Compartment Of Joint Research Articles

Efficacy of arthrocentesis with injection of hyaluronic acid in the treatment of inflammatory-degenerative disease of temporomandibular joint

Background:Temporomandibular joint (TMJ) problems refer to a group of heterogeneous pain and dysfunction conditions involving the mastication, reducing life quality of the patients. Arthrocentesis is a simple and less invasive surgical method for the treatment of inflammatory-degenerative disease than other conservative procedures and better than arthroscope. This clinical study aimed at evaluating the benefit of arthrocentesis with injection of hyaluronic acid in the management of inflammatory-degenerative disease of the TMJ. Material and methods: Eighty consecutive patients were enrolled in this study with pain symptoms of TMJ, insufficient masticatory efficiency during function and limitation of mouth opening; they were assessed with clinical examination and approved with computed tomography scan. Arthrocentesis was done by inserting 18 gauge needles in the upper joint compartment, lavage by normal saline solution and at the end of the procedure 1ml of hyaluronic acid (HA) was injected. Intensity of the TMJ pain and masticatory efficiency was analyzed by visual analog scale (VAS), maximum mouth opening (MMO) was assessed by a ruler. All the assessed parameters were measured before the procedure then 1 and 4 months later. Results: During 5 months follow-up, comparison of the obtained results showed reduction in pain at chewing and rest 87.5%, improvement in mouth opening 100% and significant improvement in masticatory efficiency 87.5% of patients. Conclusion: The procedure of arthrocentesis with Sodium Hyaluronate injection, used in patients who suffered from inflammatory-degenerative disease (IDD), showed therapeutic benefits, simplicity, safety, patient satisfaction, lack of significant side effects and complications.

Systematic analysis reveals that colony housing aligns gait profiles and strengthens link between histological and micro-CT bone markers in rat models of osteoarthritis.

Osteoarthritis (OA) etiopathogenesis is complex with strong environmental/lifestyle determinants that, in laboratory animals, extend to social context and stress levels. This study seeks to identify whether colony housing of rats exerts a social impact on locomotion behaviors to influence alignment between symptomatic (gait) and structural (bone micro-CT measures, cartilage morphometry, and histology) OA outcome measures. Rats were randomly allocated to conventional (type IV; n=48) or rat colony cage (RCC; n=30) housing, further randomized to OA surgical models (ACLT+tMx, MMT or DMM) or no surgery (control), and maintained for 19weeks during which multiple gait recordings were made. Standard histological grading and bone micro-CT data were collected at necropsy. Principal component analysis was used to summarize the variation in gait, micro-CT or histology. Linear mixed effects model or two-way ANOVA was employed to evaluate the impact of the housing system, surgery and time on gait, or micro-CT and histology components Analyses reveal that RCC exaggerates trends in gait change via a combined effect of the housing system and surgery. Intriguingly, RCC-housed nonoperated control rats showed similar gait changes to rats subjected to surgery; the latter exhibited significant structural joint changes in both systems. Stronger correlation between histological and micro-CT bone changes were found in medial and lateral tibia joint compartments of rats housed in RCC system. This study has established that rat social housing exaggerates outcomes in traditional histological measures of OA, generates stronger links between histology and micro-CT bone changes and removes gait differences as a variable in their etiology.

Does saddle height influence knee frontal-plane biomechanics during stationary cycling?

IntroductionCycling is a common modality for rehabilitation and exercise. However, there is a lack of information in the literature on the effects of saddle height adjustments on internal peak knee abduction moment, which is an important loading variable for the medial compartment of tibiofemoral joint for patients with knee osteoarthritis. The purpose of this study was to examine effects of saddle height on frontal-plane biomechanics of the knee during cycling. MethodsFourteen recreational cyclists (age: 57.1 ± 6.37 years) performed 2-min bouts of cycling at three saddle heights of 40°, 30° and 20° knee extension angle at bottom crank position, at two workrates of 80 and 120 W. Three-dimensional kinematic, kinetic, and electromyography data were collected and analyzed using a 3 × 2 (height × workrate) analysis of variance (ANOVA). ResultsThere were no changes in internal knee abduction moment across saddle heights. Increases in saddle height from 40° to both 30° and 20° reduced the knee extension moment (d = 0.3 and 0.4, respectively, P = 0.012). Increases in workrate increased both knee abduction and extension moments (η2p = 0.75 and 0.88, respectively, P < 0.001 for both). ConclusionsIncreased knee extension moment with decreased saddle height is likely to indicate increased knee joint load.

