Knee Research Articles

Overview of Meniscus Injury Repair

In recent decades, the perception of the meniscus has gone from being the most useless structure of the knee joint to one of the most important components. The incidence of meniscus injuries is on the rise, which may be due to the increase in daily physical activity among young people. Meniscus injuries are usually caused by excessive exercise or sudden rotation of the knee and are often accompanied by swelling and pain. There are many ways to diagnose and treat it. In the initial stages of injury, you need to follow (RICE), which can be understood as rest, ice, apply pressure to the knee, and elevate the knee to relieve pain. As the meniscus damage worsens, surgery is needed. Then you can do some endurance training to reduce the load on the knee joint. Quadriceps exercises can improve knee joint function.

Surgical planning in HTO – alternative approaches to the Fujisawa gold-standard

Background Presurgical planning of the correction angle plays a decisive role in a high tibial osteotomy, affecting the loading situation in the knee affected by osteoarthritis. The planning approach by Fujisawa et al. aims to adjust the weight-bearing line to achieve an optimal knee joint load distribution. While this method is accessible, it may not fully consider the complexity of individual dynamic knee-loading profiles. This review aims to disclose existing alternative HTO planning methods that do not follow Fujisawa's standard. Methods PubMed, Web of Science and CENTRAL databases were screened, focusing on HTO research in combination with alternative planning approaches. Results Eight out of 828 studies were included, with seven simulation studies based on finite element analysis and multi-body dynamics. The planning approaches incorporated gradual degrees of realignment parameters (weight-bearing line shift, medial proximal tibial angle, hip-knee-ankle, knee joint line orientation), simulating their effect on knee kinematics, contact force/stress, Von Mises and shear stress. Two studies proposed implementing individual correction magnitudes derived from preoperatively predicted knee adduction moments. Conclusion Most planning methods depend on static alignment assessments, neglecting an adequate loading-depending profile. They are confined to their conceptual phases, making the associated planning methods unviable for current clinical use.

How Does Induced Deceleration of One Treadmill’s Belt in the Pre-Swing Gait Phase Change Gait Pattern?

This study aimed to investigate how external perturbations caused by the treadmill belt’s deceleration during the pre-swing phase affect gait kinematics and kinetics in young adults. Twenty-one healthy young females walked on a treadmill in a virtual environment (GRAIL, Motek), where unexpected perturbations were applied to the left belt, mimicking a ‘trip-like’ effect at toe-off. The spatiotemporal, kinematic, and kinetic parameters were analyzed during two cycles. The first cycle involved the first perturbation and the response to it. The second included a gait cycle without the perturbation (treadmill gait). The perturbation resulted in an increased stride duration for both limbs when compared to the treadmill gait. The perturbed limb had a longer support phase, while the reactive limb had the longest double stance phase. The responding limb exhibited more than double the ankle plantarflexion compared to the normal treadmill gait and the perturbed limb. At the hip joint, both limbs showed significantly higher values, with a 40.8% increase in flexion and a 227% increase in extension for the perturbed limb, and a 24.5% increase in flexion and a 212% increase in extension for the responding limb, compared to the treadmill gait. Muscle torque was generally lower in most joints for both limbs, except for notably higher hip and knee extensor values for the perturbed limb. The responding limb exhibited lower values for the ankle, knee, and hip joints, indicating unexpected muscle activity patterns. Studying treadmill belt deceleration during pre-swing gait can provide valuable insights into biomechanical adaptations and motor control strategies.

Morphological Study of Menisci of Knee Joint in Human Cadavers

Morphological Study of Menisci of Knee Joint in Human Cadavers

Understanding the concept of Sandhigata Vata through Samprapti and Shatkriya Kala

The illness known as Sandhigata Vata is prevalent in both industrialised and developing nations. Rarely, the illness results in fatality as well as mild, moderate, or severe morbidity. Problems are becoming more common place these days as a result of dietary and lifestyle changes, as well as social and cultural shifts and travel. Sandhigata Vata is detailed in all Samhitas, according to Ayurveda. Sandhigata Vata is the ailment that Acharya Charak described separately. A major phenomenon in the Samprapti of Sandhigata Vata is the problem of Sandhis, as described by Prakupita Vata. The most prevalent type of joint problem in older and obese people is Sandhigata Vata. It is a primary contributor to morbidity and disability. This condition develops slowly and can lead to deformities and loss of function in joints, particularly weight bearing joints like the knee joint.

