Frequent Knee Research Articles

Do Existing MRI Definitions of Knee Osteoarthritis Identify Knees That Will Develop Clinically Significant Disease Over Up To 11 Years of Follow-Up?

In individuals without radiographic knee osteoarthritis (OA), we investigated whether magnetic resonance imaging (MRI)-defined knee OA at baseline was associated with incident radiographic and symptomatic disease during up to 11 years of follow-up. Osteoarthritis Initiative participants without tibiofemoral radiographic knee OA at baseline were assessed for MRI-based tibiofemoral cartilage damage, osteophyte presence, bone marrow lesions, and meniscal damage/extrusion. We defined MRI knee OA using alternative, reported definitions (Def A and Def B). Kellgren-Lawrence (KL) grade, joint space narrowing (JSN), and frequent knee symptoms (Sx) were assessed at baseline, 1-, 2-, 3-, 4-, 6-, 8-, and 10/11-year follow-up visits. Incident tibiofemoral radiographic knee OA (outcome) was defined as (1) KL ≥2, (2) KL ≥2 and JSN, or (3) KL ≥2 and Sx. Adjusted Cox proportional hazards regression models examined associations of baseline MRI-defined knee OA (Def A and Def B) with incident outcomes during up to 11 years of follow-up. Among 1,621 participants (mean age ± SD 58.8 ± 9.0 years, mean body mass index ± SD 27.2 ± 4.5 kg/m2, 59.5% women), 17% had MRI-defined knee OA by Def A and 24% by Def B. Baseline MRI-defined knee OA was associated with incident KL ≥2 (odds ratio 2.94 [95% confidence interval (95% CI) 2.34-3.68] for Def A and 2.44 [95% CI 1.97-3.03] for Def B). However, a substantial proportion of individuals with baseline MRI-defined knee OA did not develop incident KL ≥2 during follow-up (59% for Def A and 64% for Def B). Findings were similar for the other two outcomes. Current MRI definitions of knee OA do not adequately identify knees that will develop radiographic and symptomatic disease.

Bicycling over a Lifetime Is Associated with Less Symptomatic Knee Osteoarthritis: Data from the Osteoarthritis Initiative.

This study aimed to evaluate the relationship between a history of bicycling and symptomatic and structural outcomes of knee osteoarthritis (OA), the most common form of arthritis. This was a retrospective, cross-sectional study within the Osteoarthritis Initiative (OAI), where we investigated OAI participants with complete data on bicycling, knee pain, and radiographic evidence of knee OA. We used a self-administered questionnaire at the 96-month OAI visit to identify participation in bicycling during four time periods throughout a participant's lifetime (ages 12-18, 19-34, 35-49, and >50 yr). Using logistic regression, we evaluated the influence of prior bicycling status (any history, history for each time period, number of periods cycling) on three outcomes at the 48-month OAI visit: frequent knee pain, radiographic OA (ROA), and symptomatic radiographic OA (SOA), adjusting for age and gender. A total of 2607 participants were included: 44.2% were male, mean age was 64.3 (SD, 9.0) yr, and body mass index was 28.5 (SD, 4.9) kg·m -2 . The adjusted risk ratios for the outcome of frequent knee pain, ROA, and SOA among those who reported any history of bicycling compared with non-bicyclers were 0.83 (0.73-0.92), 0.91 (0.85-0.98), and 0.79 (0.68-0.90), respectively. We observed a dose-response among those who participated in bicycling during more time periods. People who participated in bicycling had a lower prevalence of frequent knee pain, ROA, and SOA. The benefit appeared cumulative. This study indicates that bicycling may be favorable to knee health and should be encouraged.