Advanced compositional imaging T2 mapping sequence in detection of stages of medial knee joint compartments articular cartilage degeneration

BackgroundThe predictive value of the new imaging sequences, especially T2 mapping in assessment of articular cartilage abnormalities of the medial knee compartments in patients with medial knee pain. The purpose of this study is to evaluate the additional value of T2 mapping over using a baseline standard knee MRI to detect cartilage lesions of the medial compartments in patients representing with medial knee pain.ResultsThe study included 60 patients presented with medial knee pain, where divided into two groups ; control group (20 volunteers) with age range from 19 to 41 years old 26.80 ± 8.05 (mean ± SD) and patients (40 candidates) with age range from 13 to 57 years old with a mean age 33.00 ± 14.1 (mean ± SD).ConclusionOn adding T2 mapping sequence to the routine MRI of the knee, the sensitivity for detecting knee cartilage lesions was increased, especially in the detection of early cartilage degeneration at the medial compartment.Compositional MR imaging including T2 mapping plays an important role in the assessment of early and potentially reversible cartilage damage especially among the young population.

Factors Influencing Clinical and MRI Outcomes of Mesenchymal Stem Cell Implantation With Concomitant High Tibial Osteotomy for Varus Knee Osteoarthritis.

Background:Cartilage repair procedures using mesenchymal stem cells (MSCs) can provide superior cartilage regeneration in the medial compartment of the knee joint when high tibial osteotomy (HTO) is performed for varus knee osteoarthritis (OA). However, few studies have reported the factors influencing the outcomes of MSC implantation with concomitant HTO.Purpose:To investigate the outcomes of MSC implantation with concomitant HTO and to identify the prognostic factors that are associated with the outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 71 patients (75 knees) were retrospectively evaluated after MSC implantation with concomitant HTO. Clinical and radiological outcomes were evaluated, and magnetic resonance imaging (MRI) was used to assess cartilage regeneration. Statistical analyses were performed to determine the effect of different factors on clinical, radiographic, and MRI outcomes.Results:Clinical and radiographic outcomes improved significantly from preoperatively to final follow-up (P < .001 for all), and overall cartilage regeneration was encouraging. Significant correlations were found between clinical and MRI outcomes. However, radiographic outcomes were not significantly correlated with clinical or MRI outcomes. Patient age and number of MSCs showed significant correlations with clinical and MRI outcomes. On multivariate analyses, patient age and number of MSCs showed high prognostic significance with poor clinical outcomes.Conclusion:MSC implantation with concomitant HTO provided feasible cartilage regeneration and satisfactory clinical outcomes for patients with varus knee OA. Patient age and number of MSCs were important factors that influenced the clinical and MRI outcomes of MSC implantation with concomitant HTO for varus knee OA.

Clinical Anatomy of the Anterior Meniscofemoral Ligament of Humphrey: An Original MRI Study, Meta-analysis, and Systematic Review.

