Knee Joint Disease Research Articles

A Spectrum of MRI Findings in the Knee Joint: A Retrospective Study of Selected Population in South-South Nigeria

The knee is a very important joint and injuries affecting it may cause significant disability and discomfort to the patient. Despite a variety of methods available to assess injuries of the knee joint, Magnetic Resonance Imaging (MRI) continues to play a major role. This study evaluated the spectrum of MRI findings in a relatively low resource environment, with limited access to MRI modality. The outcome should justify further investment in MRI services in this locality. The study involves retrospective analysis of MRI reports of 198 clinically symptomatic patients referred for imaging in a Port-Harcourt. All examinations were performed using GE BRIVO MR 235 machine with 0.35 Tesla field strength in a well-coupled standard knee coil. All images were analyzed for normality or otherwise and radiological reports generated by competent radiologists. The most common findings are traumatic in origin, notably cruciate ligament tears (37.37%) and meniscal tears (33.3%) as well as quadriceps tendon tears (3.03%). The medial meniscus and anterior cruciate ligaments were more frequently involved. Furthermore, patients in the 3rd and 4th decade of life were more commonly involved, with a male preponderance. The less common findings of Synovial chondromatosis, cyst-like lesions, tumors and loose bodies, all buttress the importance of routine MRI in atraumatic cases. The spectrum of MRI findings in this study is a reflection of growing interest and confidence in MRI of the diseased knee joint in our environment. The outcome would be a justification for future investments in MRI. Keywords: Magnetic Resonance Imaging, knee injuries, tibial meniscal tears, incidental findings

Good Postoperative Flexion Angle Improves Knee Function and Improvement of Flexion Angle Increases Patient Satisfaction After Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is a well-established procedure for treating knee joint diseases. However, the postoperative range of motion (ROM) varies and is an important indicator of TKA success. Recently, patient-reported outcome measures (PROMs) and patient satisfaction have drawn attention. However, the relationship between ROM and knee function obtained by PROM and satisfaction is not well understood. MethodsWe retrospectively reviewed the data of 375 patients who underwent 500 primary TKA procedures. We measured the ROM before and after surgery. Knee joint function was evaluated using the Knee Injury Osteoarthritis Outcome Score, a PROM, and patients were classified into good function and poor function groups. Patient satisfaction was evaluated on a 5-graded scale as overall satisfaction, and patients were divided into a satisfied or a dissatisfied group according to the obtained scores. ROM was compared between the 2 groups, then significantly different factors were analyzed using multiple logistic regression analysis. Moreover, cut-off points of ROM for obtaining good function and patient satisfaction were determined using ROC curve analysis. ResultsThe postoperative flexion angle had a significant effect on knee function (P < .001). The cut-off value of the postoperative flexion angle for good knee function was 120°. The improvement in flexion angle had a significant effect on patient satisfaction (P = .004). The cut-off value for the improvement in the flexion angle was 5°. ConclusionThe postoperative flexion angle had a significant effect on knee function and improvement in the flexion angle had a significant effect on patient satisfaction.

Automatic Discoid Lateral Meniscus Diagnosis from Radiographs Based on Image Processing Tools and Machine Learning.

The aim of the present study is to build a software implementation of a previous study and to diagnose discoid lateral menisci on knee joint radiograph images. A total of 160 images from normal individuals and patients who were diagnosed with discoid lateral menisci were included. Our software implementation includes two parts: preprocessing and measurement. In the first phase, the whole radiograph image was analyzed to obtain basic information about the patient. Machine learning was used to segment the knee joint from the original radiograph image. Image enhancement and denoising tools were used to strengthen the image and remove noise. In the second phase, edge detection was used to quantify important features in the image. A specific algorithm was designed to build a model of the knee joint and measure the parameters. Of the test images, 99.65% were segmented correctly. Furthermore, 97.5% of the tested images were segmented correctly and their parameters were measured successfully. There was no significant difference between manual and automatic measurements in the discoid (P=0.28) and control groups (P=0.15). The mean and standard deviations of the ratio of lateral joint space distance to the height of the lateral tibial spine were compared with the results of manual measurement. The software performed well on raw radiographs, showing a satisfying success rate and robustness. Thus, it is possible to diagnose discoid lateral menisci on radiographs with the help of radiograph-image-analyzing software (BM3D, etc.) and artificial intelligence-related tools (YOLOv3). The results of this study can help build a joint database that contains data from patients and thus can play a role in the diagnosis of discoid lateral menisci and other knee joint diseases in the future.

