Increase In Intra-articular Pressure Research Articles

Effect of different ulnar osteotomies on loading of the distal radioulnar joint: a finite element analysis

BackgroundUlnar impingement syndrome is a prevalent source of ulnar carpal pain; however, there is ongoing debate regarding the specific location of shortening, the method of osteotomy, the extent of shortening, and the resulting biomechanical alterations.MethodTo investigate the biomechanical changes in the distal radioulnar joint (DRUJ) resulting from different osteotomy methods, a cadaveric specimen was dissected, and the presence of a stable DRUJ structure was confirmed. Subsequently, three-dimensional data of the specimen were obtained using a CT scan, and finite element analysis was conducted after additional processing.ResultsThe DRUJ stress did not change significantly at the metaphyseal osteotomy of 2–3 mm but increased significantly when the osteotomy length reached 5 mm. When the osteotomy was performed at the diaphysis, the DRUJ stress increased with the osteotomy length, and the increase was greater than that of metaphyseal osteotomy. Stress on the DRUJ significantly increases when the position is changed to pronation dorsi-extension. Similarly, the increase in stress in diaphyseal osteotomy was greater than that in metaphyseal osteotomy. When the model was subjected to a longitudinal load of 100 N, neither osteotomy showed a significant change in DRUJ stress at the neutral position. However, the 100 N load significantly increased stress on the DRUJ when the position was changed to pronation dorsi-extension, and the diaphyseal osteotomy significantly increased stress on the DRUJ.ConclusionsFor patients with distal oblique bundle, metaphyseal osteotomy result in a lower increase in intra-articular pressure in the DRUJ compared to diaphyseal osteotomy. However, it is crucial to note that regardless of the specific type of osteotomy employed, it is advisable to avoid a shortening length exceeding 5 mm.

Biomechanical Consequence of a Posterior Root Tear of the Lateral Meniscus in the Human Knee. Stabilizing Effect of the Meniscofemoral Ligament.

The integrity of the meniscofemoral ligament holds the meniscus in place and guarantees an equal distribution of the intraarticular pressure. In case of an ACL injury a root tear of the lateral meniscus is a common concomitant injury. The aim of this study was to examine the biomechanical effectiveness of a root tear classification. The classification respects different localizations of a tear and their influence on the intraarticular pressure in the lateral compartment. Does the intact meniscofemoral ligament restore the meniscus function, stabilizing the intrarticular pressure in case of a posterior root tear? According to their localization posterior root tears are classified depending on their relationship to the posterior meniscofemoral ligament. 3 different types can be distinguished. The type I root tear is an isolated avulsion of the root. The type II is a complete radial tear of the posterior horn of the lateral meniscus and localized between the root and the meniscal attachment of the meniscofemoral ligament (MFL). The type III tear complies with a complete rupture of the posterior meniscus attachments (root tear and rupture of MFL). After preparation 10 human cadaveric knees were tested in a material testing machine (Zwick/Roell Z005-TN2A). The intraarticular pressure was measured using a digital sensor (Novel type S2042) when an axial load of 100 N was applied. The intraarticular pressure was recorded 1.)for the intact state of the lateral meniscus, 2.) for a type I root tear and 3.) for a type III tear after transection of the root and the meniscofemoral ligament. To calculate the mean intraarticular pressure a region of interest (ROI) was used. The ROI was defined as the 1.0 × 1.0 cm2 area around the peak contact pressure. Statistical analysis was performed by the use of SPSS Software for Windows, release 15.0.1 (SPSS, Chicago, IL). Before statistical testing, each continuous variable was analyzed in an explorative manner for its normal distribution (Kolmogorov-Smirnov test). The Mann-Whitney U test was used for comparison of nonparametric variables (peak contact pressure, difference in pressure) between each study group. The significance level was P < .05. In case of an intact posterior attachment of the lateral meniscus the axial load of 100 N creates an intraarticular pressure of 120 kPa. After creation of a posterior type I root tear (transection of the root) no significant increase of intraarticular pressure was measured (141 kPa; p<0,6). The type III root tear (transection of the root and the MFL) leads to a significant increase of the intraarticular pressure up to 946 kPa (p<0,004). The isolated root tear (type I) has no significant influence on the intraarticular pressure. The MFL holds the meniscus in place and restores the lateral meniscus function guaranteeing an equal distribution of the intraarticular joint pressure. The type III tear leads to an extrusion of the lateral meniscus and a decrease of the contact area with a significant increase of the intraarticular pressure. These results support the usefulness of a root tear classification of the posterior lateral meniscus. The classification of lateral meniscus root tears allows estimation of the impact of different tear localizations. In clinical practice we recommend a fixation of a root tear in case of an MFL injury or absence of the MFL.

