and increases the flexibility of the affected knee joint.

Systemic bee venom exerts anti-arthritic and anti-inflammatory properties in a rat model of arthritis.

Bee venom (BV) is widely used as a traditional China medicine to treat various conditions, including rheumatoid arthritis (RA). The aim of the present study was to evaluate the effects of systemic BV (60 mg/kg) as an anti-arthritic natural product, compare it with Methotrexate and determine the possible underlying mechanisms of BV action using complete Freund's adjuvant-induced arthritic rats. The development of signs of RA signs (knee joint circumference and arthritis scoring index) was evaluated. Erythrocyte sedimentation rate, serum tumor necrosis factor-α (TNF-α) and serum interleukin-1β (IL-1β) levels were measured at the end of the study. Histopathological examination followed by immunostaining of NF-κB (P65) was performed on the affected knee joints. Additionally, in vitro cyclooxygenase (COX) inhibition activity, carrageenan paw edema test and acetic acid writhing tests were performed to evaluate the anti-inflammatory and analgesic effects of the assessed dose and compared with diclofenac. An acute toxicity test was performed to establish the safety of BV at high doses. The results of the present study highlighted the potential of systemic BV on preventing the development of signs of RA. BV also significantly reduced serum levels of TNF-α, IL-1β and NF-κB in the affected joints. In addition to its potent analgesic activity, BV exhibited favorable inhibitory activity of the COX pathway in both in vivo and in vitro models. Therefore, high dose administration of systemic BV displayed safe and promising anti-arthritic, anti-inflammatory and analgesic properties through regulation of different mechanisms associated with the pathogenesis of RA.

Single-leg forward hopping exposures adversely affect knee joint health among persons with unilateral lower limb loss: A predictive model

Single-leg hopping is an atypical, yet convenient, method of ambulation for individuals who have sustained unilateral lower limb-loss. Hopping is generally discouraged by therapists but many patients report hopping, and the potential deleterious effects of frequent hopping on knee joint health remains unclear. Mechanical fatigue due to repeated exposures to increased or abnormal loading on the intact limb is thought to be a primary contributor to the high prevalence of knee osteoarthritis among individuals with unilateral lower limb amputation. We aimed to compare knee joint mechanics between single-leg hopping and walking at self-selected paces among individuals with unilateral lower limb-loss, and estimated the associated probability of knee cartilage failure. Thirty-two males with traumatic unilateral lower limb-loss (22 transtibial, 10 transfemoral) hopped and walked at a self-selected pace along a 15-m walkway. Peak knee moments were input to a phenomenological model of cartilage fatigue to estimate the damage and long-term failure probability of the medial knee cartilage when hopping vs. walking. We estimate that each hop accumulates as much damage as at least 8 strides of walking (p < 0.001), and each meter of hopping accumulates as much damage as at least 12 m of walking (p < 0.001). The 30-year failure probability of the medial knee cartilage exceeded a “coin-flip” chance (50%) when performing more than 197 hops per day. Although a convenient mode of ambulation for persons with unilateral lower limb-loss, to mitigate risk for knee osteoarthritis it is advisable to minimize exposure to single-leg forward hopping.

A case of deep vein thrombosis associated with methicillin sensitive Staphylococcal aureus genu septic arthritis.

Septic arthritis caused by bacteria Gram positive Staphylococcus aureus (S. aureus) infection has been widely reported from Europe and the United States. This case presentation reported the first Staphylococcal septic arthritis, preceded by systemic erythroderma skin lesions from aregional hospital in Surabaya, Indonesia. Radiology imaging was used for confirming the defect. Joint fluid aspirate from the affected knee joint lesion was sent for joint fluid analysis and microbiology culture. The analysis showed infiltration of neutrophil inflammatory cells. S. aureus was isolated on culture and demonstrated catalase positive and coagulase positive reactions. Antimicrobial susceptibility testing was performed to determine the appropriate selection of antibiotics. Clindamycin was used for treatment and the complicated occurrence of deep vein thrombosis was treated with anticoagulant. Awareness of this disease and its progression to its complication deep vein thrombosis is required to understand the burden of this disease.

Breast Support Alters Knee Joint Biomechanics During A Landing Task.