Estimation and Validation of Knee Joint Kinematic Parameters Using IMU Sensors in a Wearable Device

Abstract In physiotherapy, joint kinematics is conventionally analyzed using the universal mechanical goniometer involving manual measurements and is only possible for static assessments of biomechanical parameters. The aim of the present research is to estimate and validate the knee joint kinematic parameters using the inertial sensor in a wearable device. A video motion analysis study is performed using ‘Kinovea’ software for measurement validation. No statistical difference is observed in hypothesis testing (t-test, p>0.7). The Pearson correlation coefficient (r2) and intraclass correlation coefficient values are observed to be 0.99 and >0.99, respectively, for a 95% confidence interval in the inter-rater reliability test. Further, data normality using the ‘Kolmogorov-Smirnov’ test, and Bland-Altman analysis is performed to validate quantitative agreements. The Standard error measurement confirms the reliability between the two systems. The developed device can be used as an alternative to the universal mechanical goniometer to measure joint kinematics in dynamic movements.

Knee joint injuries in the structure of injuries among elite athletes of the highest achievements

The article carries out a statistical analysis of sports injuries, with the greatest attention paid to injuries of the knee joint, as the most common among athletes of a high level of professional skill in various sports. An analysis of the causes leading to injuries and operations on the knee joint was carried out, most often these are stress injuries. Risk factors for injury were analyzed.

Correction of coronal angular deformity around knee joint in children aged less than 10 years by temporary epiphysiodesis using eight plate

Correction of coronal angular deformity around knee joint in children aged less than 10 years by temporary epiphysiodesis using eight plate

Meniscus Tears: Risk Factors, Physical Examination, and Preventive Approaches

Abstract. Meniscus injuries are among the most frequent knee issues, affecting individuals across a wide age range and often resulting from acute trauma or age-related degeneration. The meniscus, essential for knee stability, shock absorption, and joint lubrication, is particularly vulnerable to injury in sports involving twisting and pivoting motions. This review discusses the anatomy of the meniscus, various types of tearssuch as radial, horizontal, complex, and bucket-handle tearsand the primary risk factors, including sports activities and occupational stress. Diagnostic tools like the McMurray and Apley compression tests, along with MRI, are crucial in assessing the severity of the injury. Effective prevention strategies include strengthening exercises for the quadriceps and hamstrings, flexibility routines, proper movement techniques, and the use of protective gear like knee braces. Early detection and consistent preventive measures are critical in preserving knee function, minimizing the risk of re-injury, and preventing long-term complications such as osteoarthritis.

Histological Evaluation of the Effects of Intra-Articular Injection of Caffeic Acid on Cartilage Repair in a Rat Knee Microfracture Model.

BACKGROUND Cartilage injuries are challenging to treat due to limited self-healing. Standard treatments often lead to the formation of less durable fibrocartilage. Caffeic acid phenethyl ester (CAPE), a polyphenolic compound, can improve cartilage repair. This animal study aimed to evaluate the histological effects of intra-articular injection of CAPE on cartilage repair in a rat model of microfracture of the knee joint. MATERIAL AND METHODS Twenty-four male Sprague-Dawley rats were divided into 4 groups. A cartilage defect was created in all groups, but Group A received no further intervention. Group B underwent a microfracture. Group C received intra-articular CAPE in the presence of a defect, without microfracture. Group D underwent both microfracture and CAPE treatment. Also, each rat underwent bilateral surgery, with one knee receiving CAPE (150 µg/kg) and the other receiving a control solution. After 28 days, histological analysis was performed on the cartilage tissue samples obtained from the defect sites by using the International Cartilage Research Society (ICRS-I and -II) visual assessment scale. Statistical analysis was performed using appropriate tests to compare histological scores between groups, with significance set at P<0.05. RESULTS Intra-articular CAPE significantly improved histopathological outcomes across several parameters, including reduced inflammation (P<0.05), enhanced tissue morphology (P<0.05), and improved cartilage matrix staining (P<0.05). No significant difference was observed in chondrocyte clustering or surface architecture among the groups. CONCLUSIONS Intra-articular CAPE enhances cartilage healing by improving tissue morphology and cartilage matrix quality.