Evaluation of a measure of end-stage knee osteoarthritis compared to total knee replacement: An observational study using multicohort data

ObjectivesTo determine if an end-stage knee osteoarthritis (esKOA) measure, based on symptomatic and radiographic criteria, can indicate progression to severe KOA earlier and with fewer research participants than total knee replacement (TKR). We employed both interventional and observational study designs as examples to estimate the required sample sizes. EsKOA in a knee was declared if either of the following two conditions were met: 1) moderate, intense, or severe symptoms of KOA indicated by pain and disability measurement and severe KOA indicated by radiographically-assessed knee structure; 2) intense or severe symptoms of KOA indicated by pain and disability measurement and frequent knee pain with mild or moderate KOA as indicated by radiographically-assessed knee structure. MethodsWe examined the association between weight loss from baseline to 2-to-2.5-year and 4-to-5-year follow-ups and the odds of esKOA and TKR in 5,593 participants (10,357 knees) from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST). We also estimated the sample sizes needed for interventional and observational study designs to detect a 10, 20, or 50% reduction in the incidence of esKOA and TKR. ResultsThe association of weight loss with both esKOA and TKR was detected at the 4-to-5-year follow-up. However, at the 2-to-2.5-year follow-up, the association was detected for esKOA but not TKR. The required sample sizes for detecting associations of weight loss with the incidence of esKOA were 85% to 93% smaller than those for TKR at the 4-to-5-year and 2-to-2.5-year follow-ups, respectively. ConclusionThe esKOA measure enables shorter and smaller studies compared to using TKR as an outcome.

Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and “All Suture” Knotless Anchors for Patellar Fixation

Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.

Relation of Intra-Articular Mineralization to Knee Pain in Knee Osteoarthritis: A Longitudinal Analysis in the MOST Study.

Intra-articular (IA) calcium crystal deposition is common in knee osteoarthritis (OA), but of unclear significance. It is possible that low-grade, crystal-related inflammation may contribute to knee pain. We examined the longitudinal relation of computed tomography (CT)-detected IA mineralization to the development of knee pain. We used data from the National Institutes of Health-funded longitudinal Multicenter Osteoarthritis Study. Participants had knee radiographs and bilateral knee CTs at baseline, and pain assessments every 8 months for 2 years. CT images were scored using the Boston University Calcium Knee Score. We longitudinally examined the relation of CT-detected IA mineralization to the risk of frequent knee pain (FKP), intermittent or constant knee pain worsening, and pain severity worsening using generalized linear mixed-effects models. We included 2,093 participants (mean age 61 years, 57% women, mean body mass index 28.8 kg/m2 ). Overall, 10.2% of knees had IA mineralization. The presence of any IA mineralization in the cartilage was associated with 2.0 times higher odds of having FKP (95% confidence interval [CI] 1.38-2.78) and 1.86 times more frequent intermittent or constant pain (95% CI 1.20-2.78), with similar results seen for the presence of any IA mineralization in the meniscus or joint capsule. A higher burden of IA mineralization anywhere within the knee was associated with a higher odds of all pain outcomes (odds ratio ranged from 2.14 to 2.21). CT-detected IA mineralization was associated with risk of having more frequent, persistent, and worsening knee pain over 2 years. Targeting IA mineralization may have therapeutic potential for pain improvement in knee OA.

Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort.

Knee pain is an important health problem due to its high prevalence, negative impact on daily activities and quality of life, and societal burden. While the link between excess weight and knee pain has been well-documented in the literature, many studies are limited to patients with osteoarthritis or use cross-sectional data. This longitudinal study investigated whether overweight and obesity were associated with the frequency and severity of frequent knee pain (FKP) episodes over 4 years in civil servants enrolled in the ELSA-Brasil MSK cohort. Knee pain was assessed during baseline face-to-face interviews (2012-2014) and four yearly telephone follow-ups (2015-2019). Disabling FKP episodes or those of moderate to very severe intensity were classified as severe. Multinomial logistic regression models adjusted for confounders were used to test for associations in two participant groups: those with knee pain at baseline (prognosis cohort) and those without knee pain (incidence cohort). A total of 2644 participants were included: 54.2% female, mean age 55.8 (SD 8.8) years. In the incidence cohort (n = 1896), obesity increased the risk of one (OR: 1.63; 95% CI 1.13-2.37) and multiple FKP episodes (OR: 2.61; 95% CI 1.71-3.97), as well as the risk of non-severe (OR: 1.72; 95% CI 1.04-2.84) and severe FKP episodes (OR: 2.10; 95% CI 1.50-2.95). In the prognosis cohort (n = 748), obesity increased the risk of multiple (OR: 2.54; 95% CI 1.60-4.05) and severe FKP episodes (OR: 2.31; 95% CI 1.49-3.59). Overweight presented the same trends but fell short of significance. These results provide further support that overweight and obesity are important contributors to the incidence and worsening of FKP, and that weight management must be prioritized in multidisciplinary knee pain prevention and treatment programs to reduce the burden of musculoskeletal disorders.