Background:The anterior meniscofemoral ligament (aMFL) of Humphrey is an anatomically variable fibrous band of connective tissue that attaches between the lateral aspect of the medial femoral condyle and posterior horn of the lateral meniscus, running posterior to the anterior cruciate ligament and anterior to the posterior cruciate ligament (PCL). The presence of an intact aMFL may contribute to stabilization of the lateral compartment of the knee joint.Purpose:The original magnetic resonance imaging (MRI) arm of this study aimed to assess the aMFL incidence among Polish patients. The goal of the systematic review and meta-analysis was to review the literature discussing the clinical anatomy of the aMFL and provide data on its prevalence. It was hypothesized that significant heterogeneity exists within the published literature.Study Design:Cross-sectional study and systematic review; Level of evidence, 3.Methods:A retrospective investigation was performed on the MRI scans of 100 knees (52 right, 48 left) of Polish patients. Scans were randomly selected from a database of MRI examinations performed in 2019. For the meta-analysis, major online databases were queried for data on the aMFL, and 2 authors independently assessed and extracted data from all included studies. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool.Results:In the MRI arm of this study, the aMFL was found in 62 of the 100 lower limbs. The meta-analysis included 41 studies with a total of 4220 limbs. The aMFL was present in 55.5% (95% CI, 45.5%-65.3%) of cases. Arthroscopic studies yielded the highest prevalence (82.3% [95% CI, 36.6%-100.0%]); of MRI studies, the highest prevalence was at 3.0-T strength (51.0% [95% CI, 13.3%-88.2%]).Conclusion:Significant variability in the prevalence of the aMFL was found in the literature. More emphasis should be placed on the clinical relevance of injuries to the aMFL because of its significant role in the function of the knee. It is important to be aware that, because of the anatomy of the aMFL, the ligament can also function to support a torn PCL.

Medial compartment osteoarthritis of the knee: a review of surgical options.

Osteoarthritis of the medial compartment, where the lateral compartment and patella-femoral joint are relatively spared, is a common orthopaedic presentation.Most frequently, the treatment of choice would be a total knee replacement, which involves removing healthy joint surfaces in such patients.Arthroscopic debridement in the osteoarthritic knee has fallen out of favour due to poor clinical results.A trend has developed towards less invasive surgery with uni-compartmental knee replacement (UKR) and high tibial osteotomy (HTO) gaining increasing popularity.Surgeons differ in their relative indications and contraindications to performing these procedures.Total knee replacement (TKR) continues to have the lowest overall revision rate of the available options.Growing evidence demonstrates more favourable patient-reported outcome measures in UKR and HTO patients, compared to TKR.Knee joint distraction (KJD) has been demonstrated as an alternative method of treatment in such patients.Cite this article: EFORT Open Rev 2021;6:113-117. DOI: 10.1302/2058-5241.6.200102

Mechanosensitive Control of Articular Cartilage and Subchondral Bone Homeostasis in Mice Requires Osteocytic Transforming Growth Factor β Signaling.

Transforming growth factor β (TGFβ) signaling plays a complex tissue-specific and nonlinear role in osteoarthritis (OA). This study was conducted to determine the osteocytic contributions of TGFβ signaling to OA. To identify the role of osteocytic TGFβ signaling in joint homeostasis, we used 16-week-old male mice (n = 9-11 per group) and female mice (n = 7-11 per group) with an osteocyte-intrinsic ablation of TGFβ receptor type II (TβRIIocy-/- mice) and assessed defects in cartilage degeneration, subchondral bone plate (SBP) thickness, and SBP sclerostin expression. To further investigate these mechanisms in 16-week-old male mice, we perturbed joint homeostasis by subjecting 8-week-old mice to medial meniscal/ligamentous injury (MLI), which preferentially disrupts the mechanical environment of the medial joint to induce OA. In all contexts, independent of sex, genotype, or medial or lateral joint compartment, increased SBP thickness and SBP sclerostin expression were spatially associated with cartilage degeneration. Male TβRIIocy-/- mice, but not female TβRIIocy-/- mice, had increased cartilage degeneration, increased SBP thickness, and higher levels of SBP sclerostin compared with control mice (all P < 0.05), demonstrating that the role of osteocytic TGFβ signaling on joint homeostasis is sexually dimorphic. With changes in joint mechanics following injury, control mice had increased SBP thickness, subchondral bone volume, and SBP sclerostin expression (all P < 0.05). TβRIIocy-/- mice, however, were insensitive to subchondral bone changes with injury, suggesting that mechanosensation at the SBP requires osteocytic TGFβ signaling. Our results provide new evidence that osteocytic TGFβ signaling is required for a mechanosensitive response to injury, and that osteocytes control SBP homeostasis to maintain cartilage health, identifying osteocytic TGFβ signaling as a novel therapeutic target for OA.