Changes in the intra-articular pressure inside the radiocarpal joint with different volumes of the intra-articular fluid

Intra-articular pressure was measured in 14 carpal joints of 7 fresh corpses of adults, who had not any diseases of the above joints in their case histories, after introduction of 2, 3 and 5 ml of a fluid inside the joint cavity with the normal position of the hand, as well as after its maximum flexion, extension, adduction and abduction. It was found out that the lowest pressure in the above joint was observed in cases of the neutral hand position, which was accepted to be with 5° of dorsal flexion and 10. of ulnar deviation. The maximum extension and abduction resulted in the most significant rise of pressure: more than 10 times versus the neutral position. The maximum flexion and adduction were accompanied with an increase of intra-articular pressure too. A strong positive correlation was demonstrated between intra-articular pressure and fluid volume in the joint in cases of the examined hand positions. The volume of the intra-articular cavity of the radiocarpal joint was approximately determined as equal to 2 cm3.

Reperfusion capacity of the femur head after ischemia--an experimental study

The aim of this study was to evaluate bone blood flow of the proximal femur during experimentally induced ischemia and to document the ability of epiphyseal and metaphyseal reperfusion. 11 pigs (danish landrace) were used to investigate the effect of tamponade by increased joint pressure (Dextran 70) on the perfusion of the femoral head. Additional 8 pigs were used as control. The blood flow in the hip joint was studied by means of the microsphere technique. The flow was determined before, during and after intraarticular pressure increase. With the "radioactive tracer microsphere"-method the blood flow of the epiphysis, metaphysis and proximal femoral corticalis could be measured. In the epiphyseal femoral head the initial blood flow rate, 11.7 ml/min/100 g, was not significant different from that of the control side (11.1 ml/min/100 g). The blood flow decreased in the ischemic phase to 1.8 ml/min/100 g followed by reperfusion to 13.5 ml/min/100 g (p < 0.01). The bone blood flow of reperfusion was not significant different from that of the initial blood flow rate but in 2 cases a "blow out" of the epiphyseal bone blood flow was seen. The proximal femoral metaphysis showed the highest of the measured intraosseous flow rates (17.9 resp. 23.3 ml/min/100 g). During ischemia and reperfusion of the epiphysis bone blood flow of the metaphysis remained the same. The proximal femoral corticalis showed the lowest of the measured intraosseous flow rates. The operated (10.1 ml/min/100 g) and contralateral hip side (11.7 ml/min/100 g) showed no significant differences in the initial blood flow rate. During ischemia and reperfusion the blood flow of the proximal corticalis showed no significant difference to the initial blood flow corresponding to the metaphysis. Our study demonstrates disturbances of the circulation of different regions of the femoral head during intraarticular pressure increase and following pressure decrease of the growing pig. 2 "blow outs" document a vulnerable proximal epiphysis already after a 6-hour ischemia. Additional minor "bone quality" in cases of certain diseases (kidney transplantation, leukemia) and special administration of drugs (corticosteroids) seem to create an additional vulnerability of the proximal femoral head. The experiment proves to be a reliable model for decreasing the blood flow of the growing epiphysis temporarily and to document the beginning of normal reperfusion. With this model it is possible to examine the vulnerability of the epiphyseal perfusion after different diseases and under the influence of different medication.