Surgical Treatment of an Unusual Ski Injury: Combined Tibial Fracture With Anterior Cruciate Ligament Avulsion and Segond Lesion

Background: Alpine skiing is considered to be a high-risk sport due to frequent knee injuries and lower limb fractures. The most common lower limb fracture is tibial shaft fracture, while the most common ligament injuries include anterior cruciate ligament (ACL) or medial collateral ligament tears. An injury rarely described in the literature is the association of a bony leg fracture with an ACL injury and Segond fracture. Indications: While the tibial fracture can be managed with intermedullary nailing and proximal ACL tears can be managed with primary repair, the combination of treatments including fixation of the Segond fracture is uncommon. Technique Description: We report combination treatment with nailing for the tibial fracture, primary repair for the ACL avulsion, and primary fixation of Segond fracture. Results: Simultaneous reduction and fixation of the fracture and stabilization of the knee with ACL and anterolateral ligament repair in a single stage resulted in an excellent outcome with complete healing of tibial fracture, ACL repair, and Segond fixation at final follow-up. Discussion/Conclusion: Even if combined leg fracture associated with ipsilateral ACL tear and Segond fracture is a very rare injury, the described technique based on 1-stage fixation of the 3 injuries is a viable option. This surgical technique can be considered a reparative treatment, with the goal of preserving the joint. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

MMP3 single-nucleotide polymorphisms are associated with noncontact ACL injuries in competing high-level athletes.

Matrix metalloproteinases (MMPs) play an important role in matrix remodeling, as well as in ligament integrity. Anterior cruciate ligament (ACL) rupture is a severe and frequent knee injury in sports. The aim of this study was to investigate polymorphisms within the MMP3 gene with the predisposition for noncontact ACL rupture in the Croatian professional athletes. One hundred eighty-seven (95 with ACL rupture occurring through a noncontact mechanism and 92 asymptomatic controls) unrelated Caucasians were recruited between 2016 and 2017. All participants were genotyped for three single-nucleotide polymorphisms (SNP) within the MMP3 gene: rs591058 C/T, rs650108 A/G, and rs679620 G/A using the pyrosequencing method. For all three investigated SNPs, genotype frequencies have significantly differed between cases and controls. The MMP3 rs591058 TT (p = 0.0012, odds ratio [OR] = 38.541, 95% confidence interval [CI] = 1.7024-8.7254), rs650108 GG (p = 0.0051, OR = 23.338, 95% CI = 1.2899-4.2226) and rs679620 AA (p = 0.0030, OR = 34.750, 95% CI = 1.5266-7.9101) genotypes, as well as haplotype variant T-G-A (p = 0.0104, OR = 1.71, 95% CI = 1.13-2.59) were significantly overrepresented in cases compared to controls. These results support association between functional variants within the MMP3 gene and the risk of ACL rupture. Still, further research is needed to corroborate these results in a larger population.