Increased Q-factor increases medial compartment knee joint contact force during cycling

As Q-Factor (QF: inter-pedal distance) is increased, the internal knee abduction moment (KAbM) also increases, however it is unknown if this increased KAbM is associated with increased medial compartment knee joint contact force in cycling. In the absence of in vivo measurement, musculoskeletal modeling simulations may provide a viable option for estimating knee joint contact forces in cycling. The primary purpose of this study was to investigate the effect of increasing QF on knee joint total (TCF), and medial (MCF) compartment contact force during ergometer cycling. The secondary purpose was to evaluate whether KAbM and knee extension moment are accurate predictors of MCF in cycling. Musculoskeletal simulations were performed to estimate TCF and MCF for sixteen participants cycling at an original QF (150 mm), and wide QF (276 mm), at 80 W and 80 rotations per minute. Paired samples t-tests were used to detect differences between QF conditions. MCF increased significantly, however, TCF did not change at wide QF. Peak knee extensor muscle force did not change at wide QF. Peak knee flexor muscle force was significantly reduced with wide QF. Regression analyses showed KAbM and knee extension moments explained 87.4% of the variance in MCF when considered alongside QF. The increase of MCF may be attributed to increased frontal-plane pedal reaction force moment arm. Future research may seek to implement QF modulation as a part of rehabilitation or training procedures utilizing cycling in cases where medial compartment joint loading is of importance.

Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

BackgroundSubchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA.MethodsWe analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analyzed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline and changes in the BML scores and changes in pain after 24-month follow-up.ResultsGreater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex, and body mass index (BMI) (medial femorotibial; B = 0.08, p = 0.02. patellofemoral; B = 0.13, p = 0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B = 0.11, p = 0.01, and B = 0.10, p = 0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively (B = 0.14, p = 0.02). Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B = 0.10, p = 0.01).ConclusionsSubchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically induced OA pain.

Clinical and pathological perspectives on elbow arthritis and arthroplasty

: The basic design of replacement arthroplasty components for treating arthritis in the hip, knee and shoulder had been established by the end of the 1970s/early 1980s. Replacement arthroplasty components for elbow arthritis were being developed at the same time, but a wide variety of designs were manufactured, and the basic design characteristics required for a successful elbow joint arthroplasty remain a matter of debate today. Whereas the number of total elbow joint replacements (TERs) performed for elbow fractures has increased steadily over recent years, the reverse is true in arthritis surgery where there has been a steady decline. We explain this in terms of how our understanding of the pathology and evolution of degenerative changes in the elbow over the past 40 years have influenced our perspectives on the design of elbow arthroplasty components for arthritis and the predilection of the degenerative changes for the lateral (radiocapitellar) compartment of the elbow joint. This has led to the concept of unicompartmental elbow replacement and development of components to resurface the lateral compartment of the elbow [lateral resurfacing elbow (LRE) arthroplasty]. We now believe that the future direction of elbow arthroplasty lies in the further development of components to resurface specifically only those areas of articular cartilage destroyed by the disease process in an individual elbow joint and the development of ‘anatomical designs’ of TER with replaceable bearing surfaces for those joints in which the areas of cartilage destruction are more widespread.

Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up.

Background:There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients.Purpose:To determine whether implantation of a composite of allogeneic umbilical cord blood–derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participants who improved by ≥1 grade on the ICRS Macroscopic Cartilage Repair Assessment (blinded evaluation) at 48-week arthroscopy. Secondary outcomes included histologic assessment; changes in pain visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) score from baseline; and adverse events.Results:Among 114 randomized participants (mean age, 55.9 years; 67% female; body mass index, 26.2 kg/m2), 89 completed the phase 3 clinical trial and 73 were enrolled in the 5-year follow-up study. The mean defect size was 4.9 cm2 in the UCB-MSC-HA group and 4.0 cm2 in the microfracture group (P = .051). At 48 weeks, improvement by ≥1 ICRS grade was seen in 97.7% of the UCB-MSC-HA group versus 71.7% of the microfracture group (P = .001); the overall histologic assessment score was also superior in the UCB-MSC-HA group (P = .036). Improvement in VAS pain, WOMAC, and IKDC scores were not significantly different between the groups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up (P < .05). There were no differences between the groups in adverse events.Conclusion:In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture.Registration:NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).