Relationship between increased serum & synovial fluid decorin levels & knee osteoarthritis.

Background & objectives:Decorin is a proteoglycan that plays a role in the binding of collagen and has an important role in the pathogenesis of osteoarthritis (OA). This study was aimed to determine serum and synovial fluid decorin levels in patients with knee OA and to investigate whether these levels were associated with OA and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score.Methods:In this prospective study 88 participants were included (44 knee OA and 44 with other knee joint diseases) in the study and control groups. Knee function was assessed using the WOMAC score. The serum and synovial fluid decorin levels were analyzed using a human decorin ELISA. Binary logistic regression with a single and multi-categorical predictor was used to determine the possible risk factors for OA.Results:The serum decorin levels were significantly higher in the OA group than the control group (P<0.002). The synovial fluid decorin levels were not significantly different between OA and control groups. WOMAC score [odds ratio (OR)=1.073, 95% confidence interval (CI): 1.032-1.116, P<0.001] and high serum decorin levels (OR=1.114, 95%CI: 1.030–1.205, P=0.007) were found to be significant in the determination of OA. Serum decorin levels were positively correlated with the WOMAC score in OA.Interpretation & conclusions:An increased serum decorin levels may be indicative of changes in extracellular matrix structure. The positive correlation between serum decorin level and WOMAC score supports this result. Increased serum decorin levels and WOMAC score were found to be risk factors associated with OA. However, the decorin level in the joint fluid was not associated with OA.

Epidemiological Characteristics of Osteoarthritis in Yichang City - Hubei Province, China, 2017-2018.

What is already known about this topic?OA has been listed as the fastest increasing major public health problem and ranked second as a cause of disability by World Health Organization (WHO). With population aging, osteoarthritis (OA) is causing an increased economic burden for individuals and society and is attracting an increasing amount of scientific attention.What is added by this report?This research used healthcare data to analyze the epidemiological characteristics of OA in Yichang City, Hubei Province, China. The exact number and distribution of patients were obtained, and a descriptive analysis of OA visits by age, gender, and season was performed. Knee joint disease among women was most common, followed by other joint diseases. Knee osteoarthritis was the most common OA diagnosis between 60 and 69 years of age.What are the implications for public health practice?In China, the prevalence of OA among middle-age and elderly people was high. With increases in the size of the elderly population, the burden of disease caused by OA may increase. It is necessary to strengthen publicity to improve people’s awareness of self-health care of bone and joint. Interventions and preventive strategies targeting high-risk groups are urgently needed in order to improve healthy bones and healthy life quality among middle-age and elderly people.

Comparative gait analysis of patients with different design of total knee arthroplasty

Introduction/Objective. The essence of the treatment of degenerative knee joint diseases is pain relief, restoring motion range and stability of knee joints. Methods. In this study, 35 patients participated after having surgery of the knee joint. The patients had a posterior-stabilized (PS) endoprosthesis in one joint, and a posterior cruciate ligament retaining (CR) endoprosthesis in the other. Kinematic data was collected using a 3D optical system for tracking fluorescent markers in time. Based on these data, the following parameters were determined: degree of flexion, mediolateral (ML) translation, lateral gap, medial gap, and the angle of change between the transtibial and transfemoral axes. Results. The results show a more pronounced flexion degree with the PS prosthesis compared to the CR prosthesis. Also, the results show negligible values of the ML translation, lateral gap, and medial gap in both types of prostheses. Using the non-parameter Wilcoxon test, a substantial difference in the angle change between the transtibial and transfemoral axes was confirmed, that is, in the flexion angles on the CR and PS prostheses. Conclusion. This study shows that there is no great difference in the use of the PS or CR designs of endoprostheses. Better behavior and range of motion in the knee joint were established with the implantation of the PS endoprosthesis. This conclusion is confirmed by the substantial difference in the degree of flexion of the knee joint and in the position of the transversal axes of the tibia and femur.