Females have a greater rate of traumatic knee injuries than male athletes. Trunk position has been shown to affect knee joint biomechanics during a landing task. Given the position of breast tissue, insufficiently supported breasts may also alter knee joint biomechanics. However, no previous research has investigated the effect of breast tissue or support on knee joint biomechanics during landing. PURPOSE: to determine the effect of breast support on knee and hip joint kinetics during a landing task. METHODS: Fifteen female athletes performed five step-off landings from a height of 40 cm in each of three bra support conditions: control (CON), low support (LOW) and high support (HIGH). 3D kinematics and ground reaction forces (GRFs) were simultaneously recorded using a 9-camera motion capture system (240 Hz,) and pair of force platforms (1200 Hz,)..) was used to calculate knee and hip joint angles and moments. Custom software (was used to determine peak joint angles and moments. Repeated measures ANOVAs with Tukey’s post-hoc analyses were used to compare mean knee and hip joint kinetics. RESULTS: No differences in peak knee abduction moments were observed, though peak knee external rotation moments were smaller in the LOW compared to CON (p = 0.007) and HIGH conditions (p = 0.013). No differences were observed between CON and HIGH (p = 0.423). No differences were observed in peak hip abduction moment or peak hip external rotation moment. CONCLUSIONS: These findings indicate that knee joint biomechanics during a landing task are affected by breast support. The current study did not address the role of trunk orientation or differences in breast size amongst participants. Future research should address the role of breast motion on trunk kinematics and kinetics.Table 1: Mean knee and hip joint moments in the CON, LOW and HIGH support conditions.

Acute Effects Of Practical Blood Flow Restriction On Knee Proprioception During Low Intensity Aerobic Exercise

Practical blood flow restriction (pBFR) exercise techniques decreases blood flow to targeted muscles while increasing local metabolic accumulation, both of which could impair joint proprioception post-exercise. The impaired proprioception which typically occurs after high intensity aerobic exercise can provide faulty sensory feedback to the brain during movement, resulting in increased risk of injury. Currently, there have been no studies investigating whether pBFR low intensity aerobic exercise has an effect on joint proprioception. PURPOSE: To investigate how low intensity aerobic exercise with pBFR affects knee joint proprioception. METHODS: Fourteen participants (8 males and 6 females) completed 3 sessions. On the first session, participants walked at 5.6 km/h at a 0% grade for two minutes followed by a 2% increase in the incline each minute until 40% of their heart rate reserve was achieved. Participants were familiarized with a “7/10” (moderate tightness) on the perceived tightness scale using elastic knee wraps as well as the position sense and countermovement jumps. On session 2 or 3, participants walked on a treadmill for 15 minutes with or without elastic wraps at 5.6 km/h at the grade determined on the first session. Absolute angular error (AAE) was measured before and immediately after each treadmill walking protocol. Muscle fatigue was determined by changes in average power and peak power measured during countermovement jumps. Change scores were computed for each condition and paired sample t-tests were used to determine differences between pBFR and Control. RESULTS: The change in AAE was not different (pBFR: -1.5 vs. Control degrees: 0.19, p=0.171) between low intensity exercise with and without pBFR [mean difference of -1.73 (-4.3, 0.85) degrees]. The change in peak power was also similar (pBFR: -34.5 vs. Control: 150.1 W, p=0.739) between exercise with and without pBFR [mean difference of -185 (-1358, 988) W]. Similarly, the change in average power (pBFR: 9.1 vs. Control: -3.4 W, p=0.544) was also not different [mean difference of 12.6 (-31.1, 56.2) W]. CONCLUSION: The walking exercise with pBFR did not effect joint proprioception in young adults, suggesting that walking exercise with pBFR might be safely applied without increasing the risk of injury.