Effects of prolonged walking with body borne load on knee adduction biomechanics

BackgroundSoldiers that suffer a service-related knee musculoskeletal injury routinely develop joint osteoarthritis. Knee osteoarthritis is a substantial and costly problem among soldiers, yet it is unknown how body borne load and duration of walking impact knee adduction biomechanics linked to progression and severity of osteoarthritis. Research questionThis study determined the adaptations in magnitude and variability of knee adduction joint angle (KAA) and moment (KAM) during prolonged walking with body borne load. MethodsThirteen recreationally active participants had knee biomechanics quantified while walking over-ground for 60-min at 1.3 m/s with three body borne loads (0, 15, and 30 kg). Magnitude and variability of KAA and KAM measures were quantified and submitted to a RM ANOVA to test the main effect and interactions between load (0, 15 and 30 kg) and time (0, 15, 30, 45 and 60 min). ResultsBody borne load increased peak KAM (p < 0.001), whereas time increased peak and range of KAA (both: p < 0.001). Specifically, peak KAM increased with each addition of body borne load (all: p < 0.025), and peak and range of KAA increased after 30 min of walking (both: p < 0.040). Neither body borne load, nor time had a significant effect on KAA or KAM variability (both: p > 0.05). SignificanceProlonged walking with heavy body borne load increased knee adduction biomechanics related to osteoarthritis. Adding heavy body borne load increased in peak KAM whereas duration of walking increased KAA, knee biomechanics that may increase loading of the medial knee joint compartment and risk of OA at the joint.

Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint

IntroductionFemoral and patellar cartilage defects with a defect size > 2.5 cm2 are a potential indication for an autologous chondrocyte implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation autologous chondrocyte implantation.MethodsA total of 50 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively.ResultsIKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2–15) and patella (4.6, range 2–12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2–13.9; pat: 18.9, range 4.0–47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization.ConclusionThird-generation autologous chondrocyte implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.

Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The Multicenter Osteoarthritis Study.

© 2019, American College of Rheumatology This is the peer reviewed version of the following article: Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23864. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective: To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. Methods: The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. Results: A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2, and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1–3.8]) and TF (RR 1.8 [95% CI 1.1–2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1–3.9]). Conclusion: Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

Fibrin Polymerization Ability Influences Joint Condition in Patients with Severe Haemophilia