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up

To compare the incidence of postoperative anterior knee pain at rest and during "knee walking" in patients who had anterior cruciate ligament reconstruction (ACLR) surgery with hamstring tendon (HT) grafts versus bone-patellar tendon-bone (BPTB) grafts harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects. Adult patients who had undergone an ACLR and had completed a questionnaire enquiring about anterior knee symptoms at a minimum of 1 year postoperatively were identified. Two groups were compared: 1) patients who had received a BPTB graft harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects, and 2) patients who had received a HT graft. A total of 142 adult patients were included: 88 had a BPTB graft and 54 had a HT graft. The prevalence of anterior knee pain at rest was 10% in the BPTB group and 28% in the HT group (P= .006). Overall, knee walking scores were worse in the BPTB group when compared to the HG group, but the difference in the proportions of patients who found it impossible to knee-walk was not statistically significant (17% vs 6%; P= .069). Our results showed that pain at rest was less in the BTPB group compared to the HT group contradicting historic literature. In addition, there was no statistically significant difference between the 2 grafts when comparing the proportion of patients who found it "impossible" to knee-walk. Level III, retrospective comparative study.

On-ice and Field Performance Characteristics of Ice-hockey Players: Focusing on the Relation with Patient-reported Outcome

PURPOSE The purpose of this study was to investigate the characteristics of field and on-ice performances of ice-hockey players and the relationship of performance with subjective joint pain and dysfunction.METHODS A total of 25 male college icehockey players were evaluated for 19 items of performance. Pain and dysfunctions in the lower extremities and lower back were confirmed through the Foot and Ankle Outcome Score, Knee Injury and Osteoarthritis Outcome Score, Hip Dysfunction and Osteoarthritis Outcome Score, and Osweatry Disability Index questionnaire. Players with similar performance characteristics were classified through a cluster analysis, and differences in performance and patient-reported outcomes between clusters were analyzed with a one-way analysis of variance.RESULTS The ice-hockey players were classified into “lower muscular strength and performance (cluster 1),” “lower cardiorespiratory endurance (cluster 2),” and “high muscular strength and performance (cluster 3).” Players in cluster 1 had more frequent ankle and knee joint dysfunctions and pain compared to those in cluster 3. Several performance test items affected the subjective joint score, and the related performance items were more in the proximal joint than in the distal joint.CONCLUSIONS Ice hockey players should perform training to supplement their individual lack of on-ice and field performance. Since performance may be limited because of joint dysfunction and pain, a joint-specific intervention strategy should be applied to improve physical and athletic performances.

Return to Sport After Anterior Cruciate Ligament Reconstruction Among Physically Active Adults

An anterior cruciate ligament (ACL) is one of athletes' most severe and frequent knee ligament injuries. The primary function of the ACL is preventing excessive anterior tibial translation, and it limits varus/valgus stress when the knee is in full extension and rotatory movements. Returning to sport after an ACL injury is a crucial aim of ACL reconstruction (ACLR). Multiple factors, modifiable and nonmodifiable, can influence the time to return to sport. This study aimed to discuss factors that affect optimal return-to-play (RTP) timing, symptom recurrence, and long-term consequences of an ACL injury. This is a cross-sectional study involving patients who are following in orthopedic surgery outpatient clinics with a history of ACLR at least six months before surgery and not beyond six years after surgery. Participants received a survey about their sociodemographic data, details of the type and site of injury, and ACL return to sport before and after reconstruction scale. Full data description and testing of dependent variables against participant variables using two-sided tests were performed with a significance level of P ≤ 0.05. The study involved 129 participants, of which the majority were male Bisha residents aged 20 to 29 years. The study found that the right leg was the most commonly injured, with the dominant leg being the most frequently reconstructed due to problems with knee function. Before the injury, most participants ran, cut (quick changes of direction during running), decelerated, and pivoted activities four or more times per month. However, physical activities notably reduced after ACLR. Age and body mass index (BMI) showed statistical significance related to the likelihood of returning to physical activities. The study found a significant reduction in the frequency of activities such as cutting, deceleration, and running after ACLR. Age was identified as a predictor affecting the likelihood of returning to the sport, with older patients being less likely to return than younger ones.

Higher knee flexion moment during walking is associated with a lower risk of knee pain developing among the elderly after 24 months.