Role of MRI in Evaluation of Anterior Knee Pain

Abstract Background: MRI is well known for being particularly useful for scanning and detecting abnormalities in soft tissue structures like the cartilage tissues, tendons, and ligaments. Moreover, MRI can also aid in determining those patients with knee injuries who will require surgical intervention. MR imaging is recognized as a standard procedure and has replaced diagnostic arthroscopy as the primary diagnostic modality for many knee pathologies. Furthermore, MR images can be used to assess anatomic variants that may contribute to chronic patellar instability. Aim of Study: To go over several of the most common causes of Anterior Knee Pain (AKP), with emphasis on their MRI findings with the goal of allowing diagnosis that is more accurate and grading of some of the most common pathologies, for interpreting, reaching an efficient treatment and drastic improvement of this common complaint. Patients and Methods: This study included 25 patients (8 females and 17 males). Their ages ranging between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation. This descriptive study was done to detect the role of MRI in the evaluation of anterior knee pain and apply advanced MRI techniques such as sagittal T2 mapping to visualize the articular cartilage of the knee. Most patients were subjected to MR imaging of the affected knee joints on high field strength scanners using Philips scanners Achieva or Intera (1.5T). Results: The present study revealed that 26% patellar tendon disorders which included (patellar Tendinopathy 21% and Osgood Schlatter disease 5%). Quadriceps tendon disorders represented 10% and they are including (Quadriceps Tendin-opathy 5% and Quadriceps tendon tear 5%). 69% of the sample size showed Patellar disorders represent and they are including (chondromalacia patella 32%, patellar instability 21%, transient patellar dislocation 11% and painful bipartite patella 5%). Hoffa's disease was demonstrated in 21% of the sample size and they are including (Hoffa impingement syndrome and Hoffa ganglion cyst), finally we have torn anterior horn of the lateral meniscus and they represent 5%. Conclusion: MRI is generally safe, accurate, and specific modality, which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also it has a high specification in detecting the grades and types of some of these diseases or factors predispose to them as patella Alta and trochlear dysplasia.

Aging Cartilage in Wild-Type Mice: An Observational Study.

To describe the spontaneous evolution of age-related changes affecting knee joint articular cartilage, walking speed and a serum biomarker of cartilage remodeling in C57BL/6-JRj wild-type male mice. Histological changes were assessed by the Osteoarthritis Research Society International (OARSI) score (0=normal, 6=vertical clefts/erosion to the calcified cartilage extending >75% of the articular surface) in newborn, 1-week- and 1-, 3-, 6-, 9- and 12-month-old C57BL/6-JRj wild-type male mice, walking speed by the Locotronic system, and serum C-terminal telopeptide of type II collagen (CTX-II) content by ELISA in 1-, 3-, 6-, and 9-month-old C57BL/6-JRj wild-type male mice. Mean (SD) OARSI score significantly increased from 0.2 (0.3) to 1.3 (0.6) (p=0.03) between 1 and 3 months of age and from 1.3 (0.6) to 3.3 (0.6) (p=0.04) between 3 and 6 months of age. Mean walking speed was stable between 1 and 6 months of age but significantly decreased from 11.4 (1.8) to 3.2 (0.8) cm.s-1 (p=0.03) between 6 and 9 months of age. Serum CTX-II content was maximal at 1 month of age, then decreased from 12.2 (8.5) to 2.4 (8.4) pg/ml (p=0.02) between 1 and 3 months of age, remaining low and stable thereafter. C57BL/6-JRj wild-type male mice showed continuously increasing osteoarthritic changes but delayed decreasing walking speed with age. These variations were maximal between 3 and 9 months of age. Maximal serum CTX-II content preceded these changes.

Efficacy and safety of two “Carmolis” forms for combined local therapy of knee osteoarthritis: results of a multicenter clinical trial