Background:Joint damage is the most frequent and most debilitating comorbidity of haemophilia and can be prevented by adequate prophylactic treatment. Nevertheless, many causes and not only plasma levels of the factor affect joint damage in severe haemophilia (SH) patients. One to be considered is variability on fibrin polymerization capacity since it might influence the bleeding tendency and, consequently, would affect the joint condition in SH patients. To our knowledge, there are not enough studies about that. Aim:This work aimed to evaluate if there exists a relationship between fibrin capacity of polymerization and joint condition in SH patients. Methods:This is a prospective and transversal study that was approved by Ethics Committee from Hospital Universitario La Paz. Twenty eight SH patients (25 with SHA, 5 of them with inhibitors; 3 with SHB, 2 of them with inhibitor), median age [p25-p75]=41 [29.8-51.3] years old) were recruited. Joint condition was evaluated using the HEAD-US score. Plasma level of fibrinogen (Fib) was determined by Clauss method. Rotational thromboelastometry (ROTEM) was performed with fibTEM, an extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. fibTEM results correlate well in many cases with the Clauss Fib assay, but is additionally influenced by fibrin polymerization ability which cannot reliably be detected with clotting tests. Fibrinogen capacity to increase the clot strength was evaluated by the ratio R= Fib/fibTEM maximum clot firmness (MCFfibTEM) which means the plasma concentration of Fib needed to increase maximum clot firmness in 1 mm. Data were analysed with GraphPrism Pad 6.0. Results:Median value of Fib was 306 [263-341] mg/dl, MCFfibTEM = 12 [10-15] mm and R= 25.0 [20.5-29.5] mg/dl/mm. Patients were classified taking into account the value of the 25th percentile of each variable (Fib, MCFfibTEM and R). Subjects with Fib ≤ 263 mg/dl were considered patients with low fibrinogen level, those with MCFfibTEM ≤ 10 mm were considered patients with low platelet independent maximum clot strength and subjects with a R &amp;lt; 20.5 mg/dl/mm were considered good responders to fibrinogen. Based on this analysis, neither Fib nor MCFfibTEM influenced the joint condition. However, patients with poor response to fibrinogen (R ≥ 20.6 mg/dl/mm) had a significantly greater joint damage than the good responders to fibrinogen (R &amp;lt; 20.6 mg/dl/mm) (Table 1). Poor responders to fibrinogen had frequently joint damage in ankles followed by elbows and knees being cartilage the most commonly affected joint compartment. Good responders to fibrinogen only presented milder joint alterations in elbows and ankles. Conclusions: Our results suggested that polymerization capacity of fibrin may be variable between patients with SH and might influence joint condition. More patients need to be recruited to confirm this finding. This work was supported by grants from FIS-FONDOS FEDER (PI19/00631 and PI19/00772). EMM holds a predoctoral fellowship from Fundación Española de Trombosis y Hemostasia (FETH-SETH). Disclosures Fernandez-Bello: Pfizer:Speakers Bureau;Novartis:Speakers Bureau;Stago:Speakers Bureau;Roche:Speakers Bureau;NovoNordisk:Current Employment, Research Funding, Speakers Bureau;Takeda:Research Funding, Speakers Bureau;SOBI,:Research Funding.de la Corte:Pfizer:Research Funding, Speakers Bureau;NovoNordisk:Research Funding, Speakers Bureau;Takeda:Speakers Bureau;Roche:Research Funding, Speakers Bureau;Sobi:Research Funding, Speakers Bureau;Bayer:Speakers Bureau.Alvarez Román:Novartis:Speakers Bureau;Bayer:Consultancy;Grifols:Research Funding;Pfizer,:Research Funding, Speakers Bureau;Roche:Speakers Bureau;NovoNordisk,:Research Funding, Speakers Bureau;Takeda:Research Funding, Speakers Bureau;SOBI,:Consultancy, Research Funding, Speakers Bureau.Martín:SOBI:Research Funding;NovoNordisk:Speakers Bureau;Novartis:Speakers Bureau;Roche:Speakers Bureau;Pfizer:Research Funding, Speakers Bureau.Rivas Pollmar:Pfizer:Speakers Bureau;Roche:Speakers Bureau;Novartis:Speakers Bureau.García Barcenilla:Novartis:Speakers Bureau;Bayer:Speakers Bureau;Roche:Speakers Bureau;Pfizer,:Speakers Bureau;Takeda:Research Funding, Speakers Bureau;NovoNordisk:Research Funding, Speakers Bureau.Canales:Janssen:Honoraria;Sandoz:Speakers Bureau;Takeda:Speakers Bureau;Karyopharm:Honoraria;Novartis:Honoraria;Celgene:Honoraria;Roche:Honoraria;Gilead:Honoraria;Sandoz:Honoraria;iQone:Honoraria;Janssen:Speakers Bureau;Janssen:Honoraria;Roche:Speakers Bureau;Karyopharm:Honoraria;Sandoz:Speakers Bureau;Novartis:Honoraria;Takeda:Speakers Bureau;Roche:Honoraria;Sandoz:Honoraria;Janssen:Speakers Bureau;Roche:Speakers Bureau.Butta:Takeda:Research Funding, Speakers Bureau;SOBI:Speakers Bureau;Pfizer:Speakers Bureau;ROCHE:Research Funding, Speakers Bureau;Novartis:Speakers Bureau;Grifols:Research Funding;NovoNordisk:Speakers Bureau.Jimenez-Yuste:F. Hoffman-La Roche Ltd, Novo Nordisk, Takeda, Sobi, Pfizer:Consultancy;Grifols, Novo Nordisk, Takeda, Sobi, Pfizer:Research Funding;F. Hoffman-La Roche Ltd, Novo Nordisk, Takeda, Sobi, Pfizer, Grifols, Octapharma, CSL Behring, Bayer:Honoraria.