Knee pain is one of the main problems associated with knee osteoarthritis. The peak external knee adduction moment (KAM) in gait is commonly used to estimate medial knee loading, and elevated KAM has been related to a higher risk of developing knee pain in older adults. Although knee flexion moment (KFM) also contributes to medial knee loading, its role in the development of knee pain remains unclear. To investigate the association between knee moments and the incidence of knee pain in 24 months in asymptomatic older adults. Prospective cohort study. University laboratory. Community-dwelling adults aged 60-80 years were recruited. We excluded participants with knee pain/known arthritis, knee injury, knee/hip joint replacement, cognitive impairment, or neurological conditions. Three-dimensional gait analysis was conducted to compute the peak KFM and KAM. Telephone surveys were conducted 12 and 24 months after the baseline assessment. Self-reported knee pain and its intensity and frequency were captured. Logistic regression with generalized estimating equations was used to examine associations between knee moments and the risk of knee pain. Of the 162 eligible participants who completed the baseline assessment (age: 65.8±4.0 years, 61.1% females), 157 and 138 were also assessed for incident knee pain after 12 and 24 months, respectively. Compared with the lowest tertile, the highest tertile of KFM was significantly related to a lower incidence of frequent knee pain (RR=0.25, 95% CI: 0.08-0.85, P=0.027) in 24 months. In addition, a higher KFM was significantly associated with the lower intensity of incident knee pain after 24 months (β=-1.513; 95% CI: -2.879, -0.147; P=0.030). We also observed trends showing that a higher peak KAM was related to higher risks of developing any (RR=2.48, 95% CI: 0.99-6.20, P=0.053) and frequent (RR=3.82, 95% CI: 0.96-15.1, P=0.057) knee pain in 24 months. A higher sagittal knee moment is associated with a lower risk of knee pain developing in 24 months in older adults. Interventions for promoting sagittal knee moment may be considered in preventative training programs for reducing knee pain among older adults.

Prevalence of intra-articular mineralization on knee computed tomography: the multicenter osteoarthritis study

The aim of this work was to report the prevalence of computed tomography (CT)-detected intra-articular mineralization. We included participants from the Multicenter Osteoarthritis (MOST) Study. At the 12th year visit of the MOST study, bilateral knee CTs were first obtained. All participants also had posteroanterior and lateral radiographs of bilateral knees and completed standard questionnaires. Knee radiographs were assessed for Kellgren & Lawrence grade (KLG) and radiographic evidence of intra-articular mineralization. CT images were scored using the Boston University Calcium Knee Score (BUCKS) for cartilage, menisci, ligaments, capsule, and vasculature. Prevalence of intra-articular mineralization was computed for the total sample, and stratified by age, sex, race, Body Mass Index (BMI), presence of frequent knee pain, and KLG. We also determined distribution of mineralization in the cartilage and meniscus, and co-localization. 4140 bilateral knees from 2070 participants were included (56.7% female, mean age 61.1 years, mean BMI: 28.8kg/m2). On radiographs 240 knees (5.8%) had intraarticular mineralization, while CT-detected mineralization was present in 9.8% of knees. Prevalence of hyaline articular and meniscus mineralization increased with age and KL grade, and was similar by sex, BMI categories, and comparable in subjects with and without frequent knee pain. Mineralization tended to be ubiquitous in the joint, most commonly involving all three (medial/lateral tibiofemoral and patellofemoral) compartments (3.1%), while the patellofemoral compartment was the most involved compartment in isolation (1.4%). CT of the knee provides greater visualization of intra-articular mineralization than radiographs and allows better localization of the crystal deposition within the joint. Further studies should focus on the co-localization of intra-articular crystal deposition and corresponding magnetic resonance imaging (MRI)-features of knee osteoarthritis (OA).

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11-14), group 2 (age 15-17), and group 3 (age 18-21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle-trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall-Salvati index, modified Insall-Salvati index, Caton-Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal-Salvati (p = 0.001) index, and Caton-Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton-Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.