TRFSA-HQS: Transformer-based MRI Compressed Sensing Network with Frequency Domain Self-Attention

Compressive sensing (CS) can reconstruct undersampled magnetic resonance images, but its iterative optimization process tends to be computationally intensive and time-consuming. Convolutional neural networks (CNNs) have demonstrated impressive reconstruction performance through non-linear feature extraction and mapping capabilities. However, CNNs often struggle to effectively learn and capture global dependencies in the data. Therefore, constructing a MRI reconstruction method that meets clinical real-time imaging and captures dynamic global correlation is crucial in fast and high-precision MRI tasks. We propose a deep unfolding network (TRFSA-HQS) for fast and accurate CS reconstruction, which combines frequency domain self-attention (FSA) based Transformer and half-quadratic splitting (HQS) iterative optimization scheme. TRFSA-HQS adopts an iterative scheme based on HQS to effectively decouple and update optimization problems. The decoupled data subproblems are updated by minimizing the objective function with competitive terms, while the regularization subproblems are updated using the TRFSA deep prior network. The TRFSA module employs an asymmetric UNet architecture, where the encoder and decoder utilize a frequency-domain discriminative feedforward network (DFFN) and FSA. The DFFN selectively extracts deep features from different frequency components, while the FSA captures global dependencies in the frequency domain. The experiment demonstrate that the proposed model achieves an average reconstruction PSNR of 35.11dB on a 0.2 sampling rate test set on FastMRI knee joint data, with an inference time of 0.74s. It has good reconstruction performance and noise robustness, meeting the clinical real-time imaging requirements.

Intra-Articular Injection of Stem Cells for the Regeneration of Knee Joint Cartilage: a Therapeutic Option for Knee Osteoarthritis - a Narrative Review.

Current approaches to regulating osteoarthritis primarily focus on symptom management; however, these methods often have significant side effects and may not be suitable for long-term care. As an alternative to conventional treatments, injecting stem cells into knee joint cartilage is a promising option for repairing damaged cartilage. In this review, we outline the general procedure for stem cell treatment of knee joint cartilage regeneration, emphasizing the potential of intra-articular stem cell injections as a therapeutic option for osteoarthritis. We examined and summarized patient evaluation and preparation for knee joint stem cell therapy, stem cell harvesting, stem cell preparation, injection procedures for stem cell therapy, post-injection care and monitoring, potential outcomes of stem cell therapy, and considerations and risks associated with stem cell therapy. Overall, stem cell injections for knee joint cartilage damage represent a promising frontier in orthopedic care. They offer potential benefits such as pain and inflammation reduction, promotion of cartilage repair and regeneration, and the possibility of avoiding more invasive treatments such as knee surgery. Ongoing collaboration among researchers, clinicians, and regulatory organizations is crucial for advancing this field and translating scientific discoveries into effective clinical applications.

COL9A1-related disorder with pectus carinatum, without epiphyseal dysplasia: case report and review of literature.