Can an OA Knee Brace Effectively Offload the Medial Condyle? An In Vivo Fluoroscopic Study

BackgroundPrevious studies evaluating the effectiveness of OA offloading knee braces focused on qualitative results. The objective of this study was to analyze the effectiveness of an off-loading knee brace with respect to in vivo three-dimensional knee kinematics to quantitatively measure the changes in medial joint space and relative bone alignment when wearing the brace. MethodsTwenty subjects diagnosed with medial compartmental joint space narrowing and varus deformity due to OA were recruited. During fluoroscopic surveillance, subjects performed normal gait on a treadmill with and without the brace. Images were sequenced at heel-strike and mid-stance during the weight-bearing portion of gait. 3D-to-2D image registration was performed on each subject using 3D bone models derived from CT segmentation and 3D ultrasound scans. ResultsMedial joint space was to increase when the brace was applied in all subjects (1.6 ± 0.7 mm at heel-strike, 1.6 ± 0.8 mm at mid-stance) and was statistically significant (P < .001). It was also found that sixteen of the twenty subjects experienced a medial joint space increase of more than 1.0 mm during heel-strike while thirteen of twenty experienced this change at mid-stance. While wearing the brace, over half of the subjects experienced a valgus correction to their alignment. ConclusionsAll subjects in this study experienced a positive change in the medial joint space when wearing the offloading knee brace. In addition, many subjects also saw joint space values representative of previously documented, nonosteoarthritic subjects and valgus changes in bone alignment more akin to the normal knee.

The influence of body mass index and sex on frontal and sagittal plane knee mechanics during walking in young adults

BackgroundObesity and female sex are independent risk factors for knee osteoarthritis and also influence gait mechanics. However, the interaction between obesity and sex on gait mechanics is unclear, which may have implications for tailored gait modification strategies. Research questionThe purpose of this study was to examine the influence of obesity and sex on sagittal and frontal plane knee mechanics during gait in young adults. MethodsForty-eight individuals with (BMI = 33.03 ± 0.59; sex:50 % female; age:21.9 ± 2.6 years) and 48 without obesity (BMI:21.59 ± 0.25; sex:50 % female; age:22.9 ± 3.57 years) matched on age and sex completed over-ground gait assessments at a self-selected speed. Two (BMI) by two (sex) analysis of variance was used to compare knee biomechanics during the first half of stance in the sagittal (knee flexion moment [KFM] and excursion [KFE]) and frontal plane (first peak knee adduction moment [KAM], knee varus velocity [KVV]). ResultsWe observed a BMI by sex interaction for normalized KFM (P = 0.03). Females had smaller normalized KFM compared to males (P = 0.03), but only in individuals without obesity. Males without obesity had larger normalized KFM compared to males with obesity (P = 0.01), while females did not differ between BMI groups. We observed main effects of sex and BMI group, where females exhibited greater normalized KAM (P < 0.01) and KVV (P < 0.01) compared to males, and individuals with obesity walked with greater KVV compared to those without obesity (P < 0.01). All absolute joint moments were greater in individuals with obesity (all P<0.01) and males had greater absolute KFM compared to females (P < 0.01). SignificanceWe observed sex differences in gait mechanics, however, KFM differences between males and females were only evident in individuals without obesity. Further, females and individuals with obesity had a larger KAM and KVV, which may contribute to larger medial compartment joint loading.