Medial Collateral Ligament Calcification, Presenting as Knee Pain. An unusual Case Report

Background: The tibial collateral ligament, also known as the medial collateral ligament (MCL), is a ligament extending from the medial epicondyle of the femur to the posteromedial crest of the tibia. The ligament is a broad and strong band that mainly functions to stabilize the knee joint in the coronal plane on the medial side Since MCL calcification is not a frequent knee pain manifestation, exclusion of other confusing clinical mimicries is of paramount importance. Here, in this report, we describe a well-circumscribed calcific deposit in the left femoral condylar attachment of MCL reported very rarely in the medical literature. &#x0D; Case Report: A 37-year-old laborer presented to the Outpatient department with pain and flexion deformity of the Right knee for 6 months. He walked on a flexed knee with a limping gait. A plain radiograph of the right was taken in AP and Lateral view which showed a massive well-defined calcification at the medial side of the knee joint. Considering the large size of the lesion, surgical treatment was chosen. Intra-operatively, as the MCL was involved a reconstruction was done using the semitendinosus tendon.&#x0D; Conclusion: Chronic pain located at the medial side of the knee is not always osteoarthritic pain. Thorough clinical and radiological investigation with plain radiographs and MRI in some cases is mandatory. Calcification or ossification of the medial collateral ligament of the knee responds well to conservative treatment. Surgical resection is needed in some cases with larger lesions.

Meniscal Injuries in Patients Aged 40 Years or Older: A Comparative Study Between Meniscal Repair and Partial Meniscectomy.

Introduction Meniscal tears represent one of the most frequent knee injuries and are the most common cause of knee surgery. Historically, age has been considered an independent factor contraindicating meniscal repair due to the assumption that meniscal injuries in this population are frequently chronic tears, mostly with a degenerative tear pattern, and low healing potential. However, recent literature has questioned this paradigm with studies reporting successful outcomes with meniscal repair in older patients. Our study aimed to evaluate and compare the short-term clinical outcomes of meniscal repair versus partial meniscectomy in patients aged ≥40 years old. Methods A retrospective study was conducted that included patients over the age of 40 years, diagnosed with meniscal tears, that underwent arthroscopically assisted meniscal repair or partial meniscectomy between 01 January and 31 December 2020.The patients were divided into two groups: Group 1- partial meniscectomy (PM) and Group 2-meniscal repair (MR). The clinical evaluation was performed 24 months after the surgery, and the studied variables were: function(Tegner Lysholm Knee Scoring Scale), pain (Visual Analogue Scale), patient satisfaction, and failure rate. Results Fifty-one patients met the inclusion criteria, and 7 were excluded due to loss of follow-up during telephone contact. Thus, the final sample consisted of 44 patients (mean age 52.18y), both groups with 22 patients. In both groups, we found an improvement in pain 2 years after the surgery, with a decrease in the VAS value between the pre and post-surgery. On average, the VAS score decreased from 7.9 to 4.5 in the group subjected to partial meniscectomy, and from 7.5 to 3.2 in the meniscal repair. This was statistically significant in both groups, with a p-value <0.01, but not between them (p-value = 0.363). Comparing the degree of satisfaction between both groups, we found no statistically significant difference between them (p=0.167). Regarding the functional outcome(Tegner Lysholm Knee Scoring Scale), the group that underwent the meniscal repair obtained a statistically superior score compared to the partial meniscectomy group (77.55 vs. 64.77; p-value 0.033). Thefailure rate was exactly equal in both groups(4.5%), thereforeno statistically significant difference was found in this variable. Conclusion Age, as an independent factor, should not be considered a contraindication for meniscus repair. In fact, if technically possible, meniscal repair should always be performed as it is associated with better functional outcomes, similar failure rates, and may be protective against the development and progression of arthritis.

Automated machine learning-based prediction of the progression of knee pain, functional decline, and incidence of knee osteoarthritis in individuals at high risk of knee osteoarthritis: Data from the osteoarthritis initiative study.