Objective – to evaluate efficacy and safety of “Carmolis” fluid and gel in patients with knee osteoarthritis, as well as the gel efficacy combined with ultraphonophoresis.Materials and methods. The study included 200 patients, who were divided into 2 groups depending on the way of application of “Carmolis” forms. Group 1 included 165 patients with knee osteoarthritis (the main group included 90 patients, the control group – 75 patients), who underwent complex local treatment with 2 “Carmolis” forms. Group 2 included 35 patients (20 people in the main group and 15 in the control one). The main group received phonophoresis with “Carmolis” gel, and the control group received “Carmolis” gel locally on the affected knee joint. Patients’ average age in group 1 was 62,7 ± 8,5 years, the average age in the control group was 61.4 ± 8.7 years, the disease duration was 10.1 ± 4.7 and 9.2 ± 6, 0 years, respectively. In group 2 the average age and disease duration were 60.1 ± 12.8 and 5.7 ± 5.4 years, respectively.At the initial stage 90 patients of the main group 1 were rubbed “Carmolis” fluid locally in the joint followed by massage. After the fluid absorbed completely, “Carmolis” gel was applied, followed by massage. In the comparison group (75 patients), standard therapy was combined only with “Carmolis” fluid applied on the II knee joint.Twenty patients of the main group 2 were treated with phonophoresis combined with “Carmolis” gel. Clinical efficacy was assessed by pain dynamics.Results. Treatment with two “Carmolis” local forms significantly decreased average on moving from 61.8 ± 14.2 to 30.7 ± 14.2 (р &lt;0,001), at rest – from 49 ± 19, 9 to 20.4 ± 8.5 (р &lt;0,001), on palpation – from 38.7 ± 10.4 to 18.4 ± 5.7 (р &lt;0,001). A similar dynamics was also revealed during WOMAC assessment (Western Ontario McMaster Universities OA Index). Before the treatment start the average WOMAC pain level in the main group was 240.5 ± 39.8, after the treatment – 114.8 ± 30.4 (р &lt;0,001). The control group also showed pain decrease, but to a much lesser extent than in the main one. At the end of the treatment course, patients of both groups demonstrated a pronounced decrease of synovitis sings, but there were no differences between the groups. The dose of non-steroidal anti-inflammatory drugs in the main group was reduced in 70 (77.8 %) patients, in the control group – in 50 (66.7 %). The tolerability of both forms was very good and good. No adverse events were registered. Data on the effectiveness and safety of “Carmolis” gel combined with ultraphonophoresis are presented in the article.Conclusion. According to the results, combined therapy using “Carmolis” liquid and gel significantly reduces joint pain and synovitis severity, increases joints» functional ability and improves patients» general condition, which allows reducing the dose of non-steroidal anti-inflammatory drugs. Both “Carmolis” forms had excellent and good tolerability.

The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus.

Different alignment types for a better outcome after TKA were described. However, it is not clear how kinematic alignment influences knee joint kinematic. The purpose of this study was to analyze whether adapted tibial cuts in constitutional varus knees affect knee joint kinematics regarding femoral roll-back, varus/valgus angle, and femorotibial rotation. Seven cadaveric knees with constitutional varus alignment were examined in the native state and after implantation of a cruciate retaining (CR)-TKA with 0°, 3° and 6° tibia cuts using an established knee joint simulator. The effects of varus alignment on femorotibial rollback and rotation was determined. In addition, the native knee joint and different tibial cuts in CR-TKA were compared with Student's t test. Total knee replacement with a 3° and 6° varus tibia cut had the greatest varus deviation to the native knee (mean 1.6° ± 0.09°, respectively); while, knees with a 0° (mean 0.2° ± 0.01°) tibia cut were most similar to the constitutional varus knee joint. The femoral roll-back in the medial compartment was increased in the native knee (5.7-12.5mm). A 6° varus cut had a restricted translation in the medial compartment (2-3.2mm). In the lateral compartment, the extensive translation was observed with a 0° varus cut, followed by 3° and 6° and the native knee. All cuts showed significantly different mean values. Only the cuts at 3° and at 6° in the medial compartment and the cuts at 0° and at 3° in the lateral compartment did not differ significantly. In respect to tibiofemoral rotation, 0° and 3° varus cuts across all loads had the least difference to the native knee (3.4°), with a 0° varus cut showing a higher absolute internal rotation of the tibia than the native knee. Changes in knee kinematics of the tibiofemoral rotation showed significantly different mean values. The potentially improved outcome parameters in TKA with adapted tibia cuts in constitutional varus knees cannot be completely explained by the changes to knee kinematics. Mechanical alignment seems to result in more balanced load distribution and kinematics more closely resembling the native knee. From a kinematic point of view, it is not recommended to place the tibia in more than 3° of varus. Biomechanical study.