Postoperative Subchondral Bone Marrow Lesion Is Associated With Graft Extrusion After Lateral Meniscal Allograft Transplantation

Background: Adverse effects of graft extrusion after meniscal allograft transplantation (MAT) are difficult to assess and can be determined only in the long term using a simple radiograph. Recently, subchondral bone marrow lesions (BMLs) detected on magnetic resonance imaging (MRI) scans have been used to evaluate the outcomes or prognoses of various knee surgeries. However, whether subchondral BMLs on MRI scans reflect the effects of allograft extrusion remains unclear. Hypothesis: Subchondral BML in the lateral compartment of the knee joint on postoperative MRI scans would be associated with graft extrusion after lateral MAT. Study Design: Case-control study; Level of evidence, 3. Methods: Overall, 170 patients with lateral MAT between 2008 and 2013 were classified into extrusion (≥3 mm) and nonextrusion (<3 mm) groups based on findings on MRI scans obtained 3 to 6 months postoperatively. Subchondral BMLs in the lateral compartment were evaluated on the latest MRI scans. To exclude any bone marrow signal changes other than those caused by allograft extrusion, the latest MRI scans were compared with those obtained 3 to 6 months postoperatively. Only subchondral BMLs that occurred after that time point were counted. The association between allograft extrusion and subchondral BML was assessed using chi-square analysis. Logistic regression analysis was performed to control other related factors, including age, sex, body mass index, time from previous meniscectomy, alignment, and cartilage status at the time of MAT. Clinical outcomes according to subchondral BML were evaluated using the Lysholm score. Results: Of the 170 patients, 20 (11.8%) had subchondral BML on the latest MRI scans at a mean 53.6 ± 31.2 months postoperatively, with 14 and 6 patients in the extrusion and nonextrusion groups, respectively. Chi-square analysis showed a significant association between allograft extrusion and subchondral BMLs (P = .025). Logistic regression analysis showed that extrusion and age were significant factors associated with subchondral BML (P = .011 and .004, respectively). However, no differences were observed in the Lysholm scores in accordance with the subchondral BML (P = .248). Conclusion: Subchondral BMLs on postoperative MRI scans were associated with graft extrusion after lateral MAT. However, there was no difference in clinical outcomes according to subchondral BML.

The Effect of Supramalleolar Osteotomy without Marrow Stimulation on Cartilage Regeneration for Medial Compartment Ankle Osteoarthritis: Second-Look Arthroscopic Evaluation of Cartilage Regeneration

Category:Ankle Arthritis; Ankle; ArthroscopyIntroduction/Purpose:The effect of supramalleolar osteotomy (SMO) without an additional bone marrow-stimulating procedure (BMSP) on articular cartilage regeneration in ankle joint still remains unknown. This study aimed to investigate whether SMO yielded favorable clinical and radiologic outcomes, and to evaluate whether the regeneration of articular cartilage could be observed after SMO without BMSP by second-look arthroscopy.Methods:43 ankles after SMO (mean follow-up: 35.5 months) were retrospectively reviewed. Visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction were used for functional evaluations. The tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 43 patients, 31 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed at 1-year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 29 patients who had undergone SMO without BMSP.Results:The mean VAS score and AOFAS score significantly improved from 6.4 preoperatively to 1.4 postoperatively and from61.1 preoperatively to 88.4 postoperatively, respectively (P < 0.05). Regarding overall postoperative patient satisfaction, 18 (41.8%) patients reported their satisfaction as excellent, 23 (53.5%) as satisfied. The mean TAS and TLS significantly improved from 83.8° and 94.8° preoperatively to 78.4° and 82.2° postoperatively, respectively (P < 0.05). 23 out of 28 preoperative Takakura stage IIIa cases and 3 out of 7 IIIb cases improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 26 of 29 patients (89.7%), whereas cartilage deterioration was not observed in any patient.Conclusion:Medial tibio-talar articular cartilage regeneration was observed in most cases (89.7%) of medial compartment ankle osteoarthritis after SMO without BMSP, which was confirmed with second-look arthroscopic evaluation. It also showed satisfactory clinical and radiologic outcomes with high patient satisfaction.