This study aimed to examine the performance of machine learning models in predicting the progression of knee pain, functional decline, and incidence of knee osteoarthritis (OA) in high-risk individuals, with automated machine learning (AutoML) being used to automate the prediction process. There were four stages in the process of our AutoML-integrated prediction. Stage 1-Data preparation: The data of 3200 eligible individuals in the Osteoarthritis Initiative (OAI) study who were considered at high risk of knee OA at the baseline visit were extracted and used. Specifically, 1094 variables from the OAI study were used to predict the changes in knee pain, physical function, and incidence of knee OA (i.e. the first occurrence of frequent knee symptoms and definite tibial osteophytes (Kellgren and Lawrence grade ≥2)) over a 9-year period. Stage 2-Model training: The AutoML approach was used to automatically train nine widely used machine learning (ML) models. Stage 3-Model testing: The AutoML approach was used to automatically test the performance of the ML models. Stage 4-Selection of important input variables: The AutoML approach automated the process of computing the importance scores of all input variables and identifying the most important ones, using the technique of permutation feature importance. Using the AutoML approach, the weighted ensemble model and the CatBoost model showed the best performance among all nine ML models. For the prediction of each outcome in each year, the five most important input variables were identified, most of which were obtained from self-reported questionnaire surveys and radiographic imaging reports. The AutoML approach has shown potential in automating the process of using ML models to predict long-term changes in knee OA-related outcomes. Its use could support the deployment of ML solutions, facilitating the provision of personalized interventions to prevent the deterioration of knee health and incident knee OA.

Relevance of sonological evaluation in medial knee injuries and its comparison with magnetic resonance imaging findings – A prospective study

Background: Ultrasonography offers several unique strengths over magnetic resonance imaging (MRI) that makes it a promising technique for the evaluation of certain disorders of the knee. Ultrasonography has higher spatial resolution than MRI, which may be helpful in evaluating the superficial structures and popliteal fossa of the knee in detail. Visualizing the medial collateral ligament (MCL) under ultrasound is relatively easy due to its superficial location, spanning from the medial femoral condyle to the medial tibial metaphysis. Meanwhile, MRI is expensive, not advisable to all due to its claustrophobia and ferromagnetic property. Ultrasound, on the other hand, is an inexpensive, widely available, and non-invasive technique which also allows dynamic imaging. Our objective is to assess the validity of ultrasound in the diagnosis of medial knee injuries in comparison with MRI findings. Materials and Methods: Patients attending the Department of Orthopaedics are referred to the Department of Radiodiagnosis of Government (TD) Medical College, Alappuzha, who were clinically suspected to have medial knee injury, during the study. This study was a prospective study. Prospective patients with clinically suspected medial knee injuries scheduled for MRI of the knee were evaluated by ultrasound examination before the MRI. Sonographic findings were then compared to MRI results. Results and Discussion: Sixty patients were enrolled in the study. 73.3% of the study population were male and most of them belonged in their 2nd and 3rd decades. Most of the injuries were left-sided (60%) and majority (65%) presented for radiological evaluation within 1 week–1 month of history of injury. The accuracy of ultrasound in the diagnosis of MCL and medial meniscus injuries were 86.7% and 85%, respectively. Ultrasonography demonstrated 89.6% sensitivity and 75% specificity for MCL injuries and 85.3% sensitivity and 84.6% specificity for medial meniscus tears. The most frequent knee finding in this study was joint effusion which was seen in 50 (83.3%) of patients. Conclusion: Ultrasonography gives high accuracy and specificity in the detection of MCL and medial meniscal injuries. Ultrasound may have a role as the initial rapid imaging modality in patients with suspected MCL or medial meniscus injuries, and it may serve as an effective low-cost screening tool for patients with medial meniscal or MCL injuries and avoid performing the high-cost MRI.