富血小板血浆治疗膝关节疾病的研究进展

富血小板血浆治疗膝关节疾病的研究进展

Visualisation of meniscus from knee joint MRI and assessment of its size differences due to age, gender and BMI

Menisci play a major role in cushioning and distributing the stress due to body weight over the cartilage surface of femur and tibia. They also contribute in joint lubrication and provide stability for the joint with the support of ligaments. It is essential to quantify the size and volume of the meniscus in treatment of injured and discoid meniscus. Visualisation of menisci using MRI is helpful in understanding location of menisci tears and degradation. In this work, menisci were segmented from knee joint MRI using seeded region growing algorithm and volume rendered for 3D visualisation. The menisci are quantified using image processing method. The noninvasive method of visualisation and quantification of menisci is useful for diagnosis and surgical planning of diseased knee joints especially elderly people and sports injured. Influencing factors for size difference in menisci due to age, gender and BMI is analysed using statistical methods.

Aquatic Therapy Following Total Knee Replacement

ABSTRACTTotal knee replacement (TKR) has revolutionized the care of pati ents with end-stage knee joint disease. Rehabilitation of TKR commonly consists of land-based exercises as a primary mode, but it may notalways be an optimal approach. Water provides a unique environment. The level of exertion is a function of water properties and the physical laws of motion. Aquatic therapy allows fine gradations of exercise, increase control over thepercentage of weight bearing, increase ROM and strength, decrease pain and swelling, and increase confidence in functional movements.Although there is inconsistency in research results, of all studies aquatic therapy is not said to be worst than land-based therapy. Moreover, it has a positive influence on social behavior and mood. This may bemore advantageous in the early postoperative phase when patient s are limited by pain. As a tool, aquatic therapy has desirable and undesirable effects. So, it is important to screen the patientsbefore undergoing aquatic therapy and to assess patient’s condition during and after it. However, so far there has been no agreement in post TKR aquatic protocols. The obstacle also may occur on the cost forfacility maintenance and hygiene, as well as the availability o f competent human resources.Keywords: aquatic therapy, total knee replacement

Segmentation and classification of knee joint ultrasonic image via deep learning

The knee is one of the most complicated joints in the human body, but it could be easily injured. Ultrasound imaging is an important technology for the diagnosis of the knee disease. To assist doctors in the treatment and reduce errors of judgment, we investigate the segmentation of disease regions and the automated identification of the typical knee joint diseases. First, we use deep learning to segment the Region of Interest (ROI). To solve the mis-segmentation and poor edge segmentation that occur when the ultrasound image is directly fed into the deep neural network, an image segmentation framework is proposed that integrates snake preprocessing, dilated convolution to expand the receptive fields, and multi-channel learning. Second, due to the small difference in features among various categories of ultrasound images, a hybrid algorithm is proposed based on the Resnet rough classification and quadratic training with graph embedding. Finally, the experiments show that the proposed image segmentation framework achieves 10% greater accuracy than a common segmentation network. By visualizing the feature vectors extracted from the classification network, we verify that the feature vectors are closer on similar images after quadratic training by graph embedding. Employing the optimization with quadratic training, we increase the classification accuracy by 11% compared to the Resnet approach.

Automated Indentation Demonstrates Structural Stiffness of Femoral Articular Cartilage and Temporomandibular Joint Mandibular Condylar Cartilage Is Altered in FgF2KO Mice.

Employ an automated indentation technique, using a commercially available machine, to assess the effect of fibroblast growth factor 2 (FGF2) expression on structural stiffness over the surface of both murine femoral articular cartilage (AC) and temporomandibular joint (TMJ) mandibular condylar cartilage (MCC). Experiments were performed using 3-month-old female homozygote Fgf2KO mice with wild type (WT) littermates. After euthanization, isolated mandibles and hindlimbs were either processed for histology or subjected to automated indentation on a Biomomentum Mach-1 v500csst with a 3-axis motion controller in a phosphate buffered saline bath using a 0.3 mm spherical tip indenter. The effect of indentation depth on normal force was characterized, then structural stiffness was calculated and mapped at multiple positions on the AC and MCC. Automated indentation of the AC and TMJ MCC was successfully completed and was able to demonstrate both regional variation in structural stiffness and differences between WT and Fgf2KO mice. Structural stiffness values for Fgf2KO AC were significantly smaller than WT at both the medial/anterior (P < 0.05) and medial/posterior (P < 0.05) positions. Global Fgf2KO also lead to a decrease in MCC thickness of the TMJ compared with WT (P < 0.05) and increased structural stiffness values for Fgf2KO at both the posterior and anterior location (P < 0.05). Automated indentation spatially resolved differences in structural stiffness between WT and Fgf2KO tissue, demonstrating FGF2 expression affects femoral AC and TMJ MCC. This quantitative method will provide a valuable approach for functional characterization of cartilage tissues in murine models relevant to knee joint and TMJ health and disease.