Blood-Induced Joint Disease: The Confluence of Dysregulated Oncogenes, Inflammatory Signals, and Angiogenic Cues

Hemophilia is a congenital disorder that commonly results in musculoskeletal bleeding and orthopedic complications. After an acute joint hemorrhage, there is pain, swelling, and limited motion due to an increase in intra-articular pressure and inflammation. Increases in intra-articular pressure induce mechanical signals that lead to cartilage cell apoptosis. Repeated bleeding results in development of a target joint, which is characterized by painless swelling and limited motion. Blood in the joint space provokes a proliferative disorder termed hemophilic synovitis (HS), with characteristics resembling those of malignant tumors. It has been suspected that one or more of the many components of blood, particularly iron, may be responsible for initiating and sustaining the inflammatory and synovial/vascular cell proliferation response associated with recurrent joint hemorrhages. In this paper, we review the pathogenesis of HS and present experimental data from mice deficient in factor VIII or IX activity in order to clarify the pathways by which blood in the joint space results in arthropathy. Understanding these pathways and cataloguing their key components may identify new targets for therapy of HS.

The impact of joint bleeding and synovitis on physical ability and joint function in a murine model of haemophilic synovitis

Haemophilia is a congenital disorder that commonly results in musculoskeletal bleeding and orthopaedic complications. After an acute joint haemorrhage, an increase in intra-articular pressure and inflammation cause pain, swelling and limited motion. Blood in the joint space provokes a proliferative disorder known as haemophilic synovitis. Overgrowth of the synovial membrane causes mechanical dysfunction. Eventually, there is destruction of the articular surface and underlying bone. The aim of this project was to test the hypothesis that a minimum number of haemarthroses negatively impacts on joint function and that this would be reflected by decreased physical performance of experimental animals. Mice deficient in factor VIII coagulant activity were trained to ambulate on a rotating rod then injured three times at weekly intervals. Their ability to walk was then compared to a group of uninjured mice. Cohorts of mice were killed after 1, 2 or 3 months and the knee joints examined by gross and histological methods. The results supported the following conclusions: (i) haemophilic mice can be trained to ambulate on a rotating rod; (ii) acute hemarthrosis temporarily impairs their ability to ambulate and (iii) following recovery from acute injury, mice developing synovitis demonstrated inferior physical ability compared to mice not developing synovitis. This is the first description of a quantitative assay to monitor joint function in experimental animals and should be useful to evaluate the efficacy of new therapies developed to prevent and treat bleeding and to test strategies to counter the devastating effects of synovitis.

Effects of Atelocollagen Gel Containing Bone Marrow-Derived Stromal Cells on Repair of Osteochondral Defect in a Dog

To clarify the contribution of autologous transplantation of mesenchymal stromal cells (MSCs), an atelocollagen gel containing or not containing fluorescently-labeled canine MSCs was transplanted into an osteochondral defect which did not repair spontaneously and the histological repair of the defect was compared. Although an early repair of the cartilage was not observed in either defect, the reproduction of subchondral bone was remarkable in the MSCs-implanted defect. Moreover, in 2 weeks after operation, the implanted MSCs were located in the deeper regions of the defect, suggesting the differentiation of osteoblasts. There was a possibility that the movement of the implanted MSCs was due to an increase in intra-articular pressure from postoperative inflammation.

Impact of Joint Bleeding on Joint Function in a Murine Model of Hemophilia A.

Hemophilia is a congenital bleeding disorder that commonly results in musculoskeletal complications due to recurrent bleeding into joints. After an acute joint bleed, there is pain, swelling and limited motion due to the increase in intra-articular pressure and inflammation. Blood in the joint space provokes a proliferative and inflammatory disorder known as hemophilic synovitis (HS), which causes mechanical dysfunction and eventually destruction of the articular surface and bone. Among persons in the USA with severe hemophilia, nearly half have some restriction in activity (Evatt 2004) and it is estimated that 73% of boys enter adolescence with arthropathy and between 13–16 years of age, two or more major joints are affected (Brackmann,1992). Detail examination of the earliest changes in joint function following 1–3 joint hemorrhages is difficult to perform in patients. In this project, a murine model of HS (Valentino,2004) was used to examine the impact of a minimum number of hemarthrosis on joint function. The hypothesis tested was that there is a relationship between hemarthrosis and joint dysfunction. It was expected that joint dysfunction would be observed following few bleeds. Also, it was expected that a single hemarthrosis will result in permanent joint dysfunction. To test these hypotheses, 25 mice deficient in factor VIII coagulant activity were injured, times three, at weekly intervals to induce hemarthrosis then their ability to ambulate monitored using a Rotorod: Economex apparatus, which is intended for testing coordination and impairment of locomotor agility of laboratory animals. Mice were trained to ambulate on the rotating rod then injured and retested 2, 4 and 7 days after each hemarthrosis. A 2nd group of 25 mice was not injured and served as controls. At the conclusion of the experiment, mice were sacrificed and the knee joints examined by gross and histological methods. Correlations were drawn between the ambulatory dysfunction and the pathological changes observed. Preliminary data showed:mice can be trained to ambulate on the Rotarod,acute hemarthrosis temporarily impairs their ability to ambulate, andafter mice recover from acute injury they regain their lost ability to ambulate to the point that their performance is better than previous.