The natural history of end-stage knee osteoarthritis: Data from the osteoarthritis initiative

ObjectiveWe aimed to describe the natural history leading to end-stage knee osteoarthritis (esKOA), focusing on knee symptoms, radiographic severity, and the presence of limited mobility or instability. MethodsWe performed knee-based analyses of Osteoarthritis Initiative data from 7691 knees (4165 participants). We used a validated definition of esKOA that relied on meeting one of two criteria: (1) severe radiographic knee osteoarthritis (Kellgren-Lawrence [KL] grade=4) with moderate-to-intense pain (Likert WOMAC pain+function>11/88) or (2) KL grade<4 with intense or severe pain (WOMAC pain+function>22) and limited mobility (flexion contracture≥5°) or instability (based on a varus and valgus stress test). We also introduced an alternate definition of esKOA that relied on meeting one of two criteria that omitted physical exam findings:(1) severe radiographic knee osteoarthritis (KL grade=4) with at least moderate symptoms or (2) KL grade=2 or 3 with intense or severe symptoms and persistent knee pain (frequent knee pain during three or more months in the past year). We used descriptive statistics to explore the frequency of components of esKOA at the index visit when they had incident esKOA, at the annual visit before developing esKOA, and the interval change between those visits. ResultsOur analytic sample was mostly female (58%), without radiographic knee osteoarthritis (KL grade=0 or 1; 60%), without stability or mobility concerns (91%), and without persistent knee pain (77%). At the visit before incident esKOA, most knees already had moderate-to-severe radiographic osteoarthritis using the original (62%) or alternate (50%) definition (versus <15% for either definition of no esKOA). Over 80% of knees that reached the criteria for esKOA achieved this based on increased knee symptom severity – typically without worsening radiographic severity (80%). ConclusionRadiographic severity predisposed a knee to esKOA. However, worsening knee symptoms led to the development of incident esKOA. If investigators want to increase the chance of identifying incident esKOA as an outcome, they should enrich their study samples with people with moderate-to-severe radiographic osteoarthritis. Our findings also highlight the potential reversibility of esKOA (a knee that is classified with esKOA but later is not classified with esKOA). Reversibility is not a flaw of an outcome defining esKOA but rather a desirable clinical outcome to demonstrate a therapeutic intervention can help people with esKOA improve their knee symptoms and delay a knee replacement.

A decellularized and sterilized human meniscus allograft for off-the-shelf meniscus replacement

PurposeMeniscus tears are one of the most frequent orthopedic knee injuries, which are currently often treated performing meniscectomy. Clinical concerns comprise progressive degeneration of the meniscus tissue, a change in knee biomechanics, and an early onset of osteoarthritis. To overcome these problems, meniscal transplant surgery can be performed. However, adequate meniscal replacements remain to be a great challenge. In this research, we propose the use of a decellularized and sterilized human meniscus allograft as meniscal replacement.MethodsHuman menisci were subjected to a decellularization protocol combined with sterilization using supercritical carbon dioxide (scCO2). The decellularization efficiency of human meniscus tissue was evaluated via DNA quantification and Hematoxylin & Eosin (H&E) and DAPI staining. The mechanical properties of native, decellularized, and decellularized + sterilized meniscus tissue were evaluated, and its composition was determined via collagen and glycosaminoglycan (GAG) quantification, and a collagen and GAG stain. Additionally, cytocompatibility was determined in vitro.ResultsHuman menisci were decellularized to DNA levels of ~ 20 ng/mg of tissue dry weight. The mechanical properties and composition of human meniscus were not significantly affected by decellularization and sterilization. Histologically, the decellularized and sterilized meniscus tissue had maintained its collagen and glycosaminoglycan structure and distribution. Besides, the processed tissues were not cytotoxic to seeded human dermal fibroblasts in vitro.ConclusionsHuman meniscus tissue was successfully decellularized, while maintaining biomechanical, structural, and compositional properties, without signs of in vitro cytotoxicity. The ease at which human meniscus tissue can be efficiently decellularized, while maintaining its native properties, paves the way towards clinical use.