Muscle activation patterns differ with knee osteoarthritis status but not with physical activity level

Purpose: The activity of muscles that cross the knee affects knee joint loading and therefore may impact the incidence and progression of knee osteoarthritis (OA). Greater activity of the quadriceps, hamstrings, or lateral muscle groups in adults with knee OA compared to asymptomatic adults has been associated with greater severity or faster progression of knee OA. However, whether the activity of these muscle groups can be used to differentiate between asymptomatic adults who will or will not go on to develop knee OA is not known.

Arthroscopic Debridement Versus Platelet Rich Plasma Injection in Treatment of Moderate knee Osteoarthritis.

Background: Knee osteoarthritis (OA) is considered the most common disease affecting knee joint. Various strategies are utilized to decrease the symptoms of knee OA, like analgesics, physiotherapy, intra-articular glucocorticoids and hyaluronic acid [HA] injection as well as arthroscopic debridement (AD). New ‌studies have concentrated on new lines of treatment that stimulate damage improving and healing process of the cartilage, including mainly platelet-rich plasma (PRP) injection as a growth factors complex.Aim: Because of the high incidence of OA and its complications, this article aimed to study the effect of AD and PRP injection on patients with knee OA.Methods: This controlled randomized clinical trial involved 20 patients with moderate knee OA. In the PRP group (n = 10), three intra-articular injections at 10-days interval were applied and compared to AD group (n = 10). All patients were prospectively evaluated before and after 6 months of the treatment by KOOS score.Results: After at least 6-months follow-up, KOOS score was significantly improved in PRP group compared to the AD group (P < 0.05). All parameters were improved in the PRP group.Conclusion: The study suggested that injection of PRP is more effective toward reducing pain and symptoms, with improvement of the daily living function, quality of life and function in sport and recreation. PRP is a method of choice in patients with mild to moderate knee OA, whom not responding to classical treatment options.

Interleukin-6 serum concentration in the elderly undergoing total knee arthroplasty: A potential predictor of the early postoperative knee joint range of motion.

To analyze the relevance between serum IL-6 with the early postoperative (post-op) knee joint range of motion (ROM) in the elderly undergoing total knee arthroplasty (TKA). To evaluate the factors affecting early post-op knee joint ROM in the elderly after TKA. One hundred and forty-three patients undergoing TKA were included. The patients' general data, perioperative knee joint ROM and serum IL-6, pre-op HSS, WOMAC, SF-36 scores and Wells scores were collected. Repeated data variance analyses were performed to analyze the relevance between serum IL-6 with post-op knee joint ROM. Correlative regression and regression analysis were performed to evaluate the multiple factors affecting knee joint ROM in the elderly undergoing TKA. The 2-week-post-op (2w-post-op) knee joint ROM was significantly higher in the low IL-6 serum concentration group (< 46.45ng/L) than in the high group (⩾ 46.45ng/L) (97.78 ± 7.44∘VS 91.85 ± 7.42∘, F= 16.860, P= 0.000). A significant negative correlation was found between 1d-post-op serum IL-6 concentration with 2w-post-op knee joint ROM (R=-0.513, P= 0.000). The factors influencing the 2w-post-op knee joint ROM included pre-op HSS scores, pre-op WOMAC scores and whether to retain PCL (posterior cruciate ligament) (R2= 0.451, P= 0.009). A higher 1d-post-op IL-6 serum concentration indicated a lower knee joint ROM in the elderly two weeks after TKA.

Nano Coatings on Knee Implants – A Tribological Review

Abstract Due to the change in lifestyle, the human knee joint is facing a lot of problems which includes the damage of the cartilage, it is known as Osteoarthritis (OA). The damaged cartilage can be cured by using total knee replacement surgery where an implant is fixed to the knee joint. In the knee replacement, the implants are made of stainless steel; titanium alloys which are bio-compatible to the human body are used. The foreign body gives a lot of relief to the patient, but due to their daily activities the wear is slowly developing between the implants. The wear debris is affecting knee joint of the patient which has a painful journey. The tribological studies are done to study the wear rate and friction between the implants. To reduce this effect Nano technology is used as a life saviour. Nano coatings are used on the knee implants to reduce the friction, wear and improves the life of the implant. This paper reviews the different Nano coatings, their tribological performance on knee implants. So that the present paper will be useful for the researchers to work on biocompatible implants and their analyses which may give solution to reduce the friction and wear in knee joint implants