Increased intraarticular pressure reduces blood flow to the femoral head.

Hemarthrosis leading to increased intracapsular pressure after an undisplaced femoral neck fracture is suspected to impair blood flow to the femoral head and may lead to osteonecrosis. We hypothesized that an increase of intraarticular pressure would reversibly decrease the blood flow to the femoral head. Eleven patients having surgical dislocations for treatment of femoroacetabular impingement were included in this study. Saline was injected into the intact intracapsular space while the blood flow to the femoral head was recorded using laser Doppler flowmetry. Injection of saline resulted in an increase in the intracapsular pressure. The injected volume of normal saline until disappearance of the pulsatile signal was on average 20 mL (range, 10-35 mL) with an average intraarticular pressure of 58 mm Hg (range, 25-88 mm Hg). Aspiration of the joint resulted in a return of the pulsatile flow. Hemarthrosis after undisplaced intracapsular fractures of the femoral neck are likely to cause an increase in intracapsular pressure. Decompression of the hematoma to reduce the intracapsular pressure is strongly advocated to optimize blood flow to the femoral head in acute fractures.

Massive intraperitoneal and extraperitoneal accumulation of irrigation fluid as a complication during knee arthroscopy

A case of uncommon fluid extravasation during knee arthroscopy leading to a swelling of the groin, scrotum, and penis, with massive intraperitoneal and retroperitoneal fluid accumulation is reported. A defective pump pressure sensor relay was found to be the cause of uncontrolled fluid delivery with excessive intra-articular pressure increase. The literature reports several cases of extravasation of irrigation fluid into the calf without any sequelae. Our patient experienced proximal expansion of the fluid that expanded along the vastus intermedius and shunted into the retroperitoneal and intraperitoneal space. There was no clinical evidence of compartment syndrome despite the excessive amount of extravasation in the thigh. Diuretics were administrated, and the fluid was excreted within 36 hours. The patient suffered of no further sequelae. Arthroscopy 1998 May-Jun;14(4):401-4

Intra-articular pressure changes in rheumatoid and normal peripheral joints.

To investigate the intraarticular pressure (IAP) dynamics of a spectrum of joints in rheumatoid and normal subjects in order to determine whether a reperfusion event is likely to occur at these sites. IAP was measured in the metacarpophalangeal (MCP) (n = 8), wrist (n = 8), ankle (n = 4), and elbow joints (n = 4) of rheumatoid subjects, in addition to the MCP (n = 8), wrist (n = 6), and ankle joints (n = 1) of normal healthy controls, using the hand held portable 295-1 Intra-Compartmental Pressure Monitor System (Stryker, UK). Resting IAP was positive in all rheumatoid joints, and subatmospheric or weakly atmospheric in normal subjects (p < 0.01). Exercise produced an increase in IAP in rheumatoid subjects only (p < 0.01). The addition of saline to normal joints mimicked the IAP changes seen in the rheumatoid group. These observations suggest that increased resting IAP is a marker for chronic joint inflammation. The IAP increase seen in the rheumatoid group during exercise supports the concept of hypoxic reperfusion mediated joint injury.