COL9A1 encodes the alpha-1 chain of type IX collagen heterotrimer, which is a vital component of collagen fibrils in hyaline cartilage. There are preliminary lines of evidence suggesting that COL9A1 mutations may be associated with autosomal dominant multiple epiphyseal dysplasia (MED), a disorder affecting the epiphysis of long bones. With only 2 reported cases (both from the same family) of MED in autosomal dominant COL9A1-related disorders (MIM 614135) in the clinical scientific literature hitherto, the phenotype is poorly understood at present. Here, we report the clinical and imaging findings associated with a novel COL9A1 mutation in comparison to the previously reported cases. We studied a 22-year-old male, who presented with a chronic history of leg pain and laxity of the knee joint, in the context of a history of pectus carinatum requiring a chest brace, and tall stature (height = 186.9cm) with bilateral piezogenic pedal papules. Gene panel testing and a radiographic skeletal survey were subsequently performed. Gene panel test showed a heterozygous pathogenic variant in the COL9A1 that is denoted as c.188del (p.Phe63Serfs*3) and is predicted to result in a loss-of-function. The patient's long bones all appeared slender on a radiograph, without apparent epiphyseal dysplasia. Our findings suggest that the phenotypic spectrum of COL9A1-related disorders may potentially include other skeletal anomalies (such as pectus carinatum and slender appearance of long bones) aside from epiphyseal dysplasia.

DAIR for periprosthetic joint infections—One week to save the joint?

BackgroundPredicting the success of a Debridement, Antibiotics, and Implant Retention (DAIR) procedure for periprosthetic joint infection (PJI) for hip and knee joint arthroplasty remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimize factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection.MethodsA retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their primary or revision hip or knee arthroplasty. All patients had a confirmed PJI as per MSIS 2013 criteria and an outcome according to the MSIS working group outcome-reporting tool. DAIR surgery was then grouped into groups of “successful” or “unsuccessful” outcomes.ResultsSixty-four consecutive patients with an acute PJI underwent a DAIR procedure between 2009 and 2020, with 46 procedures performed for knees and 18 for hips. Treatment was successful in 69% (37 knees and 7 hips). The chance of a successful DAIR was significantly greater if performed at or within one week of symptom onset compared to greater than one-week duration (adjusted odds ratio (OR) 0.11; P = 0.027; 95% CI [0.02–0.78])). For DAIR performed at or within one week of symptom onset, the success rate was 93% for knees and 80% for hips. The chance of a successful DAIR however was not influenced by whether the surgeon was an arthroplasty or non-arthroplasty surgeon (OR 0.28; P = 0.13; 95% CI [0.05–1.48])). Isolated Streptococcus infection had a success rate of 100%. Next came Coagulase-negative Staphylococci (71%) and Methicillin-susceptible Staphylococcus Aureus (65%). Polymicrobial infection had the worst outcome, with a success rate of 40%.ConclusionIn our experience, DAIR surgery performed within one week of symptom onset significantly increased the chance of successful infection eradication. Collaborative work is required to ensure arthroplasty patients can access prompt appropriate surgical decision-making as soon as concerns arise, remove barriers to early assessment and minimise delays to surgery.

Correlation between Q angle and hip abductor muscle strength in patients with knee osteoarthritis

BackgroundThe Q angle has a major impact on the lower limb’s static alignment in the frontal plane; also, the lever-arm distance between the hip and knee joint centers also changes the hip abductor muscles’ ability to produce torque. An association between Q angle and hip muscle strength has been investigated in different population. However, the relationship between Q angle and hip abductor muscle strength in early knee osteoarthritis has not been investigated. Therefore, the objective of the study was to investigate the correlation between Q angle and hip abductor muscle strength in patients with initial stage of knee osteoarthritis (OA).Study designThis is a correlation study.MethodologyFifty-four involved OA knee among 32 patients (26 female and 6 male), with mean age of 49.38 ± 5.68 years, were included in the study. The Q angle was measured by universal goniometer, and the hip abductor muscle strength was measured by a hydraulic handheld dynamometer.ResultsSpearman’s correlation coefficient test showed that Q angle is significantly (weak negative) correlated (r = − 0.31; p < 0.05) with hip abductor muscle strength, in patients with knee osteoarthritis.ConclusionThere is a correlation between Q angle and hip abductor muscle strength in patients with knee OA. So, with the decrease in hip abductor, muscle strength may lead to increase in Q angle, which may be a factor responsible for early-stage degenerative changes in knee OA.

Physical therapy after femur fracture in elderly patients at the long-term rehabilitation stage

Femoral neck fractures are the leading cause of disability among the elderly. Rehabilitation is fundamental to restore functionality that was before the fracture. Aim. To conduct an observational cohort study to compare the effectiveness of rehabilitation programs in different therapeutic settings. Materials and methods. Elderly patients who underwent surgical stabilization of femur fracture were included in the study. The participants were divided into 3 groups: group 1 – outpatient rehabilitation; group 2 – inpatient rehabilitation; group 3 – rehabilitation at home. Rehabilitation results were determined at the initial stage, 3 and 6 months after the fracture. The Barthel index, passive and active range of motion in hip flexion and extension, and the muscle strength in flexion, extension, and extension of the knee joint were assessed. Results. In 6 months, all three groups showed statistically significant improvement (p &lt; 0.05) in all indices compared to baseline. Considering the intergroup analysis, the final Barthel index score was significantly higher in patients who were treated as outpatients (88.00 ± 9.6) than inpatients (68.57 ± 11.7), but no statistical difference was found between patients who were treated as outpatients and at home (82.5 ± 10.4). In general, patients who were treated in outpatient settings showed better functional outcomes, while patients who were rehabilitated in inpatient settings had worse outcomes. Patients treated at home showed intermediate final functional outcomes more similar to outpatients. Patients with hip fracture undergoing outpatient rehabilitation were more likely to have better long-term effects of the rehabilitation protocol regarding the functional status, muscle strength in hip flexion, hip extension, and knee extension. Patients referred to home rehabilitation showed intermediate results, closer to outpatients, although they started rehabilitation treatment faster after the hospital discharge. Conclusions. The data obtained indicate that rehabilitation leads to significant functional recovery after femur fracture in elderly patients. Both outpatient and home-based rehabilitation are acceptable rehabilitation options for femoral fractures.

CHANGES IN TRYPTOPHAN METABOLISM AND CYTOKINE CONCENTRATION IN SYNOVIAL JOINT TISSUE IN RHEUMATOID ARTHRITIS

The aim of the research. To identify changes in tryptophan and cytokine metabolism in synovial joint tissue in rheumatoid arthritis. Research materials and methods. The experiments were performed on 40 WISTAR rats. At the beginning of the study, each animal of the experimental groups received an intraperitoneal injection of collagen type 2 solution (Chondrex, Inc., USA) in Freund's incomplete adjuvant. The content of tryptophan, kynurenine, 3-hydroxykinurinine, L-5-hydrotryptophan by HPLC with fluorimetric and spectrophotometric detection, and the concentration of cytokines: IL1b, IL6, IL10, IL17, IL18, TNFa were determined in the tissues of the synovial membrane of the knee joint. They were determined using Rat Inflammation Panel V02 multiplex assay kits (Biolegend, USA) on a Cytomics FC500 flow cytofluorimeter (Beckman Coulter, USA). Statistical analysis was performed using the Jamovi program version 2.3.Results. The concentration of cytokines: IL1b, IL6, IL10, IL17, IL18, TNFa was found to be high during the acute development of rheumatoid arthritis. With experimental rheumatoid arthritis, the content of tryptophan metabolites along the kynurenine pathway increases and the concentration of metabolites along the serotonin pathway decreases. Direct positive correlations of IL1b, IL6, IL10, IL17, IL18, TNFa with the content of tryptophan metabolites along the kynurenine pathway have been established.Conclusions. Tryptophan metabolism and IL1b, IL6, IL10, IL17, IL18, and TNFa content are altered in rheumotoid arthritis.

Manufacturing technology of wear-resistant, complex configuration of aluminum-zirconium ceramic products for orthopedics

A high-tech manufacturing process for wear-resistant, complex configuration products made of alumocirconium ceramics for orthopedics is described. Manufactured orthopedic products made of alumocirconium ceramics have passed preclinical, clinical trials, registration as medical devices in the territory of the Russian Federation and are actively used in various clinics of the country. To date, more than 5,000 operations have been successfully performed using conjugated ceramic pairs of the hip joint. The ceramic inserts of the knee joint endoprosthesis remained functional after 5 million cycles.

Expression of CD68+ Cells in Synovial Tissue from Patients with PsA and its Association with Disease Activity Indices: A Clinical Pilot Study.

Investigating CD68+ positive cells in the synovial tissue is crucial for understanding the pathogenesis of psoriatic arthritis (PsA) and developing targeted treatment strategies. The role of CD68+ positive cells in the synovial tissue of patients with PsA for joint destruction has not been fully studied. The objective of the study was to examine the presence of CD68+ cells in the synovial tissue of patients with PsA, particularly those with high inflammatory activity. Synovial tissue samples were collected during knee joint replacement surgeries from patients with PsA (16 patients) and gonarthrosis (25 patients). Immunohistochemical methods were employed to detect CD68+ cell expression in the tissue samples. The results were analyzed by histologists, and the staining intensity and percentage of positively stained cells were evaluated. The data were then divided into three groups for statistical analysis: negative, weakly positive, and strongly positive histological samples. Routine indices for disease activity, VAS, DAPSA, PASDAI, and mCPDAI were used to assess PsA activity in all patients and to assess correlations with CD68+ positive cells in the synovial tissue. Statistical analysis was performed using SPSS version 26.0 (SPSS Inc., Chicago, IL, USA). The expression of CD68+ positive cells was significantly higher in patients with PsA compared to those with activated gonarthrosis (p < 0.001). The indices for disease activity, VAS, DAPSA, PASDAI, mCPDAI, and mCPDAI showed a significant positive relationship with the expression of CD68 + cells on synovial tissue in patients with PsA (p < 0.01) Conclusion: The findings of the study confirm the increased numbers of CD68+ cells in PsA vs. gonathrosis synovium. This suggests the need to explore therapeutic approaches aimed at suppressing or blocking CD68+ cells to potentially mitigate joint damage.

Trends in Surgeon Reimbursement for Primary Total Hip and Knee Joint Arthroplasty: An Analysis of 2,421,710 Medicare Part B Claims From 2017 to 2022.

Primary hip and knee total joint arthroplasties (TJAs) are among the most frequently performed orthopaedic surgeries in the United States, with demand projected to increase to two million cases per year by 2040. Despite the growing demand, previous studies have shown a declining value of Medicare surgeon reimbursements. Given recent inflationary trends, an updated analysis of the changing value of primary TJA reimbursement is necessary. This study examines surgeon reimbursement trends for primary TJA among Medicare patients from 2017 to 2022. We analyzed Medicare Part B claims data from the Centers for Medicare and Medicaid Services Medicare Physician & Other Practitioners database. Using Healthcare Common Procedure Coding System codes for primary TJA, we queried the database for procedures performed between 2017 and 2022. Yearly service counts and allowed Medicare reimbursements were examined. Reimbursement values were adjusted for inflation using the Consumer Price Index with all values converted to 2022 U.S. dollars. The study included 2,421,710 Medicare claims for primary TJA from 2017 to 2022. During this period, the volume of primary TJA increased by 2.9%. However, average reimbursement decreased by 4.2%, from $1,343 in 2017 to $1,286 in 2022. When adjusted for inflation, the decrease in reimbursement was more pronounced, falling by 19.6% from $1,600 to $1,286. Trends in reimbursement varied by procedure type and geographic region. Between 2017 and 2022, while the volume of primary TJA increased, Medicare surgeon reimbursement for these procedures decreased, with a markedly greater reduction when adjusted for inflation. These trends highlight the need for policy reforms to ensure sustainable reimbursement for surgeons performing primary TJA.