Knee joint vibration signal classification algorithm based on machine learning

The knee joint is the largest and most complex flexion and extension joint of the human body. It supports most of the weight of the human body during the whole body during standing or exercise. Because the knee joint has the characteristics of complex structure and large load, it is also vulnerable to damage. An effective diagnosis in the early stage of injury or lesion of the knee joint is of great help to the later treatment. At present, the commonly used knee joint examination methods have the problems of large trauma and high cost. Therefore, this paper uses machine learning technology to study the classification algorithm of knee joint vibration signal. The research results of this paper were verified by selecting the subjects to form a healthy group and a disease injury group. The experimental results show that the proposed signal denoising algorithm is superior to the traditional denoising algorithm. After analyzing several classification algorithms, the multi-classifier fusion algorithm has excellent performance in signal classification. The experimental results show that the research results can be applied to the classification of knee joint vibration signals, and then applied to the clinical diagnosis of knee joint diseases.

Graphical-based multivariate analysis for knee joint clinical and kinematic data correlation assessment.

A large amount of data including joint kinematics, joint kinetics, clinical and functional measurements constitutes the clinical gait analysis basis which is a process whereby quantitative gait information are collected to aid in clinical decision-making. Therefore, better understanding the relationship between the biomechanical and clinical data for the knee osteoarthritis (OA) patient is for a relevant importance. It's the purpose of this paper, which aims to analyze and visualize the correlation structure between biomechanical characteristics and clinical symptoms, and thus to provide an additional knowledge from the coupling of these parameters that will be useful for the pathology assessment of knee-joint disease in the end-staged knee OA patients. We perform two multivariate statistical approaches, first, a Canonical Correlation Analysis (CCA) to assess the multivariate association and, second, a graphical- based representation of the multivariate correlation to better understand the association between these multivariate data. Results show the usefulness of using such multivariate approaches to highlight association and specific correlation structure between the features and to extract meaningful information.

A Study of Wear Articular Cartilage of Synovial Human Knee Joint Using Non-Newtonian Elastic Mathematical Model

In this paper, the wear in layers of articular cartilage was calculated, parameters effective on elastic deformation were studied in normal and diseased knee joints, and relations between elastic deformation and squeeze film characteristics under lubrication condition were discussed with using a mathematical model. Conferring to the results obtained, elastic deformation effects on the performance of synovial human knee joint were analyzed from medical and dynamics perspectives. Relationships between elastic deformation and wear of layers were also discussed.

Analysis of Musculoskeletal Ultrasound in the Diagnosis of Middle-aged and Elderly Degenerative Knee Joint Disease and Its Influence on the Coincidence Rate

Analysis of Musculoskeletal Ultrasound in the Diagnosis of Middle-aged and Elderly Degenerative Knee Joint Disease and Its Influence on the Coincidence Rate

Application of Core Area Muscle Group Stability Enhancement Combined with Suspension Training in Rehabilitation Treatment of Elderly Patients with Degenerative Knee Joint Disease

Application of Core Area Muscle Group Stability Enhancement Combined with Suspension Training in Rehabilitation Treatment of Elderly Patients with Degenerative Knee Joint Disease

In vivo assessment of material properties of muscles and connective tissues around the knee joint based on shear wave elastography

Previous studies on knee biomechanics have mainly focused on the joint structure itself, largely neglecting the material properties of the muscles and connective tissues around the knee joint. Therefore, this study was purposed to conduct a systematic in vivo examination of the material properties of muscles, tendons, and ligaments, and investigated the respective influences of gender and age on the material properties. The participants were 50 healthy males and females within the following four age groups: 21–30 years, 31–40 years, 41–50 years, and above 51 years. The Young's moduli of the muscles, tendons, and ligaments around the knee joint were measured by shear wave elastography (SWE). Analysis of the Young's modulus results showed that excellent repeatability could be achieved by using SWE. For muscles, the intraclass correlation coefficient (ICC) and 95% confidence interval (CI) ranged between 0.952 and 0.987, and 0.923 and 0.992, respectively. The ICC ranged from 0.920 to 0.941, and the 95% CI was between 0.872 and 0.969 for tendons and ligaments. Additionally, the Young's moduli of the muscles, tendons, and ligaments of males were greater than those of females. With the exception for medial patellar retinaculum (MPR), the Young's moduli of other observed tissues decreased with age for both males and females, indicating that age has a significant impact on the Young's moduli of muscles, tendons, and ligaments. Hence, SWE is a reliable and repeatable technique that can be used to assess the Young's moduli of the muscles, tendons, and ligaments around the knee joint. Furthermore, gender and age affects the material properties. The results of this study provide an in vivo database of the material properties of muscles and connective tissues, and thus may prove useful for the prevention and treatment of knee joint injuries and diseases.