Cause and Prevention of Osteochondritis in Congenital Dislocation of the Hip

All treatment modalities of congenital displacement of the hip (CDH) bear the risk of ischemic necrosis at the proximal femoral epiphysis. The causes of ischemic necrosis were investigated in a review of the literature and personal experience with CDH patients during the past 30 years. Compression of articular cartilage, caused by an increase in intraarticular pressure, has been implicated as the mechanism of osteochondritis. Muscle spasm, pressure on posterior circumflex vessels, and compromised pericephalic microcirculation in the newborn have been demonstrated to increase intraarticular pressure. The most dangerous causative factors include forced reduction under general anesthesia, spica cast immobilization of the hips in the Lorenz or Lange position, insufficient continuous prereduction traction, and splints or braces that are either too rigid or that force the hip into an extreme position. An intertrochanteric varus osteotomy can also lead to ischemic necrosis when performed at the time of reduction. Preventive measures include sufficient continuous traction, casting in a moderate position, and bracing that allows active movement. None of these measures constitute a guarantee against necrosis, but they will lessen the incidence and severity of involvement.

Arthrosonography, Thermography and Dynamic Scintigraphy of the Knee and Computer Assisted Thermometry of the Hand

AbstractIn patients with rheumatoid arthritis and other joint diseases the knee is frequently involved. There are different factors such as inflammatory, degenerative, periarticular and static mechanisms which may cause pain, effusions, Baker’s cysts and atrophy of the quadriceps muscle. There is particular interest in synovitis and the associated clinical signs such as effusion, hyperthermia and an increase of intra-articular pressure. We are evaluating different non-invasive diagnostic and assessment techniques to examine the different effects of therapy such as surgical synovectomy, intra-articular injection of an anti-inflammatory drug and isometric exercises.Arthrosonography is an imaging technique performed with ultrasound tomographic equipment. It is useful for the examination of liquid cavities such as the suprapatellar recess, arthroceles, Baker’s cysts and their communication with the joint space.Infra-red thermometry has been used to measure spot temperatures compared with contact plate liquid ...

Direct assessment of synovial blood flow and its relation to induced hydrostatic pressure changes.

A method for measuring synovial blood flow changes using the laser Doppler technique is described. Mean blood flow and mean pulse amplitude decreased by 50-70% in relation to the reference level when the intra-articular hydrostatic pressure in effusive knee joints of patients with rheumatoid arthritis was increased. As an increase of intra-articular pressure of as little as 20 mmHg decreased synovial blood flow significantly it is suggested that hypoxia may occur in vivo during joint use in the presence of an effusion. This may be of aetiopathogenetic importance for tissue destruction and the persistence of chronic synovitis.

The influence of joint posture on intra-articular pressure. A study of transient synovitis and Perthes' disease.

The pathogenesis of Perthes' disease has been related to increased intra-articular pressure secondary to a joint effusion. The pressure within the hip in different positions was measured in eight children with transient synovitis and four with the synovial stage of Perthes' disease. In the position of comfort for the hip this pressure was always less than the arteriolar blood pressure and in a supine position it did not exceed the systolic blood pressure. However, in extension with medial rotation the intra-articular pressure always became several times the systolic blood pressure. This high pressure was also recorded in the stable lateral position which occurs normally during sleep. It is concluded that in the presence of a synovial effusion in the hip, a position of extension and medial rotation causes an increase in intra-articular pressure which may compromise the blood supply to the capital epiphysis of the femur.

Blood Flow in the Juvenile Hip in Relation to Changes of the Intraarticular Pressure: An Experimental Investigation in Dogs

The blood flow in the hip joint of puppies was studied by means of the microsphere technique. The flow was determined before, during and after intraarticular pressure increase. A venous tamponade of 50 mmHg resulted in a significantly reduced flow in the femoral head and after an arterial tamponade of 150 mmHg the flow almost ceased. The proximal femoral metaphysis, the acetabulum and the hip joint capsule, on the contrary, showed varying degrees of flow increase. It is suggested that the significantly increased blood flow in the hip joint capsule during the intraarticular pressure increase of 50 mmHg and 150 mmHg is caused by an autoregulatory mechanism tending to restore the blood flow in the suffering femoral head. The demonstrated disturbance of the circulation in the juvenile femoral head after venous tamponade supports the theory that synovitis may be the basic mechanism in the production of Calvé-Legg-Perthes' disease.

Hemodynamics of the juvenile knee in relation to increasing intra-articular pressure. An experimental study in dogs.

The relationships between intraosseous pressure and regional blood flow in the juxta-articular epiphyses were determined in the knees of immature dogs. Intraosseous pressures were continuously registered in one knee. Regional blood flow rates were simultaneously determined by the microsphere technique before and after venous tamponade of both knee joint capsules. During complete venous tamponade the intraosseous pressure of the distal femoral epiphyses rose 268%, while flow increased 122%. A concurrent 20-fold flow increase of the knee capsule and 3-4-fold flow increase of the proximal femoral bone was observed. Evacuation of the knee joints resulted in an immediate drop of the intraosseous pressure of the distal femoral epiphyses, whereas hyperaemia prevailed for at least half an hour and was most pronounced in the distal femoral epiphyses and knee joint capsule. Intraosseous pressure registration did not significantly influence regional blood flow. It is suggested that the changes of intraosseous pressures during knee joint tamponade reflect changes in the venous outlet resistance. The results demonstrate the significance of intra-articular pressure increase on the hemodynamics of the juxta-articular tissues of the knee and proximal femoral bone. These findings may be of importance in the pathogenesis of growth disturbances observed in juvenile degenerative arthritis.

Intraosseous pressure in the patella in relation to simulated joint effusion and knee position: an experimental study in puppies.

Simultaneous pressure measurements were carried out in the patella, juxtaarticular epiphyses and the knee joint cavity of six mongrel puppies. The mean intraosseous pressure in the patella was 12.2 mmHg, range 8-15 mmHg. An increase in intraarticular pressure in turn caused an increase in the intraosseous pressure of the patella and juxtaarticular epiphyses. The pressure increase in the patella was the most pronounced. During extension of the knee joint, a significant rise in intraosseous pressure of the tibial epiphysis and patella was observed, whereas during flexion femoral epiphyseal pressure and patellar pressure increased significantly. The introduction of moderate intraarticular effusion amplified intraosseous pressure responses during flexion of the knee joint. The intraosseous pressure changes during knee movement could not be explained solely by the corresponding changes in intraarticular pressure. Intraosseous phlebography revealed a venous drainage system largely parallel to the arterial blood supply. The contrast clearance time was decreased during moderate elevation of the intraarticular pressure, suggesting increased bone blood flow of the patella.

Intraosseous pressures in the knee in relation to simulated joint effusion, joint position, and venous obstruction. An experimental study in growing dogs.

The present study was performed in 9 mongrel puppies, 8-10 weeks old. Under anaesthesia simultaneous pressure registrations were taken from the distal femoral metaphysis, the distal femoral epiphysis, the proximal tibial epiphysis together with the arterial pressure. An intra-articular pressure increase resulted in a significant increase in the intraosseous pressure in the distal femoral epiphysis, while the pressures in the femoral metaphysis and tibial epiphysis remained unchanged. During maximal flexion of the empty joint a significant increase in femoral epiphyseal pressure was observed, while maximal extension resulted in a significant increase in tibial epiphyseal pressure. The presence of a moderate intra-articular effusion augmented these findings. By selective ligation of the venous drainage from the juxta-articular bones in the popliteal fossa and on the femur, different levels of epiphyseal hypertension could be produced. These pressure increases never reached the level of the arterial pressure. Thus they revealed only a partial impairment of the vascular circulation in the juxta-articular bones.

The effect of joint position on juxta-articular bone marrow pressure. Relation to intra-articular pressure and joint effusion--an experimental study on horses.

Six metacarpo-phalangeal joints of adult horses were studied. Pressure measurements were made in the joint and the metacarpal bone with simultaneous measurement of the systemic arterial blood pressure. Investigations performed to study the effect of joint position on juxta-articular bone marrow pressure showed that an increase in joint flexion was always followed by a rise in intraosseous pressure with a significant increase at flexion above 60 degrees. Increase in intra-articular pressure which was achieved by injection of saline was always followed by a slower rise in intraosseous pressure. Furthermore, it was shown that even a few millilitres of saline in the joint caused a rise in intra-articular pressure. The findings indicate that changes in joint position as well as effusion may block the drainage vessels from the bone marrow as they pass through the joint.