Dual Surgical Setup May Improve Infection Control Rate of Debridement and Implant Retention Procedures for Periprosthetic Infections of the Hip and Knee

BackgroundDebridement, antibiotics, and implant retention (DAIR) is an appealing treatment option for periprosthetic joint infection (PJI) due to its low cost and low morbidity. There are many nonmodifiable risk factors for DAIR failure that have previously been established. A dual DAIR setup constitutes establishing a new, sterile field after the initial debridement. The purpose of this study is to determine whether the modifiable surgical technique of a dual setup improves the infection control rate following PJI. MethodsA retrospective study was conducted from January 1, 2000 to December 31, 2017 to identify patients who underwent a DAIR procedure as initial surgical treatment for PJI of the hip or knee. Patients were divided between 2 groups, failed and successful DAIR procedures. Failure was defined as infection recurrence requiring surgical intervention. Demographic (age, gender, body mass index, smoking status, American Society of Anesthesiologists status), preoperative comorbidity (hypertension, cardiac disease, diabetes status, depression or anxiety diagnosis, pulmonary disease), operating surgeon, single vs dual setup, hospital, use of long-term antibiotics postoperatively (greater than 6 weeks of intravenous antibiotics), joint, and laterality data were compared between cohorts using multivariate regression analysis. ResultsTwo hundred sixty-three patients were identified who underwent DAIR as the exclusive and initial treatment for PJI. Single vs dual setup, knee vs hip joint, cardiac or vascular disease diagnosis, major depressive disorder or generalized anxiety disorder diagnosis, and staphylococcal infections were found to be independent predictive variables for DAIR failure. ConclusionIn our series, the dual setup DAIR was a modifiable surgical technique that significantly decreased the risk of infection recurrence compared to single setup DAIR.

Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can Affect It: A Systematic Review.

The knee joint, as the main lower limb motor joint, is the most vulnerable and susceptible joint. The knee injuries considerably impact the normal living ability and mental health of patients. Understanding the biomechanics of a normal and diseased knee joint is in urgent need for designing knee assistive devices and optimizing a rehabilitation exercise program. In this paper, we systematically searched electronic databases (from 2000 to November 2019) including ScienceDirect, Web of Science, PubMed, Google Scholar, and IEEE/IET Electronic Library for potentially relevant articles. After duplicates were removed and inclusion criteria applied to the titles, abstracts, and full text, 138 articles remained for review. The selected articles were divided into two groups to be analyzed. Firstly, the real movement of a normal knee joint and the normal knee biomechanics of four kinds of daily motions in the sagittal and coronal planes, which include normal walking, running, stair climbing, and sit-to-stand, were discussed and analyzed. Secondly, an overview of the current knowledge on the movement biomechanical effects of common knee musculoskeletal disorders and knee neurological disorders were provided. Finally, a discussion of the existing problems in the current studies and some recommendation for future research were presented. In general, this review reveals that there is no clear assessment about the biomechanics of normal and diseased knee joints at the current state of the art. The biomechanics properties could be significantly affected by knee musculoskeletal or neurological disorders. Deeper understanding of the biomechanics of the normal and diseased knee joint will still be an urgent need in the future.

A Fuzzy Rule Based Expert System for Early Diagnosis of Osgood Schlatter Disease of Knee Joint

The proposed research work is for the early diagnosis of the inflammatory disease named Osgood-Schlatter disease of the knee joint. As the system deals with fuzzy values, a MATLAB (R2013a) fuzzy logic controller is used for the implementation. The knowledge engineering phase is done with the help of an orthopedic expert. Four symptoms are used for diagnosing the severity of disease. Also, this diagnosis provides the treatment for the respective level of disease. Data collection is completed by the survey method and various defuzzification methods are used to check the accuracy. The proposed system was tested on 